The Health Bulletin, Which Will Be Sent Free to Any Citizen Requesting It

THE LIBRARY OF THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL

THE COLLECTION OF NORTH CAROLINIANA This book is due on the last date stamped below unless recalled sooner. It may be renewed only once and must be brought to the North Carolina Collection for renewal.

PuHis\e3bij T/^fl°RmCflR°UflA 5T?^ BOARD y7\E\Un

This Bullelirvwillbe .ser\t free to arwj cifozerx of the State poi\ request!

Entered as second-class matter at Postoffice at Raleigh. N. C, under Act of July 16,' 189b Published monthly at the office of the Secretary of the Board, Raleigh, N. C.

Vol. 50 JANUARY, 1935 No. 1

Carl Vernon Reynolds, M.D. Acting State Health Officer )

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

Carl V. Reynolds, M.D., President Asheville Ayden G. G. Dixon, M.D ; S. D. Craig, M.D Winston-Salem H. Leb Large, M.D Rocky Mount J. N. Johnson, D.D.S Goldsboro H. G. Baity, Sc.D Chapel Hill W. T. Rainey, M.D Fayetteville Hubert B. Haywood, M.D Raleigh James P. Stowe, Ph.G Charlotte

Executive Staff Carl V. Reynolds, M.D., Acting Secretary and State Health Officer. G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Pre- ventive Medicine. Warren H. Booker, C.E., Director Division of Sanitary Engineering. Ernest A. Branch, D.D.S., Director Division of Oral Hygiene. John H. Hamilton, M.D., Director Division of Laboratories and Vital Statistics. J. C. Knox, M.D., Epidemiologist. R. T. Stimpson, M.D., Vital Statistician. R. E. Fox, M.D., Director Division of County Health Work.

FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which will be sent free to any citizen requesting it. The Board also has available for distribution without charge special literature on the following subjects. Ask for any in which you may be interested. Fever Adenoids and Tonsils German Measles Scarlet Smallpox Cancer Health Education Constipation Hookworm Disease Teeth Chickenpox Infantile Paralysis Tuberculosis Tuberculosis Placards Diabetes Influenza Fever Diphtheria Malaria Typhoid Typhoid Placards Don't Spit Placards Measles Diseases Eyes Pellagra Venereal Residential Sewage Water Supplies Flies Cough Fly Placards Disposal Plants Whooping Sanitary Privies

months ; Prenatal Care (by Mrs. Max West) Baby's Daily Time Cards : Under 5 months ; 10, Prenatal Letters (series of nine 5 to 6 months ; 7, 8, and 9 months; monthly letters 11, and 12 months; 1 year to 19 Minimum Standards of Prenatal Care 19 months to 2 years. Breast Feeding Diet List: 9 to 12 months: 12 to 15

; 2 to 3 Infant Care. The Prevention of months : 15 to 24 months years. Infantile Diarrhea years ; 3 to 6 Carolina Midwives. Table of Heights and Weights Instructions for North

CONTENTS PACE

Our New State Health Officer - 3 The State Health Department: Administrative Division * Division of Preventive Medicine.. » Division of Sanitary Engineering Division of Oral Hygiene ' State Laboratory of Hygiene Epidemiology ^ Division of J" Bureau of Vital Statistics " Division of County Health Work J* 14 The Beginning of Pre-School Clinics in North Carolina North Carolina Emergency Nursery School Program 15 16 In Memoriam: James M. Parrott, M.D Vol. 50 JANUARY, 1935 No. 1

OUR NEW STATE HEALTH OFFICER By The Editor DOCTOR CARL VERNON REYNOLDS of Asheville on Novem- ber 10 took the oath of office and immediately assumed his duties as Acting State Health Officer, succeeding Dr. James M. Parrott, who died November 7. Doctor Reynolds was unani- mously elected to the position by his fellow members on the Board. Doctor Reynolds is a native of Asheville. His father was a successful Asheville physician who died when Doctor Reynolds was only three years old. Doctor Reynolds obtained his literary education in the private schools of Asheville and Wofford College, Spar- tanburg, South Carolina. He received his medical education at the College of the City of New York, graduating in medicine there in 1895. After his graduation he took a postgraduate course in Lon- don, England. Doctor Reynolds located in Asheville for the practice of medicine, specializing in pulmonary tuberculosis. His skill in combating that disease has been widely recognized by the medical profession. An example of their confidence was his election as president of the North Carolina Medical Society, in which place he served with distinction in 1920. On beginning practice he at once became interested in health work. His first connection was with the city health department in 189 6. Following that period, for more than twenty years he served as city health officer of Asheville. in which capacity he rendered his city and the whole State important and permanent service. Some of his contributions to public health may be cited, as follows: He organized the first crusade against the common house-fly ever undertaken anywhere. He assisted in drafting the first milk ordinance for Asheville. He secured progressive sanitary laws. He put through the compulsory vaccination law requisite to school attendance. He secured the adoption of a bread-wrapping ordinance and one requiring the tuberculin testing of cows. He saw typhoid fever drop from an average of two hundred and seventy cases a year in the city of Asheville to about five while he was city health officer, and saw smallpox practically eliminated. We enumerate these things so that the people of the State may know they have a well-trained health officer at the head of the State Health Department—one fully worthy of confidence and support. The Health Bulletin January, 1935

The State Health Department

What the State Board of Health Has To Otter To the People of North Carolina

chief reason for the exist- sible for the activities in this division THEence of the State Health Depart- of the work. Of course, the State ment is that this division of gov- Health Officer is himself the executive ernment may render essential service officer of the State Board of Health. regulations, to the citizens of the State in the pro- He executes the rules and tection of their health and lives. In outlines the work, and gives orders to order to meet the complexities of mod- the heads of all the other departments. ern business and to render efficient He assigns work of a special character service in an economical manner, in to the proper department, and he re- response to the demands of this great ceives daily, weekly, and monthly re- progressive State, which has been ports, as may be necessary, from each rapidly increasing in population dur- one of the division heads. In this way and ing the past twenty years, it has been he keeps informed of the needs necessary to organize the work of the progress of all health work through- Board of Health into separate divisions out the State at all times. The finan- with a responsible director at the head cial affairs, or division and proration different divi- of each division. of expenditures of all the In order to set forth concisely and sions, are arranged in the administra- clearly just the character and scope of tive department. Contact with the the service and cooperation the State Governor, the Budget Bureau, and the Board of Health extends to the public, other necessary departments of course, the editor of The Health Bulletin State Government is made, of has asked the director of each depart- by the State Health Officer. As a mem- Health ment to prepare a statement carefully ber of the State and Provincial describing precisely what his depart- Officers Association of North America, Officer keeps in inti- ment is doing, or is prepared to do, the State Health state in advancing the cause of public mate contact with all other and with health. We are, therefore, setting boards of health in the Union Serv- forth below a statement from each one the United States Public Health of the division heads of the North ice in Washington as well as with Carolina State Board of Health. The such outside agencies as the very im- publication of these articles should portant International Health Board in supply valuable information to the New York. The State Health Officer is reading public, and especially to the responsible for all monies paid out by Board medical profession, health officials, all of the divisions of the State and other organizations, such as the of Health. The execution of all the women's clubs, teachers' associations, State Health laws devolving upon the and so on. State Board of Health is regulated Any individual or organization de- from the administrative division. In siring additional information concern- short, he is what his title designates, ing any of the departmental activities an executive officer in every sense of wishes to herein described, or who the word. of service, may ob- avail himself the PREVENTIVE tain additional information and a DIVISION OF prompt response by simply writing to MEDICINE the State Board of Health, Raleigh, This division comprises three dis- North Carolina. tinct and separate services, under the ADMINISTRATIVE DIVISION supervision of a single director: first, School Health Su- The State Health Officer and the As- a department of sistant State Health Officer are respon- pervision; second, a department of January, 1935 The Health Bulletin 5

Maternity and Infancy; and third, a late the practice of midwives in such department of Health Education. counties. During the past ten years School Health Supervision about one-half of the midwives in the State have been eliminated, In this department a force of eight and the remaining ones specially trained nurses are constant- have been instructed until at present, for the ly at work throughout the school year most part, their work is in counties having no whole-time safer and more dependable. They teach the midwives health officers or any other form of in small groups, with frequent aid of whole-time county health work to the physicians in the communities. which the State Board of Health con- They give them brief oral examinations, tributes financially. There are, on an and at the conclusion of work in a average, about fifty such counties. Most county they award to each of these counties comprise the smaller midwife who meets the minimum requirements or less wealthy counties of the State, a permit, good for one year, which although there are a few exceptions, enables the woman to legally practice as such as Cleveland, Iredell, and other a midwife. This regulation thickly populated and wealthy coun- is effective only upon adoption by the local county ties, which, up to this time, have never board of health of an had any form of whole-time health ordinance designed to regulate such practice. service. These nurses visit every This ordinance is good for one school, white and colored, in a county year and has to be renewed annually in which they work during the school by action of the county board of health. year. They inspect the children for evidence of malnutrition, the presence In connection with this department of preventable disease or handicap, and activity, a mailing service is maintain- teach the essential elemental princi- ed at the State Board of Health offices ples of personal hygiene and sanita- in Raleigh through which any expect- tion to the school children both in- ant mother in the State may obtain dividually and collectively. Their work approved literature which will be help- has resulted in an improved standard ful to her in her expectancy. It is of health. They have been instru- supplemental to the work of the pri- mental in securing the organization of vate physician and is in no way de- a number of whole-time health designed to take the place of a physician, partments, and they have also been in- who is always necessary to render strumental in securing the treatment prenatal advice. It is exceedingly of many thousands of children for the helpful in cases where the family are removal of physical defects. They too poor to engage a private physician, take note of the sanitary surroundings, and in which they depend upon mid- the environment of the school; they wives for instruction and advice dur- report on whether or not the children ing the critical period of expectancy. are supplied with a safe drinking- This department also provides helpful water system and sanitary facilities literature in response to any requests for proper sewage disposal. Their work from mothers desiring it in caring for has gained in importance and effec- their babies. Many thousands of tiveness each year for many years. mothers are assisted annually by this helpful literature. Department of Maternity and Infancy All of this department activity is In this department an effort has been offered free to expectant mothers, to made during the years to control the the parents of babies and small chil- midwife practice in sections of the dren, as well as the work for midwives State having no whole-time health or- and the School Health Supervision ganizations. This work has covered work. Funds available for this service about fifty counties and is carried on are provided through a small annual similarly to the School Health Super- appropriation by the Legislature. vision service. The nurses devote their entire time in the summer Health Education months to an effort to strictly regu- The responsibilities in this division The Health Bulletin January, 1935 of the work are many. In this de- letters a day are sent out every work- partment all of the personal health ing day in the year. correspondence service of the State DIVISION OP SANITARY Board of Health is conducted. People ENGINEERING writing for information on various The Division of Sanitary Engineer- health subjects receive a reply through ing renders service on all non-medical this division. Such things as symp- phases of sanitary and public health treat- toms are never described, and work. The very limited means of this ment is not recommended; but there division are employed along the fol- are many forms of helpful advice lowing lines of endeavor: The promo- which have proved of great value to tion and maintenance of pure, ade- the citizens of the State. All of the quate public water supplies; municipal literature on health subjects available sewerage facilities, and safe milk sup- for the people is provided through plies; shellfish sanitation; home sani- this department. The monthly Health tation, including the installation of Bulletin, which at present goes to safe private water supplies, and means thirty-six thousand people, and which of excreta disposal; sanitation of contains useful information, is pre- State institutions, county institutions, pared monthly and published by this jails, convict camps, and public department; and at present about forty schools; swimming-pool sanitation; special publications on various sub- malaria control; hotel and cafe sani- jects are available on request—free to tation, summer camp sanitation, and any citizen who needs it and writes enforcement of a bedding law. and asks for it. The director of this There are at present some 229 pub- division is responsible for the prepara- lic water supplies in North Carolina tion of all of this material. He must which supply drinking water to mu- either write it or secure its prepara- nicipalities having a total estimated tion by other competent officials of the population in 1935 of 1,160,000 people. Board. A mailing room is maintained The engineering department examines through which multigraph and mimeo- all plans for improvements and graph material as well as the various changes and for new waterworks and printed publications are sent out to sewerage installations with special ref- those citizens requesting it. erence to public health and sanitation. In this State, of more than three mil- When possible, routine plant inspec- lion people, it is natural to suppose tions of water and sewage-treatment that a large and increasing number plants are made from time to time. of people will be constantly writing to Unfortunately, it has been impossible the State Board of Health for definite during the past several years to pro- information on a variety of subjects vide anything like the amount of engi- affecting the health of the people. An neering assistance that our waterworks inconceivable number of questions on and sewage plants deserve. Fortunate- every known subject in the field of ly during the past two years there has medicine and public health are receiv- been but one water-borne outbreak of ed during the course of every year. a serious nature in the State. In Naturally a large proportion of these that case raw, untreated sewage questions cannot be answered, but found its way into a water supply many of them can be answered with which resulted in over forty cases of benefit to the inquirer. The keynote typhoid and three deaths. In that in- to this service in the replies sent out stance this department had repeatedly is information on how to protect the called the dangerousness of the situa- individual families from the ravages tion to the attention of the proper of preventable diseases. A large authorities, but the condition had not amount of personal advice is offered been remedied before the epidemic in such matters as nutrition and im- broke forth. munization against communicable The object of milk sanitation is diseases. An average of about fifteen twofold. The primary object is of January. 1935 The Health Bulletin course to clean up our milk supplies supplies and sewage-treatment plants, and make them thoroughly safe and public and private swimming pools. acceptable. The second objective is to Likewise, much engineering assistance increase the use of milk and milk can be furnished in regard to mosquito products. The milk consumption in and malaria control through drain- North Carolina is less than half what age and otherwise. it should be. Good health depends The protection of the public through largely on good teeth, freedom from inspections of hotels and cafes by this rickets, undernourishment, and pel- department is important, but because lagra; ability to resist infections; of limited means and personnel much plenty of pep, energy, and vitality. The remains to be done in this connection. of clean, safe milk by generous use DIVISION OF ORAL HYGIENE children, adults, and the aged as well, is vitally important for good health. The Division of Oral Hygiene has on Fortunately, as a city's milk supply its staff a corps of dentists both white is cleaned up we find that the milk and colored who conduct mouth health consumption increases automatically. programs in the public schools of the In this connection it is interesting to State. The mouth health program note that within the past eighteen consists of didactic teaching of mouth months more improvement has been health. This means that the relation- made in municipal milk supplies in ship of an unclean mouth to systemic North Carolina than in any similar disease must be explained and stressed. previous period. At our present rate This didactic teaching is aided by the of improvement practically every mu- use of plaster models, placards and nicipality large enough to have more pictures, both stereopticon and mo- than one or two dairymen will soon be tion. protected with a clean, safe Grade A If the group is first grade, then the raw or Grade A pasteurized milk sup- teaching is in the form of stories in ply. This condition and this improve- first grade language. ment is due largely to the close coop- If it is in the science department of eration of the Division of Sanitary En- high school, then tooth histology is gineering with the Public Health Serv- emphasized and tooth pathology is ex- ice and the local health departments. plained. Specially prepared plans and specifica- If it is in the home economics divi- tions are available for North Carolina sion, foods, food values and proper dairymen for milk houses, dairy barns, health habits are stressed. small pasteurizing plants, and other In addition to this, mouth health is dairy structures. In this service the taught by these dentists through dem- North Carolina State Board of Health onstrative or correctional work. How- is second to none in the country. ever, the correctional work is confined Through the cooperation of this de- insofar as possible to children who can- partment, the CWA, and FERA approx- not have the corrections made in any imately 43,000, or 10 per cent of the other manner. North Carolina homes that had in- The mouths of the entire grade or sanitary privies or no privies at all, grades are inspected by the dentists have been provided with sanitary and the parents of those children who privies, which means at least reason- are not selected for demonstrative ably safe means of excreta disposal. purposes are notified through the Much more remains to be done along United States mail that the child is in this line. Assistance, advice, plans, need of dental services and should con- and literature are furnished for such sult their regular dentist. It is under- work and for protecting home water stood that no child will be used for supplies, and constructing small sew- demonstrative purposes whose parent age-treatmeat plants. sends a written objection, nor do the This department is able to assist school dentists refer any child to any engineers, architects, and others with particular dentist. They are careful to plans for school and institutional water say "YOUR" dentist. That responsi- 8 The Health Bulletin January, 1935 bility of selecting a dentist rests with 1. Examination of specimens of wa- the parent. In no case does the school ter from municipal, semi-public, and dentist make a diagnosis. That is for private supplies; the family dentist to do. 2. Examination of specimens from Dental decay is said to be a uni- patients; versal disease, and it is a disease. Per- 3. Preparation and distribution of haps it is the most widespread disease vaccines and serum for the protec- known today. Tooth decay eventually tion of the citizens of North Carolina means a dead tooth. A dead tooth is from infectious diseases. oftentimes a source of infection which Historically, the beginning of the may cause some of the many kidney Laboratory was due to the need for and heart diseases. Tooth decay is on the examination of specimens of wa- the increase in children. Probably the ter, the General Assembly appropri- teeth and tonsils cause more infection ating the sum of $600 for this pur- of hearts and kidneys in children than pose in 1905. The General Assem- any other source. This being true, it bly of 19 07 increased this appropria- is necessary that mothers be inform- tion to $2,000, and the late Dr. Clar- ed of the great importance of the ence A. Shore became director of the child's mouth being in a healthy con- Laboratory in December of that year, dition. continuing in that capacity without Knowing the great influence that the interruption for more than twenty- grade teacher has in molding the five years until his untimely death thought of the child, the Division of occurred February 10, 1933. Oral Hygiene is directing a great deal During the biennium 1909 to 1911 of its effort toward the training of there were 3,600 specimens of water teachers in teacher-training institu- examined in the Laboratory; during tions in the fundamentals of oral the biennium 19 32-1934 there were hygiene, with a hope that the teacher 11,479. In the examination of speci- will live health, teach health, and mens of water the Laboratory does correlate health teachings with all of not attempt to find infectious agents. her school work. If this could be done, It merely endeavors to determine say this September, with every first- whether or not the water is contami- grade child having such a teacher, nated with fecal matter. It is as- next year every second-grade child as sumed that if there is evidence of well as first grade having a like teach- contamination it is entirely probable er, etc., it would be just sixteen years that sooner or later infectious agents from this September until we would will find their way into the water have a generation of mothers who had and the supply is unsafe. It is im- the fundamental training in health, as possible to determine the value of the the child then would be 22 years of service which the Laboratory has age, which is the average age of rendered in the protection of the motherhood in this State. water supplies of the State; neither When all is said and done, the Divi- can an estimate be made of the num- sion of Oral Hygiene of the State ber of lives that have been saved by Board of Health is nothing more nor this activity. No thinking person, less than a health-teaching agency however, can deny that the value of using visual methods of teaching. this service, either in terms of dollars or of lives, has been great. STATE LABORATORY OF A great many unsatisfactory sam- HYGIENE ples of water are sent to the Labora- The activities of the State Labora- tory. Many of these are due to the tory of Hygiene are limited -almost use of unsuitable specimen contain- entirely to those procedures intended ers. The sanitary analysis of water is to aid in the control of infectious a delicate procedure. To insure sat- disease in man. The work of the isfactory specimen containers, the Laboratory may be grouped roughly Laboratory supplies outfits especially into three classes: prepared for this use. Other unsatis- January, 1935 The Health Bulletin

factory specimens are due to lack of pharsphenamine, bismuth tartrate so- judgment in taking specimens. No lution, scarlet-fever antitoxin, erysip- specimens should be taken from a elas antitoxin, anti-meningococcus source which has not been inspected serum, and diagnostic test materials by a competent observer. If there for scarlet fever. are any visible sources of probable A great many examinations are contamination, there is no indication made on Sundays and holidays. Such for examination. Open wells, unpro- procedure as the examination of cul- tected springs, and all open streams tures for diphtheria, blood tests for will almost invariably be contami- typhoid fever, animal heads for ra- nated. No specimen from such bies, water for bacteriological exami- sources should be sent to the Lab- nation, spinal fluid for meningitis, oratory. The most valuable exami- and all miscellaneous specimens of an nations are made from specimens urgent nature are examined as soon taken from sources which, to the as they arrive at the Laboratory. trained observer, are not subjected However, such specimens as sputum to visible contamination. for tubercle bacilli and specimens for In the examination of specimens intestinal parasite searchers are kept from patients the following proce- until the next regular Laboratory dures are used: Cultures of blood, work day. urine, feces, and bile, for typhoid All positive findings of diphtheria bacilli and other infectious organ- culture and brains from rabid ani- isms; agglutination tests of blood mals are reported by telegram collect serum for typhoid, undulent fever, immediately after the examination is Rocky Mountain spotted fever, and completed, unless we are specifically endemic typhus; examination of requested not to do so. Regular specimens of urine, both for patho- mailed reports are made on all speci- genic organisms and for evidences of mens, regardless of whether they kidney disease and diabetes; micro- have been reported by telegram or scopic examinations of throat swabs not. Two copies of this report are for diphtheria, Vincent's angina, kept in our files and are so arranged streptococcus infection; animal heads that we can refer to the report either for rabies; blood films for malarial by the county of its origin or by the parasites; feces for intestinal para- name of the physician sending the sites; sputum for tubercle bacilli; specimen. urethral smears for gonorrhea; spinal Practically all reports on speci- fluid for meningitis; serological tests mens taken from patients must be for syphilis—Wassermann tests, pre- interpreted by the physician who has cipitation test. examined the patient. It is our policy In the biennium of 1909-1911, never to report the results of these 3,66 5 specimens from patients were examinations to anyone except the sent to the Laboratory for examina- patient's physician. Reports of position. In 1920-1922 there were a few tive blood cultures are most helpful more than 45,000, and in 1932-1934 to physicians in establishing a diag- more than 256,000. nosis. Reports of examinations based The following substances for the on immunity reactions are frequently protection of man against infectious difficult to interpret, regardless of disease are prepared and distributed whether they are positive or negative. by the Laboratory: Typhoid vaccine, The Laboratory does not attempt to whooping-cough vaccine, smallpox make a diagnosis. It merely attempts vaccine, antirabic vaccine, diphtheria to assist physicians in this procedure. antitoxin, tetanus antitoxin, diphthe- Negative reports mean little other ria toxoid, Schick test material for than that the Laboratory was unable diphtheria susceptibility. The follow- to find the organism, or to detect im- ing substances are purchased from mune bodies. Negative results do manufacturers and distributed by the not necessarily mean that the patient Laboratory: Neoarsphenamine, sul- does not have the disease suspected. 10 The Health Bulletin January, 1935

The work of the Laboratory is con- ceived in this office within forty-eight fined as strictly as possible to that of hours after the diagnosis of any one a public health nature. Strictly clini- of the thirty-two communicable diseases This informa- cal examinations such as chemical has been made. analyses of blood, blood counts, etc., tion is then tabulated as to the coun- are not encouraged. Recently, be- ty or city in which the case occurs, daily report for cause of limited funds, we have had so that we have a whole, although forty- to discontinue the examination of the State as a eight hours after the disease has tissues. On the other hand, the Lab- oratory does not discourage the per- been diagnosed. the of certain formance of those tests and examina- At end each week are tabulated a tele- tions which yield information bear- diseases and graphic report sent to the U. S. Pub- ing on the public health. It is the lic Service in Washington, policy of the State Board of Health, Health D. In addition to this, a weekly of which the State Laboratory of Hy- C. report of nine principal diseases, giene is an integral part, in promot- showing incidence according to coun- ing the health of the people of North ties and larger cities, is mimeo- Carolina, to consider the Laboratory graphed for every health officer in as the official agency where public the State and staff members. A health tests and examinations should report giving the number of rightly and properly be made. monthly cases reported and a tabulation ac- In common with practically all race, and sex, is sub- other organizations and citizens of cording to age, mitted to the members of the State the State, the Laboratory and its staff Health. At the end of the have suffered from the depression. Board of year an annual report is made, show- Much Laboratory equipment has be- the occurrence, by month, of the come worn out or antiquated, while ing thirty-two diseases for each county we have been unable to make replace- and for eleven principal cities. In ments. The volume of work has addition, this annual report contains grown without a compensating in- tables showing the age distribution crease in personnel. True to the high and the sex and race distribution of ideals instilled into them by the late these diseases. These reports are Doctor Shore, the members of the compiled by two clerks and one ste- staff have shown great courage and nographer. Last year 49,767 case commendable loyalty during this try- reports were received in this office. ing time. They have made every ef- This year there will be considerably fort to render satisfactory service to more, due to an epidemic of measles the citizens of the State and to do which alone totaled over 50,000 everything in their power to protect cases. the lives and health of the people of Numerous requests for information North Carolina. of every kind come to us daily. Often DIVISION OF EPIDEMIOLOGY these require considerable time to The activities of the Division of obtain, for all of them cannot be Epidemiology are concerned prima- filled from our supply of printed rily with the control of communi- pamphlets. An effort is made to an- cable diseases. Before any control swer every request, whether or not measures can be instituted we we are able to furnish the desired must know when and where cases information. are occurring. In order that we may We have a "Facts Series" which have this information, physicians, gives pertinent information about the nurses, householders, teachers, and mere common diseases in a form parents report the existence of com- which the laity can easily understand. municable diseases to the local health Several pamphlets of this series have officer, or to the quarantine officer in been revised recently. Each month counties not having a health officer. we furnish to each county health offi- These reports are supposed to be re- cer a list of the tuberculosis cases January, 1935 The Health Bulletin 11

reported for his county the preceding require the services of an extra month, so that he may follow up trained physician in the department. these cases and try to obtain ade- With stimulation in an advisory and quate care either in the hospital or supervisory capacity by such a at home. trained man, the local county health The Division attempts to secure officers could work out problems that immunization against diphtheria, ty- would be of considerable value to the phoid fever, and smallpox. We co- local health department and to the operate with the local health depart- State at large. such, and ments, where there are VITAL STATISTICS with local physicians in counties not having a health department, by fur- People give value to property. The nishing to the latter the necessary men, women, and children of North advertising material and the immu- Carolina have greater value in dol- nizing agents without charge, as well lars than all the acres of land, the as blanks for keeping records of the farm products, hydro-electric power, number immunized in any campaign. and manufactured articles of the To the former we furnish, without State. The maintenance of accurate charge, the necessary biologic prod- records of vital statistics is a proper ucts through the State Laboratory of governmental function. No state can Hygiene. serve its people well which does not The Division also attempts to pro- provide for the proper collection of mote adequate treatment facilities permanent records of its vital capital. for those individuals who are infected A record of the gains by birth and im- with the venereal diseases. We sub- migration and losses by death and mit to the Public Health Service in emigration is of prime importance to Washington a monthly report of the a state, and is essential to a public fifty-one venereal disease clinics in health department if it is to function this State. Our efforts toward secur- with the greatest degree of efficiency. ing adequate treatment facilities have It is necessary to know the cause of tended to encourage a more liberal death, the place, and the number viewpoint toward these diseases, so of the inhabitants that are dying in that physicians and laymen alike will order that steps may be taken to

regard it as a disease that is trans- diminish the losses from preventable missible one to another, rather than causes. These records serve as a punishment for moral transgression. gauge whereby the value of the meth- It is hoped that by this attitude more ods used in fighting diseases may be individuals who are infected will seek measured and those that are benefi- treatment, and that they will con- cial continued and those of no value tinue this treatment until a cure is eliminated. effected. The Bureau of Vital Statistics of A consultative service is rendered the North Carolina State Board of through this office upon request. Our Health was created by an Act of the services are also available when there General Assembly of 1913. This Act occurs an outbreak of any disease, made the State Board of Health cus- usual or unusual. There have been todian of all records of births and many such requests. The Director of deaths and its secretary State Regis- the Division is scheduled for speak- trar of Vital Statistics. The duties ing engagements before civic organi- assigned to the Bureau by the Gen- zations throughout the State, upon eral Assembly include the collection, request of these organizations. editing, filing, and tabulation of ap- Limited personnel forbids much, if proximately 111,000 birth and death any, investigative work of a research certificates yearly. nature. With added personnel it The fundamental features of ©ur would be an easy matter to find prob- registration system are: First, each lems that are well worth solving. township and each incorporated town However, this takes time and would constitutes a registration district. 12 The Health Bulletin January, 1935

Two or more of these units may tie obtain admission to school, to estab- combined into one distr.'o^ if the lish the right to work, to qualify for State Registrar believes that this will civil service examination, to hold pub- provide a more efficient and satisfac- lic office, to establish right to vote, to tory registration. With the consent obtain a marriage license, to deter- of the State Registrar, all units of a mine legal responsibility, or to prove county may be united into one dis- qualification for or exemption from trict. Only in counties having a full- civil and military duty. Parentage, time health department are all dis- as stated in the birth certificate, is tricts consolidated. Second, a local necessary to establish the right to registrar is appointed for each town- inherit or bequeath property, to es- ship by the chairman of the county tablish identity, to obtain settlement board of commissioners of their re- of insurance, to prove that parents spective counties, and the town and have dependent children, to prove le- city registrars by the mayor. These gitimacy, or to furnish acceptable serve for a term of four years, or at evidence of genealogy. the pleasure of the State Registrar. Death certificates may be used by A birth or death certificate for each individuals to furnish evidence in person who is born or dies is record- court, to secure pensions or life in- ed with the local registrar of the surance, to establish titles and right district in which the event takes of inheritance, or to give home-seek- place, within five days in case of a ers and immigrants a guidance in birth, and before burial or removal selecting safe and healthful homes. in case of a death. These certificates In organizations interested in are forwarded to the State Board of health problems and procedure, birth Health monthly. Third, the doctor or and death records are used to deter- midwife who attends a birth must mine the magnitude of health haz- file the certificate with the local regards, to plan new activities, to pre- istrar. Fourth, the undertaker, or vent epidemics, and to evaluate pro- person acting as undertaker, is re- cedures. Since we use these records sponsible for filing the death certifi- as a yardstick for measuring our cate. In cases where no regular un- problems, it is essential that they be dertaker is employed, the member of accurate. the family or friend who purchases A certified copy of a birth or death the casket and attends to the funeral certificate may be secured from the is responsible for filing the death Bureau of Vital Statistics by anyone certificate and securing the burial who has a legitimate right to the permit. certificate upon the payment of fifty The parents of children are notified cents to cover the cost of searching when the birth certificate is received the records and making the copy. by the Bureau. These notices should Verification of age for school or em- be received within about three ployment purposes is done without months of the birth of the child. If cost to the applicant. Certain vital the parent does not receive this no- information as to the number of tice within a reasonable time, he births or the number of deaths in a should make inquiry to determine if locality from all causes or from a the birth was reported. specific cause is furnished free upon To the individual, a birth certifi- request. cate will furnish proof, which will be It is important, both to individuals accepted in every civilized nation, of and to health organizations, that we the place of birth, the time of birth, have complete and acceptable records and parentage. The place of birth as of all births and deaths which occur recorded on the birth certificate may in the State. We can only attain that be used to establish citizenship or to objective when physicians, undertak- establish residence. It is necessary in ers, midwives, registrars, and indi- order to obtain a passport. The time viduals do their part. If everyone of birth may be used to prove age, to who has responsibility in connection January, 1985 The Health Bulletin 13 with birth and death certificates will 2. Organizes new services in coun- give the consideration to these docu- ties or districts where health service ments which their importance de- is not in operation, and secures the serves, we can have records which initial appropriation to carry on such services. will fill the needs of individuals, and which will make health protection 3. Offers a consultative service in more effective. administrative policies.

4. Approves WHAT THE DIVISION OP COUNTY budgets and expendi- HEALTH WORK OFFERS TO tures, and audits financial reports. THE CITIZENS OF NORTH CAR- 5. Aids in supplying lists of ap- OLINA proved and competent personnel, but never selects the personnel for a of The State Board Health recog- health unit. nizes that the most important part of 6. Reviews the character and con- our public health service is that per- tent of health programs and evalu- formed by the local health workers ates the health service of these pro- who come into daily contact with the grams. public. The local health workers are to the State Board of Health in the 7. Acts as liaison officer between battle against disease what the in- local health departments and the sev- fantry is to the general of an army eral Divisions of the State Board of in a military campaign. County Health, and extra State agencies. health work is the right arm of the 8. The Director of County Health State's attack on disease from the Work, acting for the State Health public health standpoint. Officer, carries out such administra- The Division of County Health tive, technical, and professional su- Work is the clearing house for all pervision over the personnel of matters between the local health Health Departments as falls within units and the State Board of Health. the scope of the State Board of The financial assistance given by the Health; all other Division chiefs or State Board of Health to local county directors, and their subordinates and health units is administered through technical employes, serve only as the Division of County Health Work. consultants on technical subjects to This assistance, at present, is admin- local health departments. Complaints istered on a percentage basis of the relating to lack of interest, non- total local health budget. This as- cooperative attitudes, and misunder- sistance is given contingent upon the standings should be filed with the employment of full-time trained per- Director of County Health Work. sonnel in the local health units. The The services of the personnel of maximum percentage allocation of this Division are available at all times the total budget is 25 per cent for a to the county organizations, to the four-piece health unit, but is not to county medical society, and other exceed $1,500 per annum. This max- interested groups of citizens, to con- imum allocation has been reduced fer with them in regard to the possi- from $2,400 per annum to $1,500 bilities of improving the work of exper annum during the past two years isting local health departments, or because of the economy program un- the establishment of new health de- der which the State of North Carolina partments, either along county or has been operating. district lines. The chief functions of the Division of County Health Work are: Measles is now spreading in sections 1. Field representative of the where the people were fortunate State Board of Health to County enough to miss an epidemic last win- Health Departments in technical and ter. Already the schools in one town administrative activities. have been reported closed. —

14 The Health Bulletin January, 1935

The Beginning of Pre-School Clinics In North Carolina

SOMETIME ago we received the school clinic is to determine the following letter from Mrs. W. N. physical fitness of children just Tillinghast, the efficient super- reaching the school age of six years, visor of community work at Erwin, and to determine whether the visible North Carolina, for the past several defects could be remedied." years. We quote Mrs. Tillinghast's With reference to the above inter- letter as follows: esting communications from Mrs. Tillinghast as to the first pre-school

"Dear Doctor Cooper : clinic held in North Carolina, so far call- "So many of our 'dailies' are as we know this was the first desig- ing to mind happenings of 10, 20, or nated pre-school clinic. Anyhow, it more years ago, I am wondering if it has never been denied. If there is wouldn't be interesting to note in any record in the State of any other The Health Bulletin that community having held a pre-school clinic previous to this time, we would "Ten years ago (192 4) the first be pleased to receive information pre-school clinic in the State was held about it. Of course, all of us are in Duke (now Erwin?). Dr. M. L. aware that for at least twenty years Townsend, of the State Board of there have been conducted in vari- Health, was in charge of this clinic. ous sections of the State what those "I have the newspaper clipping of of us who were pioneer whole-time that date, among my most valued health officers in the State were possessions. pleased to term summer round-ups. These efforts were practically the "With best wishes for you, al- same thing, but the procedure had ways." not been systematized and did not We requested Mrs. Tillinghast to include as many variations as the us with a copy of the news supply present arrangements for pre-school note appearing in the News and Ob- clinics. server of October 3, 1924. Mrs. Tilling- hast very kindly did that, and we Sayings of Upton G. Wilson quote the dispatch as follows: In Reidsville Review "PRE SCHOOL CLINIC AT DUKE FIRST OF ITS KIND Willie Winkus, of Nubbin Ridge, "Duke, Oct. 3, 19 24.—Forty-one notes from time to time agitation children between the ages of three here and there against the employ- and six years were examined here ment of married women in industry and the professions. takes the Friday in the first pre-school clinic He other side in the controversy. If ever held within this State. Dr. M. L. married women could not hold jobs, Townsend of the State Board of he says, thousands of husbands would Health was in charge of the clinic, starve, and being a kind-hearted man, in a statement he said that the and he is opposed to that. children he examined were a 'fine lot' with- of youngsters, all of them being Pellagra deaths increased in North out any serious physical defect. Carolina in 1933, the first time an in- "Other clinics of a like nature will crease has been recorded since 1930. be held in the State, according to Dr. People should remember that pellagra Townsend. The purpose of the pre- is a preventable disease. January, 1935 The Health Bulletin 15

North Carolina Emergency Nursery School Program

By Mrs. Mary G. Scarborough State Supervisor of Nursery Schools and Parent Education

READERS of The Bulletin will Recognizing that physical and mental be interested to learn of the or- and emotional health are the most ganization of the plan for Parent essential possessions for any child, and Education through the Emergency that unless his parents have some con- Nursery Schools that are being opened ception of the laws governing health all over the State of North Carolina. and illness he will have a pretty slim Many of these readers know of schools chance of growing up with a sound that are being run in their immediate mind in a sound body, a reading course vicinity; and it will be a source of is being prepared for the teachers of interest to them to know that these these schools, stressing health in all its are not independent centers for the phases. underprivileged runabouts and care of A very strict supervision is being definite part of a toddlers, but are a exercised over the nursery schools, in raising the nation-wide program for order that the purpose for which they level of parenthood knowledge, espe- are formed may not be lost sight of. less favored portion cially among the Only fifty are being commissioned to of our population. start with, in order that the growth The plan in brief is this: Wherever may be sound and along the right a group of thirty underprivileged chil- lines. Just as rapidly as these can dren can be gathered together from re- be organized and placed on a basis lief families and enrolled, application that will allow them to go ahead with- may be made for an Emergency Nurs- out constant direction, others will be ery School. The initiative must be established, so that before long a very taken by the local community, which large part of the underprivileged of the must see to it that suitable housing State will be reached. As it is esti- facilities, playgrounds, heat, water, mated that each school of thirty chil- etc., are furnished. Specifications may dren will directly contact at least one be obtained explaining just what these hundred persons, it will be seen at must be, so that there may be no mis- once that the plan possesses great understanding. powers for good. The children must be between two Naturally the instruction given the and five years old, though a few five- little ones will not be along lines of year-olds may be admitted. An es- "book larnin'," as at this age any such sential part of the scheme is the re- attempt would defeat itself. Instead, quirement that parents of nursery the emphasis will be upon right health school children must attend classes in habits, right ways of playing, right Parent Education. If they refuse, methods of getting along with other their children will have to be with- children and with adults. Their health drawn. Salaries will be furnished for training will be the indirect "learning a head teacher, an assistant teacher, by doing," which the psychologists tell and a trained nurse, by the North us is the very best way for anyone to Carolina Emergency Relief Adminis- learn. The opportunities for improv- tration. ing the health of the population of this What should be of especial interest grand old Commonwealth of ours are to those Avho read The Bulletin is the practically unlimited; and thoughtful fact that health education of the par- observers will watch this phase of the ents of these underprivileged children New Deal with high hopes of what it is to be the keynote of the whole work. may accomplish. I1V MEMORIAM By G. M. Cooper THE death of Dr. James M. Parrott, State Health Officer of North Carolina, occurred on Wednesday evening, November 7, 1934. Doc- tor Parrott had been health officer of North Carolina for a little more than three years. He was so active mentally and so near and dear to his coworkers here at the office that to me, even yet, it seems impossible and unbelievable to think that he is dead. Nearly thirty years ago I "took" the State Board examination for license to practice medicine. He was a member of that board. From then on I looked on him as one of the big men in the medical profession. He held every office within the gift of his profession and loved it and served its interest with a passionate devotion. He took over the direction of the work of the State Board of Health in one of the darkest hours in the history of the Board. He brought to the affairs of the Board a new kind of leadership, a fresh outlook, a new viewpoint, and a breadth of vision which served notice on the world that the Board had a resourceful and able executive in charge. Although he came to the Board work without previous experience in an administrative capacity of this type, and knowing little or nothing of the practical workings of a modern public health organization, his chief contribution, which will be duly recorded in the history of this period, to the cause of public health advancement was his stand for the profes- sionalization of public health work. Before he had been here sixty days, he realized that all department divisions as well as all county health offices should be manned by physicians technically trained and experienced in public health work. It became necessary for him to oppose the ambitions of some of his lifelong friends in the medical profession, which hurt him; but it may be said to his credit that he stood four-square for competently trained men as public health officials. On assuming office, he realized that he had some very unpleasant duties confronting him in reorganizing the work of the Board. He soon demonstrated that he had convictions and the courage to back them up. When he laid down his armor for the great adventure, he left an organization of his own building functioning at top speed. He proved to his fellow workers here that he was tolerant to everything but laziness and lying and inefficiency. Being a man of clean personal life, and governed in all his actions by a strict sense of honor, he naturally expected such qualities in his staff and other subordinates. For the past year he struggled against the malady which finally ended his life, and at the same time he felt keenly his official responsibility. He knew all during that last year that, in justice to himself and his family, he should resign and be relieved of the extra tax on his failing strength. On the other hand, he felt that his work was not quite done. He saw many essential features of public health work sacrificed to a program of questionable economy. He did not question the good inten- tions of the Governor, the Budget Bureau, nor the Legislature, but he felt that the time had come to put an end to the further needless sacrifice of human life for the lack of intelligent preventive efforts. He had a conviction that the incoming General Assembly would see eye to eye with him. He was ready to submit a program of far-reaching importance to the people of the State. It could not be. His big brain is for- ever inactive. His profound knowledge of the public health needs of the people is left for his successor to acquire for himself. No man could build for himself a better monument than Doctor Parrott did in the record of worth-while work well done. In his death the State loses an honest public servant, and I lose a warm and understanding friend whose confidence was more precious to me than the riches of Araby. 1 — MR. JIG. G. BEARD, CHAPEL HILL, N

Yis? ^i r\ llfiissilo) mm Pu"bii 5\edbM TfiE, man cflKiifla, state, b?ards>7ao\lxa

This EmTletirvwill be seryt free to ar\\j crhzery of the 5tateupo r\ reques 1.

Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1894 Published monthly at the office of the Secretary of the Board, Raleigh, N. C.

Vol. 50 FEBRUARY, 1935 No. 2

THOMAS E. ANDERSON, M.D.

Doctor Anderson served continuously as an active member of the State Board of Health from the time of his election by the State Medical Society, May 24, 1905, until the Board was reor- ganized by the General Assembly of 1931 exactly 26 years of faithful service, during which time he collected to himself many warm friends. At 77 he is now living in re- tirement at his home in Statesville. While he suffers from many bodily infirmities, his mind is as keen as ever and The Health Bulle- tin has no more interested reader than he is. The Editor of The Bulletin has been helped over more than one weary difficulty during the past few years by Doctor Ander- son's friendly encouragement. May the Boatman be a long time coming, Doctor Anderson. )

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

Cakl V. Reynolds, M.D., President Asheville G. G. Dixon, M.D - - - - Ayden S D. Craig, M.D - Wmston-Salem H. Lee Large, M.D R°<*y Mount Gol 1 J. N. Johnson, D.D.S ^ , SK H. G. Baity, Sc.D - - Chapel Hill W. T. Rainey, M.D - Fayetteville B. Haywood, M.D - lgh Hubert , CharlotteA? Jambs P. Stowe, Ph.G -

Executive Staff Carl V. Reynolds, M.D., Acting Secretary and State Health Officer. G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Preventive Medicine. Warren H. Booker, C.E., Director Division of Sanitary Engineering. Ernest A. Bra_nch, D.D.S., Director Division of Oral Hygiene. John H. Hamilton, M.D., Director Division of Laboratories and Vital Statistics. J. C. Knox, M.D., Epidemiologist. R. T. Stimpson, M.D., Vital Statistician. R. E. Fox, M.D., Director Division of County Health Work.

FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, also has which will be sent free to any citizen requesting it. The Board follow- available for distribution without charge special literature on the ing subjects. Ask for any in which you may be interested. Fever Adenoids and Tonsils German Measles Scarlet Smallpox Cancer Health Education Teeth Constipation Hookworm Disease Chickenpox Infantile Paralysis Tuberculosis Tuberculosis Placards Diabetes Influenza Fever Diphtheria Malaria Typhoid Typhoid Placards Don't Spit Placards Measles Eyes Pellagra Venereal Diseases Residential Sewage Water Supplies Flies Whooping Cough Fly Placards Disposal Plants Sanitary Privies

SPECIAL LITERATURE ON MATERNITY AND INFANCY The following special literature on the subjects listed below will be sent free to any citizen of the State on r equest to the State Board of Health, Raleigh, N. C. Prenatal Care (by Mrs. Max West) Baby's Daily Time Cards: Under 5 months; ; 10, Prenatal Letters (series of nine 5 to 6 months ; 7, 8, and 9 months monthly letters 11, and 12 months; 1 year to 19 months; Minimum Standards of Prenatal Care 19 months to 2 years. Breast Feeding Diet List: 9 to 12 months: 12 to IB 15 to months ; 2 to 3 Infant Care. The Prevention of months ; 24 years. Infantile Diarrhea. years ; 3 to 6 Carolina Midwives. Table of Heights and Weights Instructions for North

CONTENTS pAGE

Notes and Comment Putting Economic Limitations Around Pellagra 5 More About Mouth Health 6 Food Poisoning 10 Baby Clinic Distributes Much Milk to City Tots Inconsistencies - Malaria Control Activities In North Carolina H Immunity To Disease li Dafoe Doctor ; A Message for Thinking Citizens l fi MBmmTT-5T

Vol. 50 FEBRUARY, 1935 No. 2

Notes and Comment By The Editor f AHESE lines are being penned in with him, and they were on their about one hour after the Editor way to the hospital. 1 saw a child, about six years of It was a completely unnerving age, hit by an automobile on one of sight to witness how quickly an acci- the streets of Raleigh. The account dent can happen when everything in the world may be written in composure, be- seems to be going along all right. The driver of auto- cause reports from the hospital state the mobile was driving along soberly that the child did not die, but is and at legal speed, intent getting along very well. about his business, and in the twinkling of an Briefly described, this particular eye a serious accident had happened. accident happened in the following If the child had died, the coroner manner: An automobile, running would have held an inquest, or prob- along about three hundred yards ably visited the scene, questioned ahead of ours on one of the streets the witnesses, and decided that an of Raleigh which is much traveled, inquest was not necessary, writing struck a child who ran out from it down as one more "unavoidable" behind one of the large city street accident. sweepers parked by the curb. The child dashed out just in front of the But the question must arise sooner automobile, making it impossible for or later as to just what is an un- the driver to stop before hitting the avoidable accident, to be settled in child. The driver of the car did the negative if the continually increas- everything humanly possible; kept ing accidents on the highways result- his head, and acted with instant pre- ing in death to so many people do cision. The car was not running at not cease. In the first place, this an excessive rate of speed, but the accident was avoidable in two ways. impact of the heavy automobile First, the child was old enough to against a fifty-pound child, even know better than to dash out into though the brakes were slammed on the open road, even from an open just about the time the child was sidewalk, let alone from behind the struck, hit the child with sufficient obstruction of the street sweeper. force to knock him probably twenty In the second place, the parents of feet. every child should instill into it, By the time we arrived on the from the moment it is able to walk, scene the motorist had stopped his the danger of traffic on the highway. car about two lengths ahead of It is agreed by everybody concerned where it hit the child, the action of that a six-year-old child is thought- the brakes turning the car straight less. It is intent on its play or its across the street. He had alighted, own business, which is just as im- had the child in his arms, put it portant in its own mind as the busi- into the back seat of the automo- ness of any adult; but it must be bile, was back at his wheel, and a taught to think before acting when woman spectator on the sidewalk got its life may be at stake. In the SCHOOL OF PHARMAO* The Health Bulletin February, 1935 third place, the motorist—although ought not to be expecting too much in this case a gentleman, carefully that common sense and care should operating his car—could have veered prevail in the matter of operation a little more to the left, giving a of automobiles on the streets and wider space between his own car highways of the State. and the street sweeper; and he * * * at a much could have slowed down G. WILSON, writing in the going, either UPTON lower speed than he was Reidsville Review sometime ago, would have pre- of which actions quotes the Christian Science Monitor, accident. vented the which told the story of a dairyman everywhere — on the Children who complained to a friend of the town, in the city, and streets of every poor outlook in the milk business. roads are notorious- on the country — When the dairyman made his com- of them deliber- ly careless. Some plaint, he failed to get any sympathy the street and seem ately play in from his friend. The reason, as told everything they can to dare to do by the Monitor and passed along by them. Driving the motorist to hit Mr. Wilson, was that the friend had the average streets, an auto through lately passed the dairyman's place, particularly near intersections or in and there on his silo, in great glow- traffic, is getting to be a meeting ing letters, was a beer advertisement. occupation. It is nerve-exacting Of course, the friend refused to waste and more hazardous becoming more any sympathy on any such a dairy- for every operator of an automobile. man. The friend thought that if hand, all of us see all On the other the man had no more foresight than in our driving along the too often to advertise the business of his keen- or streets the careless motor- roads est and most unscrupulous competi- seems to go faster as he ist, who tor, he did not deserve the sympathy an intersection or a approaches of anybody. parked car by the roadside, taking Mr. Wilson comments further: no thought whatever of the dangers to himself and the children or other "Both beer and hard liquor are pedestrians who may be assembled competitors of milk. Thousands by the roadside or on the curb. If spend for beer and liquor the money every motorist would adopt the rigid they should spend for milk. More- the num- policy of slowing his car down on over, farmers are among ber guilty of such unwise spending. passing a parked car, unless he can When farmers learn to patronize see completely under the body of more liberally those industries which the car or all around it and definitely consume in quantity their own prod- know there is no likelihood of a ucts, they'll become more pros- child accidentally running out in perous as a class. And they shouldn't front of him, accidents of this kind forget that cows use more hay and could reduced to zero. It is well be grain than brewers and distillers." enough for all thinking people to consider these questions in practical The Editor of The Health Bulletin detail. is in entire accord with the position the by Mr. It is the small items, such as noted assumed in foregoing in the foregoing, which will change Wilson and the Boston paper. We our unfavorable position of being have all heard of the meanest man one of the leaders in murder on the in the world, but this man that Mr. highways to a position in which we Wilson and the Boston paper describe could soon be known as one of the we think is the world's biggest fool. safer of the states in which to motor. The old toper who needs a chaser Education by the usual methods is for his hard liquor, and therefore a long and tedious process. We have eulogizes beer for its food value, in mastered or we are on the way to order to provide an alibi for the mastery of such killers of past gen- situation he finds himself in, deserves erations as typhoid fever, smallpox, little sympathy. The family who is and other diseases; therefore it rearing growing children, but pro- February, 1935 The Health Bulletin

ceeds, as some of them are reported Chowan tied, with 11 each. The fol- to do, to reduce the milk ration in lowing named counties reported the family in order to provide funds more than 100 deaths each: Bun- for increasing the beer, particularly combe, 15S; Columbus, 127; Edge- for father, is robbing the children combe, 137; Forsyth, 171; Guil- of the family of one of the most ford, 118; Halifax, 163; Mecklen- burg, 104; essential foods, a food for which New Hanover, 118; Pitt, 106; Robeson, 103; Wake, there is no substitute whatever for 159; Wilson, 16 3. growing children. The head of a The foregoing figures indicate family who will do this is foolish; that there are entirely too many people but he is in no way any such fool in North Carolina who are frequently as the dairyman who is trying to ill and who do not have the benefit make a living selling milk to his of medical care and hospital service fellows for their good, and for his during serious illness. Of course, own, and then undertakes to adver- not a few of the deaths were sudden, tise the products of a brewery, which from such causes as apoplectic will reduce his business and even- strokes, heart disease, and other con- tually destroy it if the beer-drinking ditions; and many of them, of habit becomes prevalent enough. course, were due to accidents happen- ing, without warning, There may be some food value in in which death was instantaneous. But if all beer. We do not know. Impartial, such deaths were accounted for, there unbiased chemists say that the food would still be a large number which value in a quart of beer cannot be follow days of illness unattended by more than one-half the food value in physicians. a quart of milk. Moreover, the quart of milk possesses a great many exceedingly important vitamin and Putting Economic Limitations mineral elements which are conducive to good health, none of Around Pellagra which a quart of beer will contain. But the beer has enough alcohol in One of the strangest angles of the it to bring them back for more and late lamented depression has been more. the decrease in the number of cases of pellagra. Since the ailment is ago it SOMETIME became necessary recognized as a "poverty" disease, to tabulate, by counties, the num- its incipience in inverse ratio to the ber of deaths occurring in North spread of poverty is very peculiar. Carolina in 19 32 in which the dece- Lessons of the depression perhaps dents were without the attendance will teach medical science to cease of physicians at the time of their attributing pellagra to poverty, but last illness and at death. These rather to assign it more definite figures afford material for some economic limitations. straight thinking on the part of the Pellagra, people of this State. In that year it seems, thrives on a condition which 31,000 people died; 4,617 of them, encourages artificial eating. or almost exactly 15 per cent, were without pain-relieving drugs and Prosperity, when it enables the other comforts provided by a prac- household to buy and eat red meats ticing physician during the fatal ill- and green vegetables, effectively ness or accident which resulted in banishes the spectre of pellagra. death. Every county in the State But so also does poverty when it recorded five or more such deaths. becomes so abject that it forces the Alleghany had the fewest, with 5; family to live on the Spartan but Davie was next, with 7; Polk, Clay, scientifically correct rations dished and Alexander came next, with 8 out by relief canteens. — Fayetteville each; and Graham, Camden, and Observer. —

The Health Bulletin February, 1935

More About Mouth Health Some Pertinent Facts and Important Advice for Parents By Ernest A. Branch, D.D.S., Director, Division of Oral Hygiene follow. Editor's Note.) (This is the second of a series of articles by Dr. Branch. Others will SOMETIME ago the Mouth Health teeth as "temporary teeth," and re- Survey was taken as the sub- fuse to be concerned over their condition, thinking that it is only a ject for a radio talk. Those of matter of a few years until these you who have children will doubt- teeth are lost and the permanent less remember that this survey was ones take their place. They do not conducted in the public schools of understand that the first teeth have the State on February 20 and 22, a definite purpose; they do not 1934, by members of the North Caro- understand that the first teeth must lina dental profession, and had for be kept in good condition, must be its chief objective the obtaining of an filled and cleaned and cared for just accurate cross-section of the mouth as though the child were to keep health conditions and needs actually them through all his life, for upon existing among our school children. the condition of the first teeth de- the time the talk was made it At pends the condition of the permanent was impossible to give the findings. teeth, and the first teeth must be However, the vast amount of infor- kept until they are shed naturally to mation obtained in the survey has make way for the permanent teeth. now been tabulated, and your atten- before the baby is born, his tion is called to some of the out- Long standing items. first teeth are forming in his jaws, his birth they Out of 70 5 schools, containing and by the time of approximately 325,000 school chil- are almost entirely formed beneath the first dren, 130,385 children had never the gums. However, during eats nothing visited a dentist. Why? Out of this months of life the baby same number, 18,3 52 six-year molars but milk and has no need for teeth chew. As he grows had been lost. Again why? to help him During these days of depression, bigger he needs other foods in his exercise for or following the days of depression diet and he needs more in order that they may (if you prefer), we have come to his jaws blame almost everything upon pov- grow with him. Along about this the first of all his teeth, erty. We say that people are too time comes hard breads. As poor to visit the dentist and the and with it the increases, physician, yet in this survey a care- his need of additional food his equipment for ful check was kept upon the financial so also increases it is too classification of the children inspect- masticating his food. But early to fill the baby mouth with ed and it was found that less than not one-third of the children were classed grown-up teeth. The jaws have which is as indigent or unable to pay for any reached the development some- dental work. Taking this fact into necessary. One by one, and two, the teeth come consideration, it seems hardly pos- times two by until the baby has sible that poverty would account for through the gums then the appalling number of children his full set of twenty teeth; who have never been in a dental one by one they go out again to for thirty-two perma- office. It is too easy to blame every- make room the covers thing on poverty, and too final. nent teeth. This procedure The trouble seems to be that few a period of about eighteen years and lengthy parents are aware of the importance seems to be unnecessarily considers the fact that of the first teeth to the child's mouth until one throughout a and health. They have a tendency these teeth are to last It would be too much to to look upon the first, or deciduous, lifetime. February, 1935 The Health Bulletin

expect to build anything in a day build strong teeth; he will tell her or two which would not only have to that the jaws need exercise in order be beautiful, but would also have to to develop properly (to facilitate this stand all the strains of everyday life. exercise, the dentist often recom-

Now about the fifth or sixth year mends the chewing of gum) ; he will of the child's life four teeth begin emphasize the proper cleaning of to come into his mouth—the six-year the teeth, and he will do what is nec- molars. These are the first per- essary in the way of corrections. manent teeth and are of vital im- However, the dentist cannot do it portance. They do not follow the all. He must often waste valuable loss of baby teeth; a place has been time in overcoming the child's fear left for them all the time. If the of him, when this is definitely the first teeth are prematurely shed be- mother's responsibility. Here again

fore these molars come in, then the it is up to the mother to see to it molars may come in crooked and that her child has the proper atti- the other permanent teeth which tude towards the dentist. Whether follow them will be crooked too. she has held the dentist over the It is easy to locate this six-year child's head as a sort of "boogie- molar in the child's mouth; it does man," or whether he has acquired not require a dentist to find it. If the wrong attitude through listening an imaginary line is drawn between to harrowing tales of the tooth that the two big teeth in front and six his Cousin John had pulled, or those teeth are counted on either side, that his Aunt Elizabeth had filled, upper and lower, right and left, unless he is taught to regard the these teeth will be found. In other dentist as his friend he will look words, if the child has only five upon him as the most disagreeable teeth, counting from this imaginary of all human beings. When tooth- line, then he has not cut his first aches and gumboils at last make it permanent tooth. If there are six, imperative to take him to the dentist then this sixth tooth will be the first he is likely to be a very intractable permanent tooth in the child's head. patient. It is too much to expect a Even though it is easy for the child to submit gracefully to what mother to find these six-year molars, he thinks will be a very unpleasant it is necessary for the dentist to look experience. Self-preservation is the them over as they come into the first law of nature, and you can be child's mouth. They are far back very sure that he will fight back. in the mouth and are not as easily If such a visit is hard on the child cleaned as the other teeth. They are it is equally hard on the mother and also more subject to decay. Every the dentist; yet, with a small little cavity should be filled as soon amount of preparation, it might so as it appears. If small cavities are easily be avoided. A matter-of-fact neglected, they will grow into large attitude on the part of the mother ones and the whole tooth may be will do much to create the same lost because of neglect. attitude on the part of the child. A Perhaps there is not a mother trip to the dentist holds few terrors alive who would willingly neglect her for the child who has been properly own child. Purposeful neglect is not and wisely prepared. in a mother's nature. Nevertheless, In conclusion, the mother should neglect has the same effect, whether not be satisfied to excuse herself or not it is intentional. A six-year by thinking that she wants her child to molar may be lost just as easily be- have the best. She must make it cause the mother failed to under- her business to find out what the child stand its importance as because she needs and then see that he gets it in did not care. Every mother should spite of all the depressions that may take her child to the dentist at befall. Expensive clothes and toys regular intervals as soon as his first may be beyond reach, but adequate teeth appear. The dentist will tell dental care is available to most of us, her what foods are necessary to and every child should have it. 8 The Health Bulletin February, 1935

Food Poisoning

By W. P. Richardson, M.D., Assistant Director, State Laboratory of Hygiene

4LTHOUGH the term "food poi- food with infectious organisms is ex- ex- /\ soiling" is indefinite and un- tremely common. As would be people in- -*" ^ satisfactory from a scientific pected, the number of volved in any outbreak are usually standpoint, it was chosen as the limited, because the majority of in- of this paper because it denotes title dividual preparations of foods the average individual the group to usually serve only a limited group, of conditions it is purposed to dis- often only a family; but outbreaks The term as here used may cuss. involving large numbers of people include all those dis- be defined to have been recorded, and special care eases, the main mode of transmis- should be taken in the preparation sion of which is through food and of foods for large gatherings such food products. Poisoning from as picnics and the like. poisonous plants, as mushrooms, The symptoms are so familiar as milk sickness caused by drinking the to need little elaboration. They in- milk of cows which have fed on the clude vomiting, diarrhea, prostra- plant, white snakeroot, and shellfish tion, and fever, coming on in from poisoning, rightfully belong under four to twelve or more hours after this head, but they are conditions eating the offending food. As a which are not of major importance rule, practically every individual eat- from a public health standpoint, and ing this food is affected, though the will not be discussed here. Bacillary severity of the symptoms may show and amebic dysentery and typhoid wide variations, both on account of fever are sometimes transmitted individual variations in resistance through the agency of food, but such and because different persons may transmission is only one part of the take in different numbers of bacteria. picture of these diseases, and they will not be discussed in more detail. Several species of bacteria may cause these infections, the symptoms The first, and perhaps the most with all types being reasonably uni- widespread, disease in this group is form. As has been mentioned, the that commonly and erroneously re- bacteria most commonly found are ferred to as ptomaine poisoning. It related to the typhoid bacillus, be- got this name from the old concep- longing to the group of paratyphoid tion that it was caused by poisonous organisms. Several members of this products called ptomaines, which are group have been isolated from vari- formed during the putrefaction of ous outbreaks. Other bacteria have proteins. It has been determined, been found also, including varieties however, that such products are not of the common pus-forming organ- significantly harmful in the amounts isms, staphylococci and streptococci. in which they occur in spoiled food, and that most cases of so-called Of greater interest to the non- ptomaine poisoning are really infec- medical person than the bacteria in- tions with some one of several spe- volved are the foods which may be cies of germs or bacteria, the most carriers of infection, and the way common of which are closely related they become contaminated. Most to the typhoid bacillus. This finding types of food may carry the infec- explains why food that is spoiled is tion, but epidemics are usually frequently eaten without harmful caused by prepared foods which are effect, whereas foods that are per- kept for some little time before use. fectly normal in appearance, odor, Since the number of bacteria taken and taste are frequently implicated. in plays a considerable part in de- Outbreaks of so-called ptomaine termining whether infection will poisoning caused by contamination of occur, and its severity, this time in- February. 1935 The Health Bulletin terval is important, as are the con- 4. Boiling of home-canned fruits ditions under which the food is kept, and vegetables for fifteen minutes. particularly the quality of refrigera- 5. Inspection of bought canned tion and the opportunity for con- food, and rejection of any with ends tamination from rats. Foods served of the can bulging. It might be hot immediately after cooking are stated that the high temperatures at probably never involved. The follow- which commercially canned products ing products have been proved to are processed has practically elimi- be bearers of infection in various nated the danger from this source. epidemics: all kinds of cold salads, The all too frequent occurrence of pastries, pies, eclairs, and cakes, food infections suggests further the canned food in tins, processed and need of more rigid inspection and fresh meats, and raw fruits and control of food handling and proc- vegetables. It will be seen from this essing establishments, especially as list that the kind of food is not as regards sanitation and rat infesta- important as opportunity for con- tion. tamination to occur and for infec- The second disease of the food- tion to multiply in the food, such as poisoning group is one not so com- may occur in improperly prepared mon in North Carolina, but concern- and kept foods. It should be empha- ing which we need to know a few sized that these cases of food poison- facts. It is called botulism, a name ing should not be labeled according derived from the fact that in Ger- to the food which happens to be in- many, where it was first recognized, volved. The old practice of calling it is commonly gotten from eating them meat poisoning, milk poisoning, infected sausages. In the United etc., can only confuse the picture and States, canned vegetables are most make more difficult the recognition often the source. of the infectious nature of the Botulism is a true poisoning, the disease. symptoms being caused by a poison Infection is transmitted to the food produced by Bacillus botulinus in the in different ways. Occasionally a food before it is eaten. So far as person who is just taking or recover- is known, the bacillus causes no ing from the disease, or one who has trouble when it is swallowed. The recovered, but still harbors the germ, Bacillus botulinus is an organism is the source from which the food which grows only in the absence of becomes contaminated. Rats harbor air, and that is the reason canned some of the bacteria of this group foods have been of such importance and form an important source of in its causation. It does not grow infection; perhaps the most im- in the presence of high concentra- portant. A few epidemics have tions of sugar, so that is the reason occurred from foods becoming in- fruits and preserves are not often fected from rat virus which was put involved. As has been stated, com- out to destroy the rats. mercially canned products are proc- These facts suggest a few points essed at a high temperature which to be kept in mind regarding foods makes them extremely safe. Some not to be eaten hot immediately after years ago, commercial products were cooking: involved in a good many outbreaks, 1. The importance of strictly fresh but at the present time, although meats, poultry, and sea foods. This poisoning from commercially canned means primarily adequate refrigera- food is not impossible, most of the tion before purchase. trouble comes from home-canned 2. Early consumption of prepared vegetables. This is because it is not foods or good refrigeration in the possible as a rule to get a high home. enough temperature in home can- 3. Protection of stored food from ning to kill the very resistant botu- contamination by rats—a much more linus bacillus. common occurrence than is often It is of interest to note that prac- thought. tically all animals are susceptible to —

10 The Health Bulletin February, 1935 botulism, and its occurrence in na- Botulism is a poisoning or intoxi- toxin produced in ture is not unknown. Stock some- cation caused by a food before it is consumed, and in times get it from forage preserved the United States most frequently in silos, and wild ducks have been derived from home - canned foods, known to have it. Limberneck in especially vegetables. The most im- chickens is nothing but botulism. portant preventive measure consists In contrast to the symptoms of in the thorough boiling of home- food infection, the symptoms of canned foods for fifteen to twenty botulism do not relate to the stomach minutes just before consumption. or intestines. Botulism involves the nerves and muscles, causing weakness and paralysis, first of the eye Baby Clinic Distributes Much muscles, resulting in "cross-eye" and difficulty in seeing, then of the Milk To City Tots muscles of the mouth and throat resulting in difficulty in swallowing, Showing attendance of 234 babies and then to a lesser extent of all at the Durham clinic in November, the muscles. The mortality rate is the Charity League reported having very high, but when a patient re- distributed 2,259 quarts of milk at covers, he recovers completely. a cost of $368.46 for the month. botulinup. There are two types of The league also supplied a gallon of involved in human bacilli commonly cod-liver oil and two and a half poisons, although botulism, and the crates of oranges to the babies. are they cause identical symptoms, Twenty-two babies were given toxoid Antitoxins have been pro- different. treatment, 19 4 garments were dis- of considerable help duced which are tributed. Durham Herald. in treatment if administered early, but the type of antitoxin must corre- spond to the type of organism caus- Inconsistencies ing the disease. Botulinus toxin may be present in Charles O'Leary, an Irish plumber, a food without giving any signs at was killed near his home in Ireland all, though commonly there is some suggestion that it is a little off color. when a well caved in on him. The The toxin is destroyed by thorough item was world-wide news. A hotel heating, so vegetables cooked well in Lansing, Michigan, burned, taking after opening will not give any the lives of some forty or fifty guests. trouble. The boiling of all home- Every daily newspaper in America canned foods for fifteen to twenty played up the story and foreign news before eating them will minutes services handled it. Human life is eliminate any danger of practically valuable, and important. The world botulism. is horrified at mass violent death. So-called To summarize briefly: In Wake County this year 27 people poisoning is really an in- ptomaine have lost their lives in automobile fectious disease caused by some one accidents. And we shrug and say, of several species of "germs" or bac- "Something oughta be done about teria, and this conception should not it" and continue to let 13- and 14- be confused by classifying cases of — our the disease according to the foods year-old boys and girls drive which happened to carry the infec- cars, rush along at much greater tion. Precautions to prevent this speed than the legal 45 miles an disease include insistence on fresh hour, and otherwise contribute to the meats, poultry, and sea foods, early ever-increasing danger of highway consumption or adequate refrigera- travel. Human beings are valuable, tion in the home, and the boiling of and important, and exceedingly in- home-canned foods after opening and consistent and queer. — Raleigh before use. Courier-Journal. February, 1935 The Health Bulletin 11

Malaria Control Activities In North Carolina

By M. R. Cowper, Assistant State Director, Malaria Control

SEVERAL years preceding 1933 available. With the help of the the North Carolina State Board Public Health Service experts in the of Health gave little attention field of malaria, and those members of the State Board of Health to its malaria problem. This de- who also had had experience in that linquency was due to the marked activity, a supervisory personnel was decrease in the incidence of the dis- set up and trained as quickly as pos- ease which took place during those sible. These men proved to be very years. Health authorities had begun conscientious and soon gathered a to suspect that in North Carolina great deal of information about malaria was fast becoming a disease malaria control methods. of the past. But this proved un- During the existence of the Civil true, as the decreasing incidence was Works Administration the personnel found not to be a permanent con- consisted of one assistant State di- dition. During the summer of 1932 rector, six district field supervisors, the North Carolina State Board of six assistant field supervisors, Health began to receive frequent re- and an engineer for each county quests for malaria investigations, and which participated in the program. such requests increased during the Under the Emergency Relief following summer. The Health De- Administration only seven district field supervisors partment provided for these investi- and the assistant State director gations, but only a small amount of are employed. The county supervisors control work resulted. A severe and have been combined with the abrupt transition of the intensity was regular ERA project supervisors. noted this past summer (1934), The following when the disease reached most procedure is used by the Malaria alarming proportions. Several Control Division in its relation rather severe epidemics occurred, with the Government relief agency: and judging from reports of the local physicians, there was a dis- The malarious portion of North turbing increase of malaria in all Carolina is divided into districts, parts of Eastern North Carolina and each with a supervisor. During the in many portions of the Piedmont CWA the assistant district super- district. visors served immediately under Fortunately, a program for the these supervisors. Then came the control of this disease received the county supervisors, who in turn in- necessary impetus from Government structed the foremen. No assistant relief agencies, which in November, district supervisors are employed by 1933, announced a program that in- the Emergency Relief Administra- cluded a Federal project in drainage tion. Form reports have been for malaria control for those states printed for the foremen and county subject to the disease. The respon- supervisors; the foremen forward sibility for organizing such a pro- these reports daily to the county gram was placed with the U. S. Pub- supervisors, who at the end of the lic Health Service, and that depart- week collect this information and ment, through its local agency in send it to the office of the assistant North Carolina—the North Carolina State director of malaria control. In State Board of Health—organized this office the activity reports from with relief funds a supervisory per- all the counties are accumulated and sonnel to be used for malaria con- entered on the regular U. S. Public trol. This was a slow and arduous Health Service report for this service. task, because engineers with ex- Copies of these records are then perience in malaria control were not forwarded to the Public Health 12 The Health Bulletin Felruary, 1935

Service and to the State ERA office upon the opinion of the county health for their files. officers and local physicians when Requisitions for malaria control granting approval of projects about work are first forwarded to the State which no other condemning infor- ERA office, from which they are sent mation could be obtained. Such pro- to the State Board of Health. There cedure was necessary for projects they are referred to the Malaria Con- brought to its attention after the trol Division, whereupon a district end of the Anopheles breeding sea- supervisor immediately makes an in- son. spection in order to determine the Malaria in North Carolina is most merits of the proposed project. Upon prevalent around old mill ponds and the approval of the district super- fish ponds. These ponds, as a rule, visor the project is placed before have no economic value whatsoever. the county health officer, who in turn The Malaria Control Division makes likewise adjudges its merits. Then an effort to drain all such places a meeting is called for the persons made known to its representatives, interested in such a project, as affi- and has succeeded in ridding the davits must be signed by them, stat- State of several hundred. The next ing that the responsible govern- type of project in importance is the mental unit will maintain all malaria ponded swamp. These swamps have control work installed by the Gov- no well-defined channels, but con- ernment. The project is then placed sist of a group of still-water ponds. in the hands of the county engineer, Several of this type of project have who prepares plans, profiles, and required the use of dredging ma- estimates for the proposed drainage chines. These machines were made system, under the direction of the available by the purchasing depart- district supervisor of malaria con- ment of the CWA and ERA. trol. Blue-prints of all plans and It was discovered that in the profiles are on file at the State office coastal section of North Carolina of the Malaria Control Division. Anopheles breeding was most prolific When a requisition for malaria in those small fresh-water swamps control work is finally completed it which had been clogged up by fallen is forwarded to the Malaria Control trees, debris, and floatage, and were Division, and the signature of the no longer subject to the tidal flow assistant State director attached. of salt water. In these instances Following this, it must be referred effective control was obtained by to the State ERA office, where final opening up the mouths of these approval is granted by the State swamps and rendering the breeding Emergency Relief Administrator. places salty. When this is received it is then pos- The unkept drainage districts are sible for the work to be started. another prolific source of malaria. All the projects are carefully super- Many of these had silted up to such vised, and the specifications for loan extent as to leave large lakes cation, grade and slope suggested by where Anopheles breeding was tre- the U. S. Public Health Service are mendous, and formed very dangerous strictly followed. health hazards. Control along these There are many different types of projects is, in most cases, obtained projects begun by the CWA and later by cleaning out and removing ob- completed by the ERA. Many of struction from the old channels and these had in former years been in- by installing numerous lateral spected by representatives of the ditches. North Carolina Health Department, Other types of projects which were and by representatives of the U. S. brought to the attention of the Public Health Service, and were de- Malaria Control Division were those clared to be malaria hazards. Others consisting of large and small sink- were judged as meritorious after a holes, borrow pits, shallow marshes, study of the conditions and available fresh-water pools, and sluggish malaria history. The Division relied streams. Each of these presented —

February, 1931 The Health Bulletin 13

a different type of engineering prob- 5. Maximum number labor- lem for the drainage engineer, and ers engaged in malaria each was dealt with according to the control one week 6,200 requirements of the situation. 6. Average number laborers Aside from the actual drainage engaged in malaria work, including the planning of such control one week 4,740 projects and installation according 7. Number miles canal and to specifications, district supervisors ditches either excavated or cleaned of malaria control visit all the coun- out under supervision of ties, and through the county health Malaria Control Divi- officers and local physicians have sion 566 made thorough surveys and have 8. Number new ditches ex- sought to bring to the attention of cavated 1,390 the State Emergency Relief Adminis- 9. Number of ponds drained 9 69 trator the most meritorious projects. 10. Total number acres In several instances control measures ponds drained 2,972 other than drainage have been ap- 11. Total acres swamp land plied. Filling in of several borrow drained or given pits was effected. The use of paris- proper outlet 93,278 green mixtures and oil as practical 12. Total number draglines mosquito abatement methods is now used 9 common in many cities in Eastern A summary of the results obtained North Carolina. Several extensive from the ERA drainage for Malaria screening campaigns have been com- Control program is as follows: pleted. In all such work the specifi- ERA cations issued by the U. S. Public April 14, 1934 October 27, 1934 Health Service were strictly followed. (Date of last report) A malaria survey was made in 1. Number of counties en- fifteen counties during the month of gaged in malaria con- February, 1934. The Malaria Con- trol activities 52 trol Division cooperated with the 2. Total number malaria con- State Epidemiologist in promoting trol projects approved this work, which was conducted thus far 202 3. Number under the auspices of the U. S. Pub- projects affecting cities lic Health Service. The results of 123 4. Number projects affecting this blood-slide index have not yet rural communities been made public. Another blood 79 5. Maximum number labor- survey was made in a highly ma- ers engaged in malaria larious territory of Camden County, control one week 1,180 North Carolina. The slides were 6. Average number of labor- found to be about 20 per cent posi- ers engaged in malaria tive. control one week 669 A summary of the results obtained 7. Number miles canal and from the CWA drainage for malaria ditches either excavated control program is as follows: or cleaned out under CWA supervision of Malaria Control Division 82 December 1, 1933—March 31, 1934 8. Number new ditches exca- 1. Number of counties en- vated 298 gaged in malaria con- 9. Number of ponds drained 661 trol activities 54 10. Total number acres ponds 2. Total number malaria drained 670 control projects started 3 92 11. Total number acres swamp 3. Number of malaria con- land drained or given trol projects benefiting proper outlet 5,060 cities 132 12. Total number draglines 4. Number of malaria con- used 5 trol projects benefiting CWA and ERA projects rural communities 268 completed thus far 176 — —

14 The Health Bulletin February, 1935

The work done thus far was cal- instance has malaria increased in culated to benefit nearly 500,000 those areas. It is the opinion of people. Two hundred thousand of the authorities that the completed these, in the opinion of health au- work has thus far been most effi- thorities, have already been given cient. excellent protection from the malaria The Malaria Control Division has carrier. As for the sum total benefit made many sections of North Caro- derived from malaria control activi- lina malaria-conscious. It has aided ties, there is no measuring-rod very materially in this enlighten- which can be applied. However, it ment by distributing literature and may be truthfully stated that from by delivering frequent lectures and the reports of physicians throughout radio talks on the subject. An ear- the State, and in view of the alarm- nest effort to educate the inhabitants ing upward trend in malaria this of infected areas in the ways and year, those places which have com- means of protecting themselves from pleted malaria control projects have malarial fever has been an extra duty shown a surprising decrease in the of every person employed to help prevalence of this disease. In no with this program.

Immunity To Disease By Waldemae Kaempffert

DR. REUBEN L. KAHN of the Uni- membranes, are the first-line versity of Michigan, whose work trenches, because through the evo- on the defenses of the tissues in pro- lutionary ages they have always been tecting us against disease was award- the first to resist disease-producing ed last year the prize of the Ameri- bacteria. can Association for the Advance- To account for the "allergic" con- ment of Science, arose at Pittsburgh dition—meaning that some of us are to amplify his theories. In a com- hypersensitive to particular pollens, prehensive survey of immunity he fur, wool, or other substances reached the conclusion that if we physicians talked of idiosyncrasies. are alive at all, and if animals and This is bad science, because it ex- men managed to evolve from more plains nothing. Dr. Kahn is much primitive forms, it is because of an more precise. To him an allergic acquired ability to fight off bacteria. condition (hay fever is one) is Medical science has regarded the simply an overactive defense. This phagocytes (soldier cells in the agrees with the accepted biological blood) and certain "antibodies" in principle that any physiological ac the body fluids merely as agents that tivity may become so heightened as destroy invading bacteria. The fixed to disturb the general health. The tissues (skin and muscle) were sup- Neto York Times. posed to be hypersensitive. Hence a man might be both immune and hypersusceptible to the same germ One of New York's most expert at the same time. miniature painters is not only almost Dr. Kahn has other views. To stone deaf and blind in one eye, but him an immunized person, in accord- has only part vision in the other. ance with the law of self-preserva- Under this tremendous physical tion, is in a defensive state only. handicap, she turns out astonishing All the tissues, fluids, and phagocytes work. While for many of us the of the body carry in common the day is a bust if the breakfast bacon burden of defense. In fact, the fixed isn't the right crisp.—0. 0. Mclntyre tissues, such as skin and mucous in Raleigh Times. February. 1935 The Health Bulletin 15

Doctor Dafoe

By Frank Smethurst in News and Observer GOOD Dr. Dafoe by this time Meanwhile, the Dionne quintuplets has been wrung pretty dry on the eve of startling an unsophisti- to make reading for New cated Santa Claus out of six inches of girth were receiving Yorkers who find the simple reac- the benevo- lent care which no child of prosaic tions of his naturalness highly enter- birth and similar background may taining. expect. Reporters and photographers have Adequate prenatal care is still trailed him in shifts and have something of a luxury. chronicled all the variations of A shockingly large percentage circumstance and setting in which of babies are still left to the ravages the doctor has resorted to his stock of chance, which has never been phrase of unsophisticated surprise. much kinder to babies than to Dr. Dafoe has said "My, my!" in puppies and nothing like as kind to more places and to more people than babies as to calves and pigs. "My, my" was ever said before. It is still an awful challenge of The Canadian doctor is a natural omnipotence to forestall or to inter- for that species of commercial press rupt magic accident in behalf of a agentry that dreams of a seventh well-born, competent, and self- heaven to which very lucky publicity sustaining society. Miracle over- directors will go some day, a heaven shadowed science in the birth and in which perfect exploitation in- survival of the Dionne babies. volves merely the dumping of a Dr. Dafoe has never claimed for celebrity into the lap of newspapers himself a more vital role than that equipped and eager to do their best of professional by-stander in the —or their worst. Dionne household. He has asserted Thus far, Dr. Dafoe is possibly mastery of the extraordinary obstet- the second best bet of the century, rical technique. a little better than the rating of He has confessed second best would indicate, because that he inter- rupted the process of the highest prize, Lindbergh, was medicine to invoke the services of coldly snooty toward exploitation ex- the priesthood which philosophically cept the exploitation of Wall Street, seemed to him the more which prefers a grand and golden probable need. silence. Admiral Byrd has strained But the difference between tragedy and joy in mightily to be cooperative, but the thousands of American admiral was too unrealistically happy homes is the difference between even the casual services to lay down his life for science and which an enlight- breakfast cereal. ened physician might give harassed mothers But New York's feting of the ob- and no service at all. scure country physician who came I'm not keen for socialized medi- into fame because a Canadian woman cine in its ultimate and radical con- was mathematically a superlative ception. But it seems to me that mother may serve a worthy purpose the social instinct which sanctions beyond the hoped-for ends of its laws and medical service for the pro- commercial sponsorship. It surely tection of society against communi- will if it shall direct attention toward cable diseases is both cockeyed and those services which a surely selfish, impotent when it continues to permit safety-conscious society should es- bigotry and superstition to stand in tablish for its mothers and babies the way of its protection from in- and toward the disastrous ways of sanity and from the stupendous cost nature when nature is left to the of congenital and accidental pauper- hazards of accident and ignorance. ism. —

16 The Health Bulletin February, 1935

Medical service, more largely private patient or the private phy- available than it has ever been, is sician. Dr. Dafoe himself with his still for those who can afford to pay And obstetrical fee of $3 is to date the for it. most striking illustration of the bur- Accidents of birth which create den which doctors out of their pride social disabilities are still private or stubborness or professional fears matters. refuse to permit organized society to Medical service for motherhood is discharge in their own interest and still possible only at the cost of the for the public good.

A Message For Thinking Citizens

By W. F. Marshall, Raleigh, N. C.

A MERE LAYMAN—am Writing more than in the same period of 1933. I—this letter through our State Who shall find the cause, apply the Health Bulletin to ask its thou- cure, and check the desolation if our sands of readers to do a bit of helpful State Board of Health is not provided public service that I feel most of them, with the means of meeting urgent both men and women, will gladly ren- emergencies and enlarged demands? der. It is that they speak or write to There are some things to which we their Senators and Representatives and can afford to turn deaf ears in legis- encourage them to do everything they lation, but the moans of infants dying can to provide adequate support for in their helplessness is not one of carrying on and expanding the sorely them. But in rendering them unstint- needed work of our State Board of ed first aid, it must not be forgotten Health. I believe that our legislators that the surest road to a minimum in- generally are disposed to do this any- fant mortality leads directly through how, but there is nothing like making the health, vigor, and intelligence of them feel that an interested and solid the parent stock; and the building up constituency is backing them to the of a sound-bodied, virile, and in- limit in their efforts. telligent people—this, this indeed, is With the possible exception of the the great task which we have com- suppression of crime, promotion of missioned our State Board of Health the health of its people is the most to perform. important function of a government. In every line of its broad program The State Board of Health is our for the physical well-being of all the strong arm of offense and defense in people, let us rejoice to give adequate the ceaseless warfare against disease. support to our State Board of Health. To deny it the means of prosecuting It is our never-surrendering "Battalion this war would be like sending of Death" in the war against disease soldiers into battle without breast- a war from which no public-spirited work, trenches, or weapons for their citizen wants to seek discharge. Let own defense and without first aid or us speak to our legislators and base hospital for the wounded. strengthen their hands in every effort In the first eleven months of the to provide adequate means for carry- past year 5,489 North Carolina babies ing on the war with unfaltering ag- died before they were a year old—950 gressiveness. |

. . J G. BENTON, PRIN , BX 470, CHAPEL HILL, N.

fhia Bulletin will be .sent free to qa\j citizer\ of the 5tateupor\ request.

Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1894 Published monthly at the office of the Secretary of the Board, Raleigh, N. C.

Vol. 50 MARCH, 1935 No. 3

CASEY'S CHAPEL SCHOOL, WAYNE COUNTY

The above picture shows the two teachers, the pupils, and Doctor Early, the State school dentist. All the pupils of this school who needed dental treatment received it, either at the hands of Doctor Early or private dentists. The school is, therefore, dentally speaking, 100 per cent perfect. )

MEMBERS OP THE NORTH CAROLINA STATE BOARD OF HEALTH

Carl V. Reynolds, M.D., President...- _ _ Ashevill* G. G. Dixon, M.D „ _ _ _ _ _ Ayden S. D. Craig, M.D _ _ Winston-Salem H. Leb Large, M.D _ _ _ Rocky Mount J. N. Johnson, D.D.S Goldsboro H. G. Baity, Sc.D _ __ — Chapel Hill W. T. Rainey, M.D _ _ _ Fayetteville Hubert B. Haywood, M.D ______.._ - Raleigh James P. Stowe, Ph.G _ Charlotte

Executive Staff Carl V. Reynolds, M.D., Acting Secretary and State Health Officer. G. M. Cooper. M.D., Assistant State Health Officer and Director Division of Preventive Medicine. Warren H. Booker, C.E., Director Division of Sanitary Engineering. Ernest A. Branch, D.D.S., Director Division of Oral Hygiene. John H. Hamdlton, M.D., Director Division of Laboratories and Vital Statistics. J. C. Knox, M.D., Epidemiologist. R. T. Stimpson, M.D., Vital Statistician. R. E. Fox, M.D., Director Division of County Health Work.

Adenoids and Tonsils German Measles Scarlet Fever Cancer Health Education Smallpox Constipation Hookworm Disease Teeth Chickenpox Infantile Paralysis Tuberculosis Diabetes Influenza Tuberculosis Placards Diphtheria Malaria Typhoid Fever Don't Spit Placards Measles Typhoid Placards Eyes Pellagra Venereal Diseases Flies Residential Sewage Water Supplies Fly Placards Disposal Plants Whooping Cough Sanitary Privies

Prenatal Care (by Mrs. Max West) Baby's Daily Time Cards : Under 5 months ; Prenatal Letters (series of nine 5 to 6 months ; 7, 8, and 9 months ; 10, monthly letters 11, and 12 months; 1 year to 19 months; Minimum Standards of Prenatal Care 19 months to 2 years. Breast Feeding Diet List: 9 to 12 months; 12 to 15

Infant Care. The Prevention of months ; 15 to 24 months ; 2 to 3 Infantile Diarrhea. years ; 3 to 6 years. Table of Heights and Weights Instructions for North Carolina Midwives.

CONTENTS

Notes and Comment - 3 4 Warning ! Notice to Readers of The Health Bulletin _ 4 Why Not the Child ? 4 5 Where Shall We Swim ? : Mental Hygiene Comes of Age 10 Register Your Babies 11 Physician Missing 11 A Proud Record ~ 12 Milk Sanitation in North Carolina 14 Vol. 50 MARCH, 1935 No. 3

Notes and Comment By The Editor

ABOUT the middle of January we 4,982 deaths recorded in a similar L\ finished a hurried compila- manner, month by month, for 1933. -^- ^- tion of the provisional death Thus we see a difference in provi- reports for North Carolina covering sional reports for the two years of the year 1934. These reports are pro- 1,090 deaths more last year than oc- visional. That means that they are curred the year before. compiled from the first reports that Reports are, so far, not available come to the Vital Statistics Depart- from any other state. It will be some ment; and such reports are always weeks yet before such reports are in subject to correction and adjustment hand; therefore we cannot tell how later on, when additional and supple- our State compares in this respect mentary reports come in. As a rule, with other states—not even with those such reports show fewer deaths than in the South immediately surrounding the final or corrected reports. us. Judging from the information re- We want to center interest of our ceived the latter part of the year, readers at this time, however, on two however, from other states, we fear items in these reports. Those are the that our State had a larger percentage increase in the maternal and infant increase in infant deaths than most of deaths in North Carolina during the the other states. It will be several year. By "infant" deaths is meant weeks yet before we can possibly com- those babies who die before the end pile the reports showing which coun- of their first year of life. By "ma- ties in North Carolina reported the ternal" deaths is meant those deaths largest number of infant deaths. of mothers incident to childbirth. Throughout all of 1934 there was a There were during the year reported trend to higher death rates, both 547 maternal deaths, compared to 534 general and infant, in most sections maternal deaths for 1933. On account of the country. We shall not under- of an increased number of births, and take any comparisons until all of the allowing for the increase in popula- final reports are in, which will be tion, that made a slightly lower ma- about July 1. It is sufficient, however, ternal death rate for 1934, as com- for us to know that our State wit- pared to 1933. The final reports, how- nessed, for the first time in ten years, ever, will probably dissipate this a material increase in infant deaths slightly better rate. In the case of over the previous year. We cannot the infant deaths, the situation is en- undertake at this time to go into an tirely different and much more dis- analysis of the causes of this large couraging. Comparing the provisional increase of deaths; we shall await or first reports, month by month, in further and more definite and correct 1934 with those received in 1933, we information. We do state, however, are grieved that in 1934 6,072 deaths without any hesitation, that the in- were reported in the first reports, crease was not justified in any way by month by month. This compared to conditions existing in this State. It The Health Bulletin March, 1935

-\ is true there were extremes of cold in the early part of the year, and ex- NOTICE TO READERS OF tremes of hot weather in the summer; THE HEALTH BULLETIN there were strikes in the industrial which threw people out of em- areas Again we want to request any for some time; but through- ployment person writing to the State out all the State crop conditions were Board of Health for literature, good and prices were better. It is or for any other purpose, to the salaried people suffered true that take particular pains, please, to lowered salaries and increased from place the postoffice address at living, but no one knows yet cost of the top of the letter or postal which this contributed the extent to card and to sign his name cor- high infant death rate. to the rectly at the bottom. We re- After years study and straight many ceive a large amount of mail thinking on this subject, we are con- from citizens of the State re- the infant and maternal vinced that questing literature, especially in this State could be re- death rate the maternity and infancy liter- half if intelligent efforts duced by ature, who carelessly fail to and sustained for long were put forth sign their names and give their time. do this it will neces- enough To postoffice addresses. Of course, of money sitate the expenditure some under such circumstances, we township in in every county and cannot devise any means to years al- North Carolina. For several comply with the requests; and half the infant deaths have oc- most often, because these people fail during the first two weeks of curred to receive the literature re- of births life. An increased number quested, the State Board of year. When were reported the past Health employes are blamed for there are such an increase takes place, inattention to important mat- premature births, thus always more ters, whereas the only tiling a higher mortality among causing they can do is to await instruc- nearly half the infant babies. With tion as to whom to send the ma- occurring during what we deaths terial and where to send it. might term the "neo-natal" period, it cannot be denied that such deaths could largely be prevented by putting into effect a widespread system of WHY NOT THE CHILD? prenatal medical centers covering every section of the State for indigent You know the model of your car, women. Until this is done we shall You know just what its powers are. continue our disgraceful position, at treat it with a deal of care or near the foot of the column, in pre- You venting infant deaths. Nor tax it more than it will bear. But as for Son—that's different; WARNING! His mechanism may be bent, His carburetor gone to grass, His engine just a rusty mass. In the presence of abdominal pain- His wheels may wobble and his cogs Never give a laxative or physic. Be handed over to the dogs. Give nothing by mouth. And he skids and skips and slides Call your family doctor. Abdominal pain, cramp or soreness Without a thought of things inside. which lasts for four hours What fools, indeed, we mortals are is usually serious. To lavish care upon a car bit time to see The State Board of Health With ne'er a of machinery. Medical Society of the State of About our child's North Carolina —John Kendrick Bangs. March, 19S5 The Health Bulletin

Where Shall We Swim?

By D. S. Abell, Assistant Engineer

SCENE I transmitted through the use of im- (The Smith residence, Charlottesville, properly operated and maintained N. C.) swimming pools. Health authorities quite agree that the Mk. Smith: Let's go swimming this benefits derived from swimming are largely defeated afternoon after I get home from work. unless the pools are so designed, You have the children all ready so constructed, and operated as to protect that we can start as soon as I get here. bathers from the transmission of cer- Mrs. Smith: That sounds fine, but tain infections. In fact, each bather where shall we go? I don't like the can be considered a potential menace river, because there's no beach for to the other bathers in the pool, par- little Mary, and I can't help but won- ticularly those close by. Several der about the Jones's pool. physicians in the city have told me Mr. Smith: Why, what's the matter that they can expect an increase in with the Jones's pool? ear, nose, and throat ailments when Mrs. Smith: The last time we were the swimming season begins. At a out there Fred came down with a cold, swimming pool disease-producing and I suspect that John contracted organisms should be killed as soon as Athlete's Foot out there, he goes so possible after they are introduced into much. Harry, why don't you stop to the pool or deposited on the walk- see Doctor Wilson and ask him about ways or floors. these pools and bathing places? Mr. Smith: Well, Doctor, that Mr. Smith: That's a good idea. sounds pretty bad. There are all kinds of people who go Dr. Wilson: Yes. In swimming in these pools, and the fact a swimming pool that is merely a tank filled health officer should know something with water reminds me of the other about them. I'll get in touch with fellow's bath tub. Doctor Wilson and phone you. Mr. Smith: Do you suppose it would SCENE II be all right for us to go to the Jones's (Doctor Wilson's Office) pool? Mr. Smith: Good morning, Doctor Dr. Wilson: No, Mr. Smith, the Wilson; how are you this morning? Jones's pool is not satisfactory from Dr. Wilson: I'm fine; how are you, a sanitary standpoint. I have been Mr. Smith? concerned about that pool for some Mr. Smith: I'm splendid, Doctor. time. Within the past year the State I came in to ask about swimming pools Board of Health has begun to give us from a health standpoint. I believe specific help with this problem. that swimming is one of the best types Mr. Smith: I should think swim- of exercise and recreation, but it seems ming pools would be a local problem, to Mrs. Smith and me that there are a and would need frequent inspections. lot of things about a swimming pool Dr. Wilson: That's right. Under that might be dangerous to health. the general health law which gives us Our son Fred sometimes "catches a authority, we have just recently adopt- cold" after going in swimming, and ed rules and regulations suggested by John has Athlete's Foot. Could these the State Board of Health. Our regula- come from a swimming pool? tions require that all plans and Dr. Wilson: Yes. It is very prob- specifications for swimming pools and able that, in addition to the common bathhouses be submitted to and ap- cold, and Athlete's Foot, infections of proved by the State Board of Health the eye, ear, sinus, and skin can be before we will grant permission for The Health Bulletin March, 1935 the construction of a swimming pool started and tuned up. We should be in our district. able to open the pool within a week. pool. Say, I Mb. Smith: I suppose you will in- Mr. Smith: A tile spect the pools from time to time. like that. Dr. Wilson: Yes. My sanitary in- Dr. Wilson: You know, I had quite that. When spectors and I have score sheets on a scrap on my hands about which to record the sanitary condi- I found that tile cost only a little use it. tion of each pool and the quality of more, I felt that we should We pool little the water, as indicated by a sample cut down the size of the a analyzed in our laboratory. We are to enable us to use tile with the same planning to publish in the newspapers funds. the sanitary ratings of the different Mr. Smith: What did the State pools in this county, so that the public Board of Health engineers say about will know which are the better pools. that? Mr. Smith: Well, that sounds Dr. Wilson: They said that most pool good. But, what is wrong with the everyone was trying to build a Jones's pool, Doctor? that was entirely too large, and it was im- Dr. Wilson: They have done a fair not the size of the pool that was cleanliness and the business, but I feel sure that they portant, but the water. would have had more patronage if the condition of the to pool had been better built and main- Mr. Smith: Are they going pool every tained. It is a fill-and-draw pool. change the water in this can the city afford Mr. Smith: Yes, I understand that eight hours? How it? they clean it out every Saturday night. to do you. Let's Is that often enough? Dr. Wilson: I'll show end under the Dr. Wilson: No, that is not any- go out beyond the deep where near often enough. The water walkway. are those big in a swimming pool should be changed Mr. Smith: What at least every eight hours. steel, covered tanks? the filters, Mr. Smith: Well, Doctor, I don't Dr. Wilson: Those are to drain see how they could do that. It would Mr. Smith. We are not going a day, as cost a fortune. the water out three times are go- Dr. Wilson: Yes, that's true. It Mr. Jones would have to. We continuously. The would cost Jones, for instance, about ing to filter it will out of the pool from $75 a day to change the water in his water come in the deep end, come pool that often. Mr. Smith, if you the big drains this pipe, and through the have the time I should like to take through catcher; then it goes you out to our new municipal pool. hair and lint past an ammoniator and a chlorinator, The plans for it have been approved pump, past the alkali by the State Board of Health, and the through the through engineer who designed this pool, and feeder and the alum feeder, filters, and then back into the is supervising its construction, is sure- the pool. ly interested in giving us the most What is that round modern pool in the State. Mr. Smith: tank over in the corner, Doctor? Mr. Smith: I have plenty of time. Wilson: That is a constant Let's go out to the pool. Dr. level box to keep the city water and III SCENE the swimming pool water separated. (The new Municipal Swimming Pool) Health authorities are very insistent the two types of water Mr. Smith: I have been reading upon keeping have been about this pool in the paper, but I apart. Serious epidemics connections. did not realize it was so nearly com- caused by cross afraid I should pleted. Mr. Smith: I am equip- Dr. Wilson: Yes, the equipment is be lost trying to operate this already in place, although it has to be ment. March, 1935 The Health Bulletin

Dr. Wilson: Fortunately, we have Mr. Smith: I never take a bath an expert at our city water purifica- over at Jones's pool. The shower bath tion plant, and he is going to super- water is too cold. vise the operation of this pool along Dr. Wilson: That's where we're with my inspectors. Of course, the one jump ahead. We're going to have city will have an operator and life plenty of hot water. "The cleaner the guard on duty at all times when the bather, the cleaner the pool." pool is in operation. Mr. Smith: That's right, isn't it? Mr. Smith: I should like to go I'd rather everybody would take a through the bathhouse, Doctor. We'll bath before going in. have to walk around the fence to get Let's go out closer to the pool. Doc- there. The fence goes all around the tor, what's this trough around the pool, doesn't it? That's a good idea. edge of the pool? Jones doesn't have I've often thought that people wearing anything like that around his pool. shoes had no business among the Dr. Wilson: That's called the scum bathers. gutter. You'll notice, too, that it's Well, look at this! Say, little Mary open and exposed to the sunlight, and will certainly enjoy that pool. What any debris that gets on top of the do you call it, Doctor? water can be skimmed off. Dr. Wilson: That's the baby pool. Mr. Smith: What are those big It is six inches deep at one end, and holes in the side of the pool? They two feet at the other, and it will be look like windows. Are you going to supplied with filtered and chlorinated look at the bathers from the outside? water. What is this, an aquarium? Mr. Smith: I see no place to sell Dr. Wilson: Those are for under- refreshments. water lighting. The electricians are Dr. Wilson: No, we don't want the installing a lamp right over there. pool littered up with papers, bottles, Mr. Smith: Well, I would have ex- and pieces of candy. Let's go inside pected that you'd have floodlights for the bathhouse. night swimming. I've followed you Mr. Smith: Well, this is a bath- all the way to this point, Doctor, but house. Look at the counters, the it seems to me that this underwater baskets, the first-aid kit. What's the lighting is going a little too far. It couch for, Doctor? looks like a rank waste of taxpayers' Dr. Wilson: Oh, that's just for an money. What health value can they emergency. have? Mr. Smith: The dressing room Dr. Wilson: That's just the point, here isn't what you might call fancy, Mr. Smith. Even these large lights but it is an improvement over other will not throw light through water dressing rooms I've seen. that is dirty or cloudy. These lights Dr. Wilson: The bathhouse is would do no good in the Jones's pool. large enough to take care of the ex- The water there is practically never pected patronage this summer, and it clean. Thus, the swimming-pool oper- is so arranged . that it can be enlarged ator must keep his water in the pool later. crystal clear in order to make the The arrangement of the facilities is lights effective. There is the safety important: first the toilets and feature, too. Floodlights cause a glare urinals, then the lavatories and show- on the surface. It might be possible er baths, and on the way to the pool, for a swimmer to sink to the bottom the foot bath. of the pool unnoticed at night, if the Mr. Smith: A shower bath may be water were not perfectly clear. all right, but I would rather dive right Mr. Smith: You win. Well, Doc- in. tor, I must be going. I certainly ap- Dr. Wilson: According to our regu- preciate your taking me around. As lations, you have to take a soap bath soon as I get to the office I'll phone before you put on your suit. Mrs. Smith that we will do no more — _ |

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woy 10 The Health Bulletin March, 1935 swimming until this new pool is open- they can go in swimming morning, ed. Then I am afraid the Smith fam- noon, and night. Goodbye, Doctor, ily will want to pitch a tent and live Dr. Wilson: Goodbye, Mr. Smith, all summer right next to the pool, so I am glad you came.

Mental Hygiene Comes of Age

By Sylvia Allen, M.D., Secretary, N. C. State Neuropsychiatry Society

TWENTY-FIVE years old! A cation. This movement has shown its quarter century! At an anni- influence in every field which has to versary dinner in New York deal with human personality, and the City on November 14th, President An- period of its development may prop- gell of Yale University characterized erly lay claim to being the twenty-five Mental Hygiene thus: "Without paral- years to date of greatest significance lel in the great achievements of our in understanding the laws which gov- own day." At this dinner there were ern the motivation of human conduct. leaders in all walks of life—medicine, In these twenty-five years psychiatry psychiatry, education, social work, re- has taken its great forward step ligion, law, industry, etc. Their ob- through mental hygiene, which is to ject was to do honor to Clifford Beers, psychiatry what public health is to secretary of the National Committee medicine. for Mental Hygiene. North Carolina has been talcing her It was through the desolate suffer- place, more slowly but quite surely, ings of Mr. Beers in three years of among the forty-eight states of the illness with a major mental disease Union in recognizing the volume of that the concept of better care for work to be done in this field. Recently those so afflicted and the future pre- a roster of the physicians interested vention of such affliction was born. Dr. in this subject was made by one of Jacob Gould Schurman, former presi- the most advanced thinkers on the dent of Cornell and Ambassador to question of the mental needs of the Germany, said that Mr. Beers "de- people of this State, the late Dr. scended into hell and for three years Ernest M. Poate of Southern Pines. he was a denizen of that terrible land Thirty-seven physicians were listed. of unreason." On Mr. Beers' initiative Dr. Poate called these physicians to- a thoughtful group of eight men and gether on Friday, January 18, 1935, at women met in the residence of the Dix Hill, Raleigh, and there was Reverend Anson Phelps Stokes in New formed a new and potentially vital or- Haven in 1908 to see what could be ganization which called itself "The done. The National Committee for North Carolina State Neuropsychiatric Mental Hygiene was organized as a Society." result. The desire to coordinate all factors The growth of the movement spread for mental health, the desire to de- far beyond the original concept and velop a public consciousness of these has brought about transformations, needs and to find ways and means for not only in the care of the mentally their provision had long been in Dr. sick and in the public attitudes toward Poate's mind. It seemed that life just mental disorders, but in work for the allowed him strength and vitality to socialization and training of the infuse into this group his great spirit feeble-minded, for the study and man- and insight and to put before them agement of delinquents and criminals, his broad vision of a program. On his for the training of the normal child, return from this exhausting experi- for the broadening of social work, and ence influenza, with its virulent com- for more fundamental concepts of edu- plication of pneumonia, attacked his —

March, 1935 The Health Bulletin 11 already devitalized state of health and COPIES OF BULLETIN caused the great loss of his future WANTED leadership to the organization. He died early on the morning of Friday, We are anxious to procure, if pos- February 1st, just two weeks after sible, copies of the following issues the meeting. it not be that his May of The Health Bulletin: keen vision and his selfless fore- February 1908 thought may serve this section of the May '1908 country as that of Clifford Beers has October 1915 served the Mental Hygiene movement If any of our readers should have in America? His death is an irrepa- copies of these issues and would send rable loss. His spirit is a compell- them to us, it would be greatly ap- ing challenge. preciated. Dr. John McCampbell, superintendent of the State Hospital at Morgan- HOW TO EVADE THE MILK ton and vice president of the new or- TAX ganization, will act for the group. The next meeting, on April 10th, will be in Greensboro, on the invitation of State sales tax on milk has been Dr. Wesley Taylor. recommended by the joint finance com- The immediate action of the Society mittee of the Legislature. If put into will be to present the cause of the effect, only way to beat it will be for State institutions to the Appropria- mothers to let their infants draw their tions Committee of the General As- sustenance in the natural way. — By sembly, under the leadership of Dr. Upton G. Wilson in Reidsville Review. R. S. Crispell of Duke University. The next step will be to ask admis- REGISTER YOUR BABIES sion as a section to the North Carolina State Medical Association. One time Will Rogers was going to Dr. G. M. Cooper, editor of The Europe or some foreign country and Health Bulletin of the State Board he was making an effort to secure a of Health, has kindly volunteered passport. To secure a passport one space in this Bulletin for informa- must give a general confession about tion to the public, for which the or- one's self. That is they must prove ganization is deeply grateful. among other things their place of birth. Will Rogers, it seems, was born PHYSICIAN MISSING in Oklahoma Territory, so he said, but he had difficulty to prove it. As a Physicians all over America have matter of fact if it came to a show- been requested to watch for the ap- down there are perhaps many of us pearance of Dr. George H. Bigelow, who could not prove that we were director of the Massachusetts General even born. We assume we were born, Hospital and former State Health but we are not registered, and so the Commissioner of Massachusetts, who movement now under way by the De- has been missing since December 3, partment of Commerce to register all 1934, and may be suffering from babies will serve a useful purpose. In amnesia. the years to come all grownups can Doctor Bigelow is 44 years of age, prove that they were born, because is 6 feet tall, and weighs about 175 they will have a written record to pounds. He has blue eyes and black refer to, and so it will be wise for hair. residents of this county and all coun- Hospitals everywhere are particu- ties to cooperate in a movement now larly requested to look out for all under way to "Register Your Baby." amnesia victims. The Beaufort News. 12 The Health Bulletin March, 1935

A Proud Record

the opposite page we are pub- such as cleaning, and the treatment ONlishing a graphic chart which with silver nitrate of primary teeth affords a striking comparison and extracting. They were required between conditions existing today and to emphasize the educational features those present seventeen years ago, of the plan. The treatment necessary when the State Board of Health in- in each case was to be simply a ques- augurated its State-wide oral hygiene tion of teaching by example. For in- work. The State Board of Health in stance, if a child had four permanent 1915 to 1917 made a careful survey of molars decayed, the dentist was in- twenty thousand school children in structed to fill one of them with a twelve different counties in order to simple type of filling, so that the ascertain the exact conditions then parent could see what had been done, prevailing. It was found that not less and he was urged to take the child than 95 per cent of all children en- immediately to a private dentist for rolled in the public schools needed the remainder of the work. dental treatment. A very large per- Since that July day in 1918 when centage of the children had lost one the first of these young men started or more of their sixth-year permanent out, six of them in as many counties, molars. But few of the teachers, and emissaries of this department have still fewer of the children, had any successively gone into every school but the vaguest conception of what district in the State, including the the care of the teeth and mouth health larger cities and the most remote sec- meant in the general health and wel- tions, and every school child under fare of the child. thirteen years of age has been ex- In the face of the foregoing, with amined and necessary treatment a population little interested, and with recommended, and literally hundreds no chart or compass to guide us, the of thousands of them have had their State Board of Health embarked in teeth cleaned by the dentist and in- 1918 on an extensive State-wide structed how to preserve their teeth. method of teaching oral hygiene in Hundreds upon hundreds of lectures the schools of the State. Six young have been given to parent-teacher dentists were employed and outfitted meetings, women's clubs, teachers' as- with crude equipment suitable for set- sociations, in addition to classroom ting up very quickly a rudimentary lectures to the children themselves. dental office. Each dentist had a foot When the history of this period comes engine and a folding chair, which con- to be written up, in all probability stituted the two largest pieces of this work will be accorded the dis- equipment. With this outfit, these tinction of being of as much or more young men were instructed to go into benefit to this generation and the every schoolroom in the lower grades children to follow as any other con- of every school in every school distribution made to society. trict in every county of the State and The director of the work, the man inspect and give instruction to the who invented the plan, who organized school children between the ages of it, and who fought it through to a chart six and thirteen years. They were successful establishment had no required to record on an individual or compass to go by. Nowhere in the chart, to be sent to the State Board United States in rural sections had of Health, the conditions they found such an undertaking ever been exe- in the child's mouth and the record cuted. There was nowhere that he of whatever treatment they rendered. could turn to procure advice from The treatment consisted of the sim- people who had had experience, be- plest kind of fillings, prophylactic work, cause there were none such in this March, 1935 The Health Bulletin 13 country. The work was a pioneer ganized dental profession and to the work. The chief credit, of course, forward-looking leaders of that profes- should go to the North Carolina or- sion, who realized its importance.

DIVISION OF ORAL HYGIENE NORTH CAROLINA STATE BOARD OF HEALTH

Dontal Conditions In North Carolina Public Schools as Revealed in Mouth Health Survey, Foby. 20 - 22, 1934

3/*€M^ fatfASx*-* ^lx_ £*^U &^^~- J^-c^

^ QQ u 14 The Health Bulletin March, 19S5

Milk Sanitation In North Carolina

By Warren H. Booker, Director, Division of Sanitary Engineering

development of milk sanita- This was more than any other state THEtion in North Carolina is very except Alabama, which has 27 towns gratifying indeed. In 1932 some making over 90 per cent. By July 1, Carolina had moved to 8 6 North Carolina cities and towns 1934, North were operating under the Public the head of the procession, as Ala- Health Service Milk Ordinance. In bama showed only 20 towns at that 1933 this number had increased to time to our 2 4 making over 90 per ratings. 97, and by the end of 19 34 we had cent on their milk 104 milk ordinance towns. That was According to reports which have more than any other state except just come from the Public Health Texas, which last year had 117 ordi- Service, North Carolina again leads nance towns. all the other states with 29 towns However, North Carolina consoled making more than 90 per cent on herself with the fact that even if their milk rating. The towns listed Texas had 117 ordinance towns to below in capital letters have made 90 rating. our 97, they also had 202 towns with per cent or more in their milk over 2.000 population to our 85 These milk ratings serve to indi- towns of over 2,000 population. cate to health officers, their dairy Furthermore, North Carolina had inspectors, and the general public the 24 towns in 19 33 making over 90 status of the dairy sanitation in their per cent on municipal milk ratings. respective towns.

1933 1934 U. S. PUBLIC HEALTH SERVICE MILK RATINGS IN AND

Retail Raw Pasteurized Enforcement Daily Milk Rating Milk Rating Rating Name of City Consumption (per cent) (per cent) (per cent) 1933 - 1934 1933 1934 1933 - 1934 1933 1934 Albemarle 0.69 65 92 89 92 93 ANGIER 0.11 13 65 100 t 97 APEX 0.19 97 98 Asheboro 0.33 61 74 Asheville 0A1 87 77 64 BEAUFORT 0.22 96 Black Mountain 1.70 66 89 Bryson City 0.37 72 97 BUIES CREEK 0.43 91 97 Burlington 0.58 95 79 87 Canton 0.50 0.52 98 80 96 95 Cary °- 22 88 98 CHARLOTTE 0.42 92 96 95 CLINTON 0.35 0.25 80 90 88 93 COATS °- 43 0.37 97 93 t 97 Concord 0.45 83 89 92 DUNN 0.19 0.22 95 92 "t 97 DURHAM 0.49 96 90 90 East Spencer 0.13 84 84 76 Edenton 0.10 87 ELKIN 0- 51 0.61 93 93 93 93 Enfield 0.23 71 65 ERWIN 016 0.17 95 94 t 97 Farmville °- 44 0.44 69 44 69 23 Fayetteville 0.43 0.56 95 93 81 83 98 98 Forest City 0.40 63 94 March, 1935 The Health Bulletin 15

Reta Daily Name of City Consumption 1933 - 1934 Fremont 0.15 Goldsboro 0.25 Granite Falls 0.45 0.20 GREENSBORO 0.45 0.55 Greenville 0.30 0.36 HAMLET 0.39 0.30 Henderson 0.28 0.20 HENDERSONVILLE 0.68 Hertford 0.29 Hickory 0.59 0.51 HIGH POINT 0.38 HOPE MILLS 0.16 0.18 Kannapolis 0.31 Kings Mountain 0.23 Kinston 0.35 0.34 Leaksville 1.90 1.9 LENOIR 0.47 0.35 Lexington 0.35 0.39 LILLINGTON 0.32 0.21 Lincolnton 0.41 LUMBERTON 0.40 MANTEO 0.59 0.44 MONROE 0.46 0.25 Morehead City 0.28 0.22 MOUNT AIRY 0.28 0.36 Mount Olive 0.22 NEW BERN 0.21 Oxford 0.46 0.30 PINEHURST 4.10 Raleigh 0.46 Reidsville 0.44 0.42 ROCKINGHAM 0.62 0.66 ROCKY MOUNT 0.26 0.30 Roxboro 0.24 Salisbury 0.43 Sanford 0.34 Scotland Neck 0.23 SOUTHERN PINES 0.76 Spencer 0.28 Statesville 0.28 0.32 Thomasville 0.20 Tryon 0.58 0.49

Washington _ 0.26 Waynesville 0.48 0.66 Whiteville 0.49 0.56 WILLIAMSTON 0.15 Wilmington* 0.39 0.39 WINSTON-SALEM 0.3 4 0.3 8 16 The Health Bulletin March, 1935

PERSONNEL REVUE. BEFORE: GOIHG ON DU^Y MtMORiZ^E: MfcHO .A'ifc.AVOR.IX.Er. .M-fc^O COAAB CoMfc j-Jair, .M&AX Ly •-] HAIR. MtAfLy

ntflDy "pcSMtL-Eu... £>e=. i*ifc/M>Y T° •s^^'Lfc -Speak. pL.E.Asarr]ty- ^SpEÂfC •pLEAs^M-fly. iiAVfc. cLe am. -shave fcLlpSfiClOAMD We.aR-cl.EAH CoLLar, - ROUS E- ApAR/IKG Ly"- W&ar, C Le.am S>51RT[ Tie- Tie meatLy COLLARS AMDCo^f-S^ fô B.O. ' -Tô B.O. CARRy lowfcLs over, R.R-Y CL.EA7-", ROWELS rte.M.>-10T UMt>EB.AE.M f-ORELAR,M — f~*\0 Y- Wasi^ j-jamds clean

AH© MAMltURE. KfllLs ' We.AR CLEA/A ApR-OT~V \ve-ar. cLe.ahU«i(-or.he. V&SH h}AHDS CLtrAH Cr&ASE. fR.OOSE.RS> AMD MflHICURfc MAlLs* 'WfcAR.CLtfl^UHIpOR.M^.hJoSE.o fJAVE. StlOEi.SSHIME.D "|We.AR -R*Ue>Bfc«~ >JE.E-L.& = W& AR.RUBBEE- FjEEUJN 1^flV-£- -SI-JOE-'&.SEjIHED,, pt-R. ,MOT fc ° XwtMTT CE-Hf Of- our. SUCCESS Dtft-n ON DUTY cLe-A>-*»«HD E-J-F-ICIE-TAf iMjoLoVEit-a. SERVE imkediaie -at^d GRADE- A- MILK Give- T^e. cusfowta ONLY IM E>ottL.E. WIT*} CAp^j§5| 3fcSiP& GLASS OiH. 5I)OWJrt9 GRADfc-''*p|'n OA* T_R<°>Y*

AVOID -j-otjciiii^G oaT-siDE-of-BRjMoUte.,amd SiLt-nf service DO J^S Ot -==3^=1 3t.R.Vfe. Mll-K- S<=>x tsf~Y Til^cos'ToMe.R.iH JJX& o-wm -WAY

, Care ^B.offcoxPAiRo^5£jEALT>5 fLfcASfc. "JHEi. Ct3S-J OA\E-R. — BE,VeLo)3 Greater srjov/^yo Ycx^R. ^>EvR.SO.Tv&oi&R.-wiLL£>fjt)E:ie- ^.^f>e-£^ciA-j;3oi^« EXCEL MAKE CLEANUHESS A FjABlT OR, SM.feE.'Z.Ei. Do«"T iSAVofcfc. om. astrxY- DoyJV"T R£ftDOR f-OU »Ji^Vfc T° COOTGIJ Mg. HUfY- Uojhvj tAJON ""tY'jfi'NNi pLEAse-o" J(f E - e l o^Doyy. /IjA^»ir>KELR,cr]iE.f* \(§M Oo*VTPJcfcT -T J S& ^^•O^T>°M'X pSJMp Bfcf-OKt COSlOMfcE? ^CuLtlVATt CL&AM tÂBITS- J^.£Vfc>R T-IM6ER/ fc ^•*5Poa\"t iiimt E" OR' * Vp Do^vj be." T*l JMBIf-f-fcR-faMT- Bon"! Cl-fE-V* GOHOHBU1Y. '^.osiRlLs or- otê-i^. TÂRfS boey- «uc.f) ae.it* Do^'f ttAfl OVE-R, 3f(ouLDER,S. Of- of-TÊ. ¥) costowtR.3 wjifcfl T^k-iMa orders.. AR£. 1-Mt.ii.ouSAeT.e. • "V»fes»^ ^-TfAMDS cLe-AM. XJj>OM.-R-ETOR.f^- "THS ^f-Jao/A :R6_ST ROOj^S,AHP BR.E1A1D, AMD BUTT^l X T T& Ei'VIDE-M-T -pÊ. OJUt RtjOENIMS Y°tJ tÂ-Vfe. iÔT £>EJ=..M. OfA.T*i fc -JoE> » ErAOM ATÔ cvtay X° noxY-I, a«"r touch ll^SlDli- of- DisiÊrS, cupa oa glasses wit^ K[A«rs.I)o)H"l 5tt tejay LxMfc.r\,aLess.WAR.fc •JOCJCt^ fooD Vsri-JI^ BAR.t ÂJSES. liOi^'T SILVERWARE Af-VD DJSEJBS -A-T^fc Spo? Lfc'SS. . SbRVE. SOlLe-O JOAIVE.S!fORK5,6{ioOMS WALLS,CfclU^QS,I-I-oeiRS^'WI?^X>OW5 KE&£ OB/ iiiHEiS. M(°i^\dLe, utb^siI*5 By Tnfc- CLCAM. iCEE,p f-LlE-S, OUf I'O-M'T. t°LERATE= KAMoLk-^ A Aox fLlfeS /4&AR,f OOD.KfcEf •J0lLfeT-s 4-"V/A '&1i KOOMS IWM.ACaLA1EUY CLtflK AM-"D eoppLiE_» -vvijj^ i«civiDUALti;o-wfcl.s,soAj3 ^. f-IiÂULrf"- f* lLfc atae,dicaL«^~Cert- ° fe ''v%, ,rA B EQIMni«Q JoxLfe-f j'AffeRj- If-ICATE- "WIJE) XM AGfcMtM'Jl fe/^}>L.oyj^\fe.MTiArô AX L.EASX Annually LflSI y fc ARj ~lMpR Of-DoLLftBS I!-\ TliER.tAf-XfcR-,-SljO'Wl>U3 fR,E.EPO-«. T"B» J5ISfcA3t. OUR- BUSIM65&. Syf*5lUlS >^. COJAXiAGIOUS^-XMfECXIOOS AWDtVlY " ARE./A07 A XTP^010 Cfln.R.ip.'ai IN TÊKITOJEH SUCCESS

ie eb& TvtAi^'jAi.M T^l 6- same- *1 *J I?a.sucr5 am. AlJAosptf StA^BARUS. Ke.E.f QARBACt CUSJOJ^VE-RS f-IND A 1JOVEM. IJ^ COVbBh.O -HAfe-TAL. CAMS = Kfctp Sj-ORAoe-RooJ^^-fjAM-JRY of- ioLLar-5 t° T^ 6- cLE.AMolAviTfc T*i& ^obLic to OE-3tR.VIM.S BOSllAtaS •» ISSUED BT T^ 1^ STATE: BOARD Or MErALTH MR. JNO. G. BEARD, CHAPEL HILL, N C.

I This Emlletirvwillbe aeryl to free orwj citizen of the 5 tcrte upon request !

Entered as second-class matter at Pcstoffice at Raleigh, N. ', C, under Act of July 16,' 189 Published monthly at the office of the Secretary of the Board, Raleigh, N. C.

Vol. 50 APRIL, 1935 No. 4

UPTON G. WILSON, MADISON, N. C.

For twenty-three years a physically helpless cripple; but whose life is an inspiration to the handicapped everywhere.

(See story on page 5 of this Bulletin) s MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

Carl V. Reynolds, M.D., President Asheville G. G. Dixon, M.D Ayden S. D. Craig, M.D Winston-Salem H. Lee Large, M.D - Rocky Mount J. N. Johnson, D.D.S Goldsboro H. G. Baity. Sc.D Chapel Hill W. T. Rainey, M.D Fayetteville Hubert B. Haywood, M.D Raleigh Jambs P. Stowe, Ph.G Charlotte

Executive Staff Carl V. Reynolds, M.D., Acting Secretary and State Health Officer. G. M. Cooper, M l>., Assistant State Health Officer and Director Division of Preventive Medicine. Warren H. Booker, C.E., Director Division of Sanitary Engineering. Ernest A. Branch, D.D.S., Director Division of Oral Hygiene. John H. Hamilton, M.D., Director Division of Laboratories and Vital Statistics. J. C. Knox, M.D., Epidemiologist. R. T. Stimpson, M.D., Vital Statistician. R. E. Fox, M.D., Director Division of County Health Work.

Prenatal Care (by Mrs. Max West) Baby's Daily Time Cards : Under 5 months ;

Prenatal Letters (series of nine 5 to 6 months ; 7, 8, and 9 months ; 10,

; 1 monthly letters) 11, and 12 months year to 19 months ; Minimum Standards of Prenatal Care 19 months to 2 years. Breast Feeding Diet List: 9 to 12 months: 12 to 15 Infant Care. The Prevention of months : 15 to 24 months ; 2 to 3

Infantile Diarrhea. years ; 3 to 6 years. Table of Heights and Weights Instructions for North Carolina Midwives.

CONTENTS PAGE Notes and Comment 3 Teaching Children Traffic Safety 4 Bed-Ridden, But Not Beaten 5 Safety In Bus Transportation ~ 6 Oral Hygiene and the School Curriculum 7 Social Planning and Rural Sanitation .". 8 The Story of Tooth Decay 10 Allergic Diseases 13 North Carolina Emergency Nursery Schools 14 1935 Child—1935 Parent 15 Public Health's Platform for the Preschool Child in North Carolina 16 PUBLI5ME1D BY TML HORTM CAROLINA 5TATE, BQAgD s^MLALTH I

Vol. 50 APRIL, 1935 No. 4

Notes and Comment By The Editor

these lines are written there is disease and the desirability of pre- AS a bill before the Legislature to vention at any cost. completely remove the last Without the law it is difficult for vestige of legal protection now avail- any father of a marriageable son or able to prevent the spread of venereal daughter, particularly the latter, to disease through marriage. Two years satisfy himself before the marriage ago the Assembly repealed the Bella- ceremony that his daughter is marrying a clean my marriage law enacted by the Leg- and healthy youth. After marriage occurs islature of 19 21 through which an it is too late to in- vestigate. The Bellamy law innocent woman was protected from was easily enforceable because physicians marrying a man infected with a vene- realized that if they made a careless real disease, and which protected examination or a farcical one and it both parties against insanity and tu- was proved afterward that the medical berculosis. Before repeal was com- certificate was carelessly given and plete an amendment was accepted venereal disease was present and not requiring an affidavit (not a physi- discovered and noted, that the physician's certificate) from the male cer- cian so awarding such a so-called tifying to freedom from venereal dis- certificate could be held liable for ease and tuberculosis. It is this rem- civil as well as criminal damage. Any nant of a decent requirement in the man contemplating marriage who marriage law which would be re- cannot afford a. few dollars for a com- moved. petent medical examination has no The Bellamy law was a good law, business getting married. one of the best and most reasonable About the time the bill was re- ever put on our statute books. It was pealed the force of public opinion strictly a preventive measure. It was was quietly but surely making itself based on sound scientific facts and felt toward the "slip away" to South was easy to enforce. The hue and Carolina marriages. In due time it cry which went up from numerous would have ceased. But "revenue!" petty politicians was that young folks The matter of a few thousand broken were running to South Carolina and homes, feeble-minded children, wom- Virginia for marriage to evade the en invalids, insanity, and other sordid law and we were losing—not decency, consequences must be considered as safety, or self-respect — but "rev- nothing when "revenue" is involved. enue." Verily money was what kicked the There is a division of medical and lid off Pandora's famous box. Noth- scientific opinion all over the world ing else seems to matter any more. about the desirability and effective- Instead of repealing what little is ness of eugenic legislation, steriliza- left of such safeguard in marriage, tion, etc. But there is no argument the General Assembly should enact a about the terrible ravages of venereal new and more stringent law with a The Health Bulletin April, 19S5

negative Wassermann from both the institutions for the feeble-minded and contracting parties as one of the re- insane are full, with a long waiting quirements before securing license to list outside. Many unfortunate per- marry. This should be in connection sons are detained in ordinary jails admission. with a complete physical examination while awaiting More than a third of all inmates directly inher- by a competent physician. ited their mental condition. In addi- to In matters of such importance tion, a considerable per cent of them the health of this and future genera- are there as a result of venereal tions, we feel it the duty of the State disease. Board of Health to speak plainly and Prevention is the only hope for the fearlessly about these things. Our future.

Teaching Children Traffic Safety

THE Editor appreciates the letter contention has been that the police- quoted below from Dr. Verne S. men and firemen on guard could Caviness of Raleigh. Doctor Caviness spend their time to much better advantage teaching the children to be is chairman of the Section on Practice careful in crossing the streets. The of Medicine of the North Carolina children idolize the big policeman Medical Society. He writes volunta- who holds up his hand, stops a lone rily, and we are taking the liberty to motorist, and lets the children cross that publish his letter. It is evident the street. This minimizes the dan- Doctor Caviness has given these mat- ger in their minds. The policeman ters serious and careful thought. Be protects the children perfectly, but sure to read his letter. only for a period of less than one "Dear Dr. Cooper: minute a day, five days a week, and not more than forty weeks out of "I wish to commend you most high- the year. It would be much better ly on the February issue of The in all cities if the policemen would Health Bulletin. The entire issue is teach the children to stand on the excellent, but I think that your 'Notes sidewalk until they can cross the and Comment' is the best. street in safety. The children would "It is certain that children are not learning being properly trained by anyone be to take care of themselves during the remainder of the day, and with respect to the danger of playing so many other days when there are and running about in the streets. I no policemen to protect have taken one phase of this matter them. The policemen also teach chil- up with our Commissioner of Public might the dren to cross only at street corners. Safety, and I think that he has taken kindly to my suggestion, and that in "I think that our local police de- this way the mortality rate should be partment is attempting to follow the lowered here. Policemen or firemen suggestions that were made to the are placed on guard at some of the Commissioner of Public Safety. If schools in the city to assist the chil- they will continue to do so, and will dren in getting across the street. teach the children properly, I antici- This is fine, but their efforts have pate a lower pedestrian death rate in been misdirected. Every motorist is Raleigh as a result. familiar with the act of being stopped "I realize fully the responsibility by a policeman to let one or more that rests upon the motorist, but I children cross the street ahead of do not think that pedestrians have him. I don't think that any motorist been made to see that it is a mutual could directly object to this. The responsibility and that they must do trouble comes in the influence such their part in order to lower the death procedure has upon the children. My rate." April, 19S5 The Health Bulletin

Bed-Ridden, But Not Beaten

A Short Short Story About "A Cheerful Cripple"

our front cover we are pub- After the first long months of suf- ONlishing a photograph of fering Upton were behind him, in which he G. Wilson, Madison, decided N. C. he would not die and didn't, This man's life he for twenty-three had to make several hard adjustments. years has been an inspiring example Among such was to quit pain- relieving for the afflicted to emulate. drugs, which has been too much for On July 24, 1912, he was shot many a strong man. He had to renounce through the spine by a miserable self-pity and decide not to be sorry for coward whom he had just discharged himself, one of the hardest jobs for any physically handi- intoxication and disorderly con- capped person has to do. Above all, duct. Months of intense suffering fol- he decided to be cheerful. Right lowed, during which time he had sev- here let it be written that he himself eral major operations in an effort to says: "That I have lived this long save his life. The physicians did not totally paralyzed from my chest think he could live. From the mo- downward, I attribute to two things: ment the shot was fired he was com- First, to careful, loving care by members pletely paralyzed from the ninth ver- of my family (mother now 79, tebra down. father 82, sister, brother, niece); and second, to the scientific The story of Mr. Wilson's life and medical attention of my other brother, his remarkable fight against an ad- Dr. New- ton G. Wilson. But for these verse fate has been told many times two things I am sure I would have trav- in magazines and newspapers of na- eled on long before this." tional importance. Other people have He looked upon his plight as a fought against hard circumstances challenge and cheerfully accepted the and won. Many others will do so dare. He decided on two ventures, again. The highlight in his record is both of which have been successful. the way in which he has conquered, First he took up writing. After years and the manner in which his family of study and practice his work now have helped him. is accepted by newspapers and maga- The writer has suffered from a seri- zines of the highest type. His weekly bus physical handicap for more than column formerly in the Winston-Sa- thirty years, which long ago buried lem Journal and now daily in the all possibility of practical reward in Reidsville Review is probably more his profession. The other day, how- widely quoted than any other writer ever, on a brief visit to Mr. Wilson's in North Carolina. Second, he pro- bedside he felt ashamed that he had ceeded to build up a magazine sub- ever complained. In the presence of scription business. He has been suc- this man, now forty-six years old, who cessful in this. We hope that both has spent half his life in bed, much these efforts may continue to grow. of it in pain, unable to even fall off As the writer left his bedside and the bed alone, an overwhelming sense his room on the sunny southern side of the essential greatness of the hu- of the fine old farm home, with the man mind and character and a knowl- beautiful vista of rolling hills and edge of its all but divine power comes farm homes and orchards and trees, over one. He is confined to bed with- he realized that in this case the walls in the four walls of a room, but in were not a prison and that truly mind and spirit the world and all the "Full against wind and tide some cosmos is his province. men win their way." The Health Bulletin April, 1935

Safety In School Bus Transportation

Bethany Rural School in Rockingham County Seems to Have Solved the Problem

schools in OFFICIALS of the State Board ful consolidated rural North Carolina. It is situated on a of Health have worried no lit- fine rolling hill with an abundance of tle on account of several ques- trees and open playgrounds. The tions involved in the transportation buildings are composed of one-story of school children by the State ever structures covering, we were told, since the plan was first inaugurated. when the new additions now under To begin with, the matter of safety way are completed, about one acre from injury has been of vital con- and a half of ground. More than a cern. Aside from the matter of pro- thousand children are enrolled in the tection from physical injury on ac- school there this year. About a dozen count of accidents, many other ques- years ago, when the school was first tions are involved which vitally af- built, an approved water supply with fect the health of the children. Al- sewage disposal plant was built. Re- most from the beginning of bus trans- cently the valves in the toilets in one portation it seems that the prevalence of the buildings have worn out and of communicable diseases has in- this necessitates the installation of a creased. A half hour's ride on a new system, which is probably in- school bus packed full of children stalled by this time. The new con- coming from what was previously at struction, in which several additions least two or three or more separate are being made to the buildings, will school communities and being con- include one of the most desirable fea- veyed to and from school has made tures, which we think is a necessity the spread of communicable diseases in all large schools, and that is a sep- much easier and much more frequent. arate toilet for the little girls, in Such diseases as measles, scarlet which all of the fixtures will be suit- fever, and diphtheria, to say nothing able in size and arrangement for of scabies* pediculosis, and other ag- these little ones. This is to be on a gravating conditions, have been much tile floor, with toilets, walls, and easier to contract. Most of the busses everything conducive to perfect sani- have been crowded far beyond capac- tary maintenance. The same arrange- so-called ' ity, and such conditions as ment is necessary for the little boys. colds have simply spread through the the enterprising young school like the proverbial fire in the Mr. Carter, school, showed us a broom sedge, following as the result principal of this bus which he has secured for of the packing and crowding in the new school this year. To our mind busses. Everybody knows, of course, his bus assures safety in bus that numerous accidents, in which this new driver of the one or more children have been seri- transportation. The engine and power plant, ously injured, and some lives lost, bus, with the separate have frequently been attributed to goes in front of the bus in a completely cut off from the chil- the crowded condition of the bus, in unit, for the which the driver had no room for dren to be hauled, except coupling. The bus accommodates free action. It is this point that we like one hundred and fifty wish to discuss in this article. something Recently we had the privilege of a children. The exit is from the side, of the bus. The ven- short visit to Bethany School in in the middle Rockingham County, some twenty tilation comes through the roof of arranged miles southwest of Reidsville. This the bus. The seats are so accommodate the different sizes is one of the largest and most beauti- as to April, 193.: The Health Bulletin of children without too much crowd- last twice as long and carry twice as ing. And, finally, it is of solid steel many children as the busses now or- construction all over. We were in- dinarily used. formed that a few days previous to As further proof that Mr. Carter has given the our visit a reckless driver, driving a matter careful study, he showed us some of big passenger car at about sixty miles the old busses in use by the school in which he had the an hour, ran into the rear of the local mechanic to install iron bars crowded bus sufficient to smash his which would prevent the children be- own car to pieces, but the children ing thrown to the front in case of in the bus hardly felt the jar of the accident or quick stop. This protects impact. A very small dent on the the driver as well as protects the corner of the bus was all that was children from serious injury in case visible of the accident. The driver is of accident. concerned solely with his driving. We pass this information along to There is a conductor in charge, who our readers everywhere who are in- is one of the high school students, of terested in the safety of school bus course, who opens the door and sees transportation. We hope that before that the road is clear before letting the opening of schools in September out any of the little passengers. This all of the new busses put in use by the bus, we are told, only cost about two State this year will conform to the thousand dollars complete. It will foregoing requirements.

Oral Hygiene and the School Curriculum

THERE is no reason why the tuberculosis, gastritis, gastroenteri- teaching of oral hygiene may tis, pneumonia, diphtheria, etc., or of not become a part of our pub- the very close relationship which ex- lic school curriculum. ists between affections of the teeth The principles of oral hygiene are and certain diseases of the eyes, ears, so simple that any child of school the accessory sinuses of the mouth age, with ordinary intelligence, can and nose, or of the close relationship understand them thoroughly. It which epilepsy and insanity some- would not be necessary to teach the times bear to diseased teeth. clean- child all the reasons why oral In other words, this prejudice is liness is essential to a vigorous body the result of ultra-conservatism, and mind; but he or she can be "The old way is good enough." "Why taught how to keep the mouth clean should we take up with every new and some of the more patent, simple, fad that comes along?" "Our chil- social and cosmetic reasons there- dren are better cared for than we for; reserving the more scientific rea- were and yet they are no more robust sons, such as belonging to individual in body or brighter in mind than was health, public health, increased men- our generation." These people seem tal capacity, longevity, and its influ- to have forgotten the change in en- ence upon posterity, to the higher vironment that has taken place since schools. their school days. Then the popula- There is, however, much prejudice tion was widely scattered over large to be overcome. This prejudice is in country districts with their pure air some instances due to the lack of and wholesome food, their early knowledge or appreciation of the fact hours and simple pleasures, largely of the very close relationship which enjoyed in the open. Now the popu- exists between an unhealthy and un- lation is largely crowded into cities clean mouth and many very serious with their fetid air, unwholesome general diseases of the body, such as food, food gathered green and ripened —

8 The Health Bulletin April, 19S5 in transit, stale vegetables, cold- lessens truancy, and greatly reduces storage meats and eggs, impure doc- the number of days lost from school tored milk, canned fruits, canned through sickness. meats, canned vegetables, drinks It greatly reduces the number of served at soda fountains, the syrups children who fail to pass their examinations to remain in the of which are made of synthetic chem- and have same grade for the second or third or icals rather than from pure fruit su- even the fourth year. Such conditions gars, poorly ventilated buildings, as these impose a heavy drain upon their late hours and exciting pleas- the school funds of our State each ures. wonder these children are No year and has for many years been stronger in no brighter in mind or one of the serious questions discussed body than was the generation which by our school boards. The answer to immediately preceded them. The this question has never been found great wonder is that so many have until now, and the work done so far managed to survive under the great in this State has blazed the way for handicap that has been placed upon these anxious school boards and has them. demonstrated to those interested in Others will be prejudiced against the subject of oral hygiene that this it on account of the expense attached department will prove to be one of to its practice and teaching. With the greatest factors in the conserva- little argument it can be proved to tion of public health, an equally im- the satisfaction of everyone that the portant factor in diminishing the teaching and practice of this branch ever-increasing delinquency list in of science in the public schools is a our public schools, adding to the wise and economic measure, as it im- physical comfort and happiness of proves the general health of the chil- the children, clearing their minds dren, betters their conduct, increases and making study a pleasure instead their mental activity and capacity, of a bore. Rutherfordton Netcs.

Social Planning and Rural Sanitation

By M. F. Trice, Assistant Engineer, State Board of Health

GREAT deal has been said in with both urban and rural popula- recent months about social tions that have become stranded. In A planning and adjusting the both situations are many families, to misfits of our complex present-day use the current phrase, that must be civilization to the new order of rehabilitated. things. Out of such discussions the Obviously the possibilities for ren- terms "rural rehabilitation," "home dering the indigent urban families subsistence farming," the "retire- self-sustaining are very limited. This ment of submarginal lands," "slum fact will operate to effectuate an evac- clearance," etc., have emerged to uation of them to rural areas where stand out in our minds as peaks in a the opportunities for self-sustenance mountain range of words. Much more are so much more abundant. For the remains to be said apropos the sub- same reason the reclamation of im- ject, and what is more important, poverished rural families will be con- there lies immediately ahead the fined to the country and will involve herculean task of executing the pro- a transfer from semi-barren lands to gram to be developed to effect a re- more fertile areas. adjustment in our social structure. This shake-up and redistribution of Already in North Carolina a tenta- a part of our population will subject tive program is emerging. The pro- those involved to new modes of living gram to be evolved will be concerned which in the main should result in April, 1935 The Health Bulletin more healthful lives. Certainly, how- life; none, however, were more amaz- ever, some health hazards will be en- ing than those pertaining to sanita- countered unless due consideration is tion. Only 13.6 per cent of the rural given sanitation and the public homes were found to be provided with health. Especially is this true as re- adequate and safe means of excreta disposal; 33 per cent of gards the urban population that is to them had no means of excreta disposal be transferred to the country. Such whatever, other than that provided people in all instances thus far have by barns, cribs, and the bushes; the been protected from the ravages of remaining 56.4 per cent had facilities filth diseases, such as typhoid fever, appraised as dangerous, which proba- dysentery, diarrhea, hookworm dis- bly connotes open-back, disease- ease, etc., by a wholesome and dis- spreading privies. ease-free public water supply and an adequate sewerage system. Probably Such a situation constitutes a grave as a result of these very safeguards public health problem the magnitude a natural immunity to such dis- of which can be better appreciated eases that might have been devel- perhaps by presenting the results of oped in them through constant con- the survey in terms of population. tact with such maladies will be Approximately two-thirds of our peo- lacking, and as a consequence they ple live in strictly rural areas or in will be defenseless and at the small communities that do not have mercy of such microbes once they are public water supply and sewerage removed from the protection a pater- systems. This means that approxi- nalistic municipality has always pro- mately two and a third million North vided for them. With respect to this Carolinians depend upon privately situation, it is believed that the rural owned facilities for water supply and population per se will less suscep- be sewage disposal. Of this number tible to such a possible danger. three-quarters of a million have no From the foregoing, therefore, it privy or other means of excreta dis- is not difficult to appreciate the part posal and approximately a million sanitation is to play in the readjust- and a quarter more of our people ment that is proposed. Since the pub- have privies, lean-tos, or shelters that lic health is involved, and since per- are appraised as dangerous. In other haps we should be more concerned as words, two million North Carolinians regards the status of the rural popu- either have no toilet facilities of any lation in this respect, it is well to kind, or the structures that serve as take an inventory. places of excreta disposal are of the Almost a year ago a rural housing open-back type that permit the body survey was conducted by a group of wastes to be scattered therefrom by workers especially selected for the wind and rain, animals and insects. purpose. The undertaking was Two million people from which the financed by the CWA and directed by forces of nature may spread one or Mrs. Jane S. McKimmon, State Home many of the filth diseases. Under Demonstration Agent. Counties lo- such conditions is it any wonder that cated in the mountains, piedmont the countryside is a fertile field for plateau, and coastal plain sections of the sale of medicines of all kinds? In the State were selected for survey in this connection the ailments or mis- order that the various geographic di- eries with which many of our rural visions of our commonwealth might friends are continually afflicted as- be represented and the results ob- sume new significance. That is truly tained be applicable to the State as a depressing picture of rural life in a whole. In all, twelve representative North Carolina and is one, moreover, counties were combed for facts rela- that should concern all of us, regard- tive to present-day rural housing con- less of whether we are urban or rural ditions. Astounding facts were re- dwellers, for an incapacitated group vealed relative to all phases of rural of our people may harbor and keep 10 The Health Bulletin April, 1935 virulent the germs of our deadliest must provide not only adequate sani- maladies, and among them may origi- tary facilities for the families that nate epidemics that may ravage the are rehabilitated, but also for the land the moment our public health population already established in the vigilance is relaxed or weakened by rural areas. This is essential in order a false sense of security. that the public health of the State as Compare that picture of rural life a whole may be adequately protected in the State with vital statistics such against disease. Rehabilitation is cer- as are recorded by the State Board of tain to result in an increase of min- Health and one cannot help but think gling between the rural and urban of cause and effect. During one ten- groups of people and in enlarged com- year period, arbitrarily selected, vital munion within the established popu- statistics reveal that an average of lation of our countryside. Such an 1,875 people die needlessly each year increase in contacts as is anticipated in North Carolina of filth diseases. will be attended by an increase in the And to this dreadful toll must be health hazards of the population of added countless thousands that fall the State as a whole. victims to them, but who do not suc- North Carolina with its varied re- cumb. They recover apparently and sources and wide expanse of sparsely are unmarked by their suffering inso- settled countryside is ideally endowed far as physical appearance is con- and suited to such an experiment in cerned, but no one knows to what social adjustment as is contemplated extent their efficiency has been im- by the Federal Government. Only the paired and their resistance to disease human resource is an unknown quan- weakened. It is probable in this re- tity, made so to a considerable de- spect that the effects of their sickness gree by the conditions under which it is never entirely obliterated. exists. In any contemplated program Rural conditions in North Carolina of adjustment, therefore, due regard are perhaps no worse than those that should be given the factors that influ- exist in other states, and it is not my ence and determine the value of this purpose to convey such an impres- most important of all resources. sion, the prime motive of this dis- Proper sanitation and public health course being to bring to light a situ- measures will do much to increase ation that must be considered in any and stabilize the value of the human rehabilitation scheme that involves resource and should, therefore, have the countryside. The development of a prominent part in any rehabilita- any program for social readjustment tion program that is undertaken.

"The Story of Tooth Decay"

By Ernest A. Branch, D.D.S., Director, Division of Oral Hygiene

North Carolina State Board know that a child who eats with an THE unclean is sending of Health is interested in the mouth food to his health of the children, and is stomach in an unclean condition. particularly interested in the health Germs are very small living organ- of their mouths, because of the fact isms of vegetable life and can be seen that there is a very definite relation only under a powerful microscope. between their mouths and systemic The mouth is an ideal place for them disease. There were about sixty thou- to breed. They feed upon dead ani- sand children who entered the schools mal and vegetable matter and thrive of North Carolina this year for the best where it is dark, warm, and first time. Quite a number of them moist, as it is within the mouth. The have been examined and have been temperature is just right for them found to have unclean mouths. We there; it is dark and there is plenty April, 1935 The Health Bulletin 11

of moisture, and if the teeth are de- from sugar. When milk becomes sour cayed and are not cleaned, if food is it is caused by germs decomposing in between left on their surfaces and the sugar in the milk, thus produc- multiply very these teeth, the germs ing lactic acid, which gives the milk fast indeed, millions of them being its sour taste. Starchy food, if al- swallowed every day. produced and lowed to remain in the mouth, can are harmless Many of these germs be changed to sugar by an ingredient will and under ordinary conditions in the saliva. The sugar can then be little trouble; but if the cause very acted upon by germs in the mouth disease-producing germs get into an and changed to lactic acid; so that it mouth rapidly increase unclean and may easily be seen that to leave in there is danger of sick- number, starches and sugars on the teeth for ness. any length of time is to produce It is well to remember that in lactic acid, which can dissolve the order to keep children free from cementing substance between the en- sickness it is necessary to train them amel rods. However, in order that (1) to keep the fingers out of the the acid become strong enough to refrain mouth and to from touching actually dissolve the enamel, it is food with dirty hands; (2) to see necessary that it be held against the that they have sound teeth and that tooth surface for some time, and that the food is brushed off after «ach is done in this way: meal. In saliva there is an ingredient If these two rules are followed, it called mucin. This substance is what means the prevention of much of the makes the saliva viscid, or stringy, sickness of childhood and adult life. and is intended to lubricate the It is difficult to explain how teeth chewed food so that it may be easily decay without using technical names swallowed. If a thin glass bottle and words that are hard to under- were filled with saliva and a little lac- stand, but every intelligent adult tic acid were dropped into it, it would should have a reasonably correct idea produce a white fog which would about it in order to help the children settle to the bottom of the bottle and to have sound teeth. stay there. This white substance is Decay of the teeth always starts mucin and is sticky like glue. When from the outside surfaces of the acids are formed in the mouth from teeth, never from the inside. The the sugars and starches which have surfaces which are most frequently been eaten, this white mucin forms subject to decay are: (1) those be- on the surface of the teeth. If there tween the teeth, where one tooth is food with many germs upon the touches the other; (2) in the fis- teeth, a glue-like tent is gently sures or rough surfaces on the tops formed over both the germs and the of the teeth which are used for chew- food by the mucin. As the germs de- ing food; and (3) close to the gums compose the starches and sugars in where the food clings to the border the food to form lactic acid, this acid of the gums. is held tightly against the tooth, un- Meat will not cause the teeth to der the tent, and becomes stronger decay, because when it is decom- as more acid is formed. Now, if it posed by germs an alkali is produced remains next to the enamel for any and the enamel is not affected by the length of time it will start to dissolve alkali. Acids are the agents which the cementing substances between the cause the teeth to decay. enamel rods. The enamel of the tooth is made of The little tents are called plaques crystal-like rods, between which is a and they are formed and stay where cementing substance which holds the friction of chewing does not dis- them tightly in place. This can be place them. If we eat coarse, whole- dissolved by acids, especially lactic some food and chew it thoroughly, acid, which is very easily formed we can keep a great many of these —

12 The Health Bulletin April, 19S5

plaques rubbed off the enamel. It is ed children in our schools we have true that we cannot keep these found great numbers of them in a plaques from forming, but it is also deplorable condition. There are at true that if we keep the food brushed least three kinds of influences result- off the teeth the germs will find little ing from dental decay: (1) Decreased upon which to feed. We can also power of mastication; (2) toxic effect have all of the surfaces of the enamel of pus which is absorbed directly polished every two or three months, into the stomach and intestines; for it is more difficult for them to (3) reflex nervous disturbances. form on smooth, polished surfaces. Many children from six to twelve It is undeniable that tooth neglect years of age are deprived of half the directly affects many more people normal chewing surface by decayed and that more physical degeneracy teeth. The loss of one of the six-year can be traced to this source than to molars means the functional loss of few other conditions. Dental caries, its opposite. or decayed teeth, have been called When we realize that the mouth is "The People's Disease." Every day the gateway to the body, and see how hundreds of thousands of teeth are it is neglected, we are not surprised aching. However, children who are that so many of our children are sick. allowed to eat constantly soft, mushy With so many of them underweight foods, cake, sweets, and candy cannot and in a run-down condition, suffer- hope to have sound teeth and well- ing with decayed teeth, gum boils, developed faces. abscesses, and so on, it is not surprising that they naturally fail to make Diseased teeth are responsible for their grades in school. Their physi- a vast amount of ill health. Toxemia cal condition is such a handicap that from the swallowing and absorption it would be more surprising if they of pus is probably the most serious passed their work. evil of neglected teeth. Many dis- We need our teeth as long as we eases of the heart, lungs, and kidneys need the rest of our body, and they have been traced to decayed teeth. should last a lifetime. So the food, Every cavity is filled with decayed the exercise, the fresh air, the sun- food and bacteria. The germs of tu- light that promote the general health berculosis and diphtheria are often are also conducive to the health and found in dental cavities, and are long life of the teeth. When we obey thought to sometimes find their way the laws of health, when our diet con- into the body from this source. When sists of cleansing foods with their teeth are decayed the tonsils are mineral salts and vitamins, the blood more likely to become diseased. will be charged with life-giving ma- of The causes dental decay are terial so that throughout a long life definitely known, tangible, and amen- our teeth will be kept clean and able to control. Dental decay is chief- strong and beautiful. ly a disease of childhood and youth. If kept in repair until the age of twenty, teeth should be sound at The Maternity Center Association sixty. Neglected teeth till twenty of New York City has designated one teeth with any tendency to decay day in the year as "Mother's Day." A are beyond salvage. Nation-wide observance of this day is Until recently the mouth of the planned for May 12 this year. The idea child was to the average teacher an is to make maternity safer. Also, the unknown quantity. Even the dentist American Child Health Association and physician were not aware of the has for several years, by act of Con- actual conditions, for the reason that gress, sponsored the celebration of a very small percentage of the chil- "Child Health Day" every year on dren came to them for examinations. May 1. These two special days should In examining the mouths of retard- be widely observed in North Carolina. April. 1935 The Health Bulletin 13

Allergic Diseases

Reported by W. P. Richardson, M.D.

JOHN A. KOLMER, profes- quently involved, though sensitive- DR.sor of Medicine at the Temple ness to food substances is not un- University School of Medicine, common. summarized modern knowledge of There are four modes of entrance allergic diseases before a meeting of of offending substances: inhalation, the Forsyth County Medical Society ingestion through the gastrointestinal at Winston-Salem, December 20, tract, entrance through the skin, and 1934. Allergic diseases are those hypodermic or other injection. which are caused by contact with Heredity plays a dominant role in some substance to which an individ- the production of allergy, the indi- ual is sensitized. These substances vidual inheriting not the sensitive- cause no symptoms in normal, un- ness, but an increased capacity for sensitized individuals. becoming sensitized. Figures given Doctor Kolmer listed as the com- by Doctor Kolmer showed that 50 monest of the allergic diseases, and per cent of the offspring of one aller- those most familiar to the average gic parent and over 60 per cent of person, hay fever, asthma, some cases the offspring of two allergic parents of eczema and certain other skin con- develop manifestations of allergy by ditions, dermatitis venanata (poison the age of 30 years. ivy), migraine headaches, certain Treatment by so-called desensitiza- gastrointestinal upsets, and serum tion was discussed. This has been sickness, both acute shock and the attempted by treatment with some commoner serum disease with its protein preparation having no rela- itching skin eruption and joint symp- tion to that to which the individual toms. Epilepsy is thought also by is sensitive, and by treatment with some to belong to the group of aller- carefully graded doses of the sub- gic diseases. stance itself. Only the latter holds The state of sensitivity, known as much promise of success, and its suc- allergy, is developed through contact cess depends first of all on an accu- with the offending substance. The rate diagnosis of the offending sub- primary contact sensitizes, and substance. sequent contacts bring on the charac- In making this diagnosis tbe first teristic symptoms. Only protein sub- essential is a careful history and stances, or those having a protein physical examination. After that, combination of their makeup, are skin tests are of great value, al- thought to cause allergy. In the case though their limitations must be kept of certain metallic drugs, which cause in mind. They do not react to the the characteristic symptoms in some offending substance in some cases, individuals, it is supposed that they and in others give false reactions. combine with some body protein to The most satisfactory and effective form a new protein sufficiently for- treatment, if that is possible, is com- eign to cause sensitivity. plete avoidance of the offending sub- Doctor Kolmer stated that human stance. Of course in many cases this beings may acquire allergy to any is impossible, and then treatment by foreign protein of plant or animal desensitization should be attempted. origin. Thus the number of sub- The use of adrenalin to control symp- stances which may be involved is al- toms is only temporary symptomatic most limitless. Pollens, the products treatment, and can in no wise take of bacteria, and animal sera are prob- the place of treatment based on the ably the three substances most fre- specific cause if that can be found. —

14 The Health Bulletin April, 1935

North Carolina Emergency Nursery Schools

By Mrs. Mary G. Scarborough, State Supervisor of Nursery Schools and Parent Education

N October, 1933, Mr. Harry Hop- Everyone." Every nursery school reported that the slogan was realized, kins, director of the Federal the I Emergency Relief Administration, due to the hearty cooperation of to local communities where the nursery said: "It has been brought my schools are located. In January the attention that young children of pre- old slogan of happiness was retained, school age in the homes of needy and unemployed parents are suffering and to it was added the new slogan, the Hour of Sleep in Individual Beds from the conditions existing in "An Nursery School Child." homes incident to current economic for Every education- Again the local community cooper- and social difficulties. The of nursery ated in securing individual beds, and al and health programs in again the slogan was realized all over schools can aid, as nothing else, combating the physical and mental the State. handicaps being imposed upon these The slogan for February was, "Not young children." The Federal Emer- a Common Cold in a Nursery gency Relief Administration then School." Every precaution was taken asked the National Office of Educa- to protect these children from colds. could tion whether nursery schools Every child was given cod-liver oil to provide a means for employing needy build up his resistance, and a well- and unemployed teachers. The an- balanced meal was served in the mid- the swer to this question came in dle of the day. A program of out- statement of October 23, 1933, when door play in warm suits and an hour Mr. Hopkins announced that the of sleep in comfortable beds did much nursery school would constitute the to reduce the number of colds. This sixth of the Emergency Education slogan extended into the homes, and Programs. Fifty nursery schools were at least twelve hundred homes in opened in Porto Rico, ten in the Dis- North Carolina put on an intensive thousand trict of Columbia, and one program to prevent the common cold, one hundred seventy-eight in the so prevalent during the winter months. fifty United States. Of this number, The slogan for March is, "Perfect were established in North Carolina Parent Cooperation." Through this thirty- fifteen for Negro children and slogan the teachers hope to secure five for white children. better attendance at Parent Educa- Each nursery school program pro- tion Classes, better home cooperation, vides for physical, mental, emotional, and a better understanding between child. Therefore, and social development of the teachers and parents. by Realizing that this training would be keeping the old slogans and adding inadequate unless it were supple- a new one each month the nursery mented by similar home training, school is gradually building up a parents of the nursery school chil- program that makes for better physi- dren are required to attend Parent cal, mental, emotional, and social Education Classes. In these classes welfare of the boys and girls. Realiz- a simple course of study, taking up ing the wisdom of the old adage the everyday problems of the parents, "Train up a child in the way ha teachers, and children, is followed. should go," it is hoped that better Free discussions of practical prob- habits, attitudes, and appreciations lems are held. may be established, that the citizens During December the State-wide of tomorrow may develop into the slogan for the Emergency Nursery highest type of individual of which School was, "A Happy Christmas for he, with his native ability, is capable. April, 1935 The Health Bulletin 15

1935 Child-1935 Parent By Cora Beam, R.N.

Child two kinds, your child The — vegetables, and this should never be and my child. considered. And there still may be Parent two kinds, The — you and me. the hidden hunger with other causes Doctor Crumbine of the Child that need looking into, other than Health Organization in radio talk, a shortage of substances. The gasoline January 22, 1935, asks 1935 questions. at the filling station does not run the First four questions of for the 1935 car until it is in the car's gasoline child: tank; the 1935 child, to grow right, Do you have a yearly physical ex- must be taken care of with 1935 food amination made of your child? ideas. Do you have a yearly physical ex- Fourth of the four questions: amination of your child to know that What are you doing to help your he is in good condition—his heart, child grow up? his lungs, his ears, his eyes, his If he is not doing his job, chief of throat? Is he nourished and growing which is to grow up, there is no ex- as every child should be doing at all change to be made. You may trade times? This examination done pref- or discard your car, but not erably physician. this your by your In ex- child. amination, if defects are found, do Then Docor Crumbine gives another you have these taken care of as you list of questions: would should you find a defective part Are you a friend to your child? in your car? Do you give him a place in your Second of the four questions: home? What protection do you give the Does he have chores of his own? 1935 child? How much praise and approval do The 1935 parent with the right pro- you give him? tecting attitude would see that there Does he have books and a place of would be no more danger of epidemics his own to read them? diphtheria, of smallpox, or typhoid How strong is his body? fever, see that is protected and he What education is he getting? against exposure to the commonly Are you the parent for him to mod- known contagious children's diseases. el after? Keep your child at home, when he has Would you like for him to be like symptoms of infection of throat or you? with apology. colds, until you know he is all right. I wish I could have taken, word If all children were kept in, at home, for word, Doctor Crumbine's talk. when symptoms of disease appear, Most interesting to me, as I listened there would be no need of fear of to it the first thing when I got in measles, scarlet fever, and other epi- from work this evening, to hear him demics of the "children's diseases." —the great doctor that he is—talk Protect the 1935 child. in this simple way about the things Third of the four questions: we nurses in our small way, day after Have you the 1935 food attitude day, dig away at and wish so much for your child? that the day would come when all Your child must have food that children can be Doctor Crumbine's keeps all parts of the body in good 1935 children, and all parents his condition. Is your child hungry with 19 3 5 parents. a hidden hunger for something that Don't you think when North Caro- tells only in an obscure way? Per- lina gets health organizations 100 haps for financial reasons there must strong that we might get our children be a reduction made. There has better under the yearly watch-care of never been a substitute for milk or the physicians of the State? — —— —

Public Health's Platform for the Preschool Child in North Carolina Health in reference to Th* policies of the North Carolina State Board of below. If these policies are the infant and preschool child are outlined properly followed they will help in: mind and a sound body to com- 1. Providing for every child born a sound pete for his place in the world; care; 2. Providing the best medical and dental medicine; 3. Preventing State and Federal 4. Improving the public health. In such a procedure the proper place to start is: means competent medical prenatal 1. With the child before birth, which

care; • medical,. , obstetrical, , care; 2 With the child at birth, which means competent the preschool years, which means 3 With the child in infancy and during health and health habits, (a) proper food and food habits, (b) proper protection against the preventable diseases, (d) prompt medical (c) Com- and dental corrective and curative measures when illness occurs. determines petent medical and dental supervision during this period the success of this program. The accomplishment of such a program needs the cooperation of the following: Parpnts; and Their part is possible of 1. To assure that each child born be as free as Guardians physical and mental handicaps; 2. To secure competent medical prenatal and obstetrical care; diseases; 3. To secure protection against the preventable 4. To provide prompt medical and dental supervision during illness. Thus the parental duty to one's child becomes a service to the community. program is Physicians Their responsibility in such a 1. To advise and insist upon measures to keep well; and Dentists 2. To advise and insist upon measures to get well. Governmental Their responsibility is 1. To provide funds sufficient to assure medical care for the Agencies proven indigent, such plan of care to meet the approval of the organized medical profession; 2. To provide funds adequate to promote the application of approved public health procedures. Public Health Their responsibility is 1. To furnish leaders in this program through education by Officials bulletin, press, radio, and field work; 2. To provide, upon request, expert consultation for communities and individuals; 3. To promote general sanitation and local health services; 4. To provide adequate laboratory facilities for examination of samples of water and milk, and of specimens from patients for diagnostic purposes; 5. To furnish prophylactic agents for distribution; 6. To act in a supervisory and an advisory capacity over all public health activities, either State or local.

It is American for every child bom to have equal protection against infectious diseases and to be physically and mentally fit to compete for his place in the world! PREVENT THE PREVENTABLE! CORRECT THE CORRECTABLE! CURE THE CURABLE! MR jnu CHAPEL HILL, «•

This Bulletin will be ser\t free to ar\\j citizen of the 5tateupor\reque5t.i

Entered as second-class matter at Pcstoffice at Raleigh, N. C, under Act of July 16 ' 189 i Published monthly at the the office of Secretary of the Board, Raleigh, N'. C.

Vol. 50 MAY, 1935 No. 5

SUN-BATH DEMONSTRATION AT THE BABIES' HOSPITAL

A BLESSED RETREAT FOR SICK BABIES

Dr. J. Bnren Sidburj of , Wilmington, who operates the Babies' Hospital at Wrightsville on the coast near Wilmington, again supplies our front cover for May. For several years Doctor Sidbury has sent us an original photograph for tins purpose. This photograph, made last summer, demonstrates the method of giving sun baths to babies at the Babies' Hospital. ) 1

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

Carl V. Reynolds, M.D., President _ _Asheville G. G. Dixon, M.D _ _ Ayden S. D. Craig, M.D Winston-Salem H. Lee Large, M.D „ _ _ Rocky Mount J. N. Johnson, D.D.S Goldsboro H. G. Baity, Sc.D Chapel Hill W. T. Rainey, M.D _ Fayetteville Hubert B. Haywood, M.D _ _ _ Raleigh James P. Stowe, Ph.G _ ~ _ Charlotte

Executive Staff Carl V. Reynolds, M.D., Acting Secretary and State Health Officer. G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Preventive Medicine. Warren H. Booker, C.E., Director Division of Sanitary Engineering. Ernest A. Branch, D.D.S., Director Division of Oral Hygiene. John H. Hamilton, M.D., Director Division of Laboratories and Vital Statistics. J. C. Knox, M.D., Epidemiologist. R. T. Stimpson, M.D., Vital Statistician. R. E. Fox, M.D., Director Division of County Health Work.

FREE HEALTH LITERATURE

The State Board of Health publishes monthly The Health Bulletin, which will he sent free to any citizen requesting it. The Board also has available for distribution without charge special literature on the following subjects. Ask for any in which you may be interested.

Care Mrs. Max West) Baby's Daily Time Cards : 5 Prenatal (by Under months ;

Prenatal Letters (series of nine 5 to 6 months ; 7, 8, and 9 months ; 10, monthly letters 11, and 12 months; 1 year to 19 months; Minimum Standards of Prenatal Care 19 months to 2 years. Breast Feeding Diet List: 9 to 12 months; 12 to 15

Infant Care. The Prevention of months ; 15 to 24 months ; 2 to 3

Infantile Diarrhea. years ; 3 to 6 years. Table of Heights and Weights Instructions for North Carolina Midwives.

CONTENTS Page Notes and Comment 3

An Indictment Against Some Fathers 5 Safeguards for Mothers and Infants 7 Infantile Diarrhea 8

Gift of Health _ 1 Recipe for Health _ ^ 12 The Conquest of Diphtheria 13 We Do Not Harvest Our Bumper Baby Crop 15 Sorrowfully Dedicated to the Memory of the 6.072 North Carolina Babies Who Died During 1934 Before They Were One Year Old 16 —

PUBLI5AEL0 BY I TME, HORTA CAgQUhA 5TATL. feQAI^D s^HEALTm"

Vol. 50 MAY, 1935 No. 5

Notes and Comment By The Editor

many years the month of FOR enumerate the reasons. We do not May has been notable for the mind saying, however, that we have emphasis which has been placed labored for the past two years here by many organizations throughout under adverse circumstances. It the country on care for mothers and takes some money to provide the babies. It is a month which nearly kind of constructive work child- always in North Carolina records a saving measures necessitate to teach sharp upturn in infant deaths. It is the large number of new mothers a month in which the houseflies make many of them ignorant and un- their appearance in full force. Gen- learned—about the safeguards neces- erally there are some hot nights. sary for the care of infants. Every- There are many hot days with cooler one connected with the State Board nights; and for very young babies of Health and the different city and the transformation from the care county boards of health during the given during cooler months, in order past two years has been laboring to be adjusted to changing climatic under the handicap of inadequate conditions and to resistance to infec- funds. The year 1934 registered a tions of various kinds, makes it a material increase in the number of difficult month for infants. infants dying under one year of Many years ago the American age—the largest increase which has Child Health Association succeeded occurred in any year in a long time. in getting a resolution passed through Only a cowardly people, however, lose Congress setting apart May 1 as courage and lay down and quit. "Child Health Day." The idea is to There is nothing, therefore, for one emphasize the things that may be to do but to take heart and try again done to make babyhood safer. Later and keep on trying. on a Philadelphia woman originated To prevent needless infant and ma- the idea of "Mother's Day." A reso- ternal deaths in this State requires lution concerning that was also several things: first, there must be passed by Congress setting aside the an extension and an expansion of second Sunday in May as "Mother's competent medical prenatal service Day." to the expectant mothers who have In the columns of The Bulletin for heretofore not been getting it; sec- May we always endeavor to present ond, information of the right kind the facts with reference to child must be placed in the hands of young health conditions in our State. We mothers telling them in plain lan- also try to present as much informa- guage of the experience in the past tion on how to safeguard the health and of the things to do and not to of the babies as space will allow. do in order to rear a healthy baby; This month we labor in a depressing third, community sanitation, and atmosphere. It is no use to try to therefore community safeguards, The Health Bulletin May, 1935 must be better stressed and more ment there through which the senior widely employed. All tbe forces for class of Duke University Medical civilization must be brought into School keeps two senior students on play all along the line if we are to duty in the health department office prevent the needless sacrifice of in- day and night to attend the confine- fant life. ment cases among the poverty-strick- * * * en class of the city. This is financed by the Charlotte Health Department, are publishing a short article WE and Doctors Rea and Hand and the elsewhere in this issue written nurses in that department should be by Dr. W. Z. Bradford of Charlotte. commended for their unselfish labors We requested Doctor Bradford to in organizing this work. write this article, setting forth briefly and Doctor Nance some of the things that have been Doctor Bradford services free of done in Charlotte, during past two or have given their city for three years particularly, for the ex- charge to the poor of that be tension of competent obstetrical serv- several years. Their work cannot highly. The work is prac- ice to the extremely poor classes of praised too is simply extending compe- that city. We would like to call tical. It service, which especial attention to the following tent prenatal medical paragraph, which we quote from Doc- should be extended to the women in North Carolina, to tor Bradford's article: every township of an indigent class of women that "The lay campaigns for maternal would find it hard to secure such and infancy welfare heretofore have service otherwise. It is impossible, focused popular attention upon the for any medical school, abnormal, the neglected, and the mis- of course, there were more gradu- treated, and hence the dangerous even though supply phases of child-bearing. The result ate schools in the State, to has been a tendency to ignore the se- students for all the larger cities and curity with which the pregnant wom- towns; but it points in the right di- an can be surrounded, provided she rection. competent medical places herself in The work Doctor Bradford and his hands at the onset of pregnancy." associates are doing there points the We wish to emphasize the forego- emphasis to his statement, that the ing statement. It is a clear-cut state- pregnant woman can be assured of ment of the desirability of positive security, provided she is in compe- health. It is a statement which pre- tent medical hands. Let us hope that sents clearly the safety with which the day will soon come when every this period may be approached by expectant mother in this State may the expectant mother, provided she have the services of a competent med- is in competent medical hands from ical attendant to advise with her the beginning of her pregnancy. Doc- from time to time during the entire tor Bradford is right in calling atten- period of her pregnancy and to see tion to this tendency: there is great her through the confinement. danger in over-emphasizing the per- ils incident to childbirth and things which beset the child in its earlier WE have not had the opportunity days of life. of tabulating and classifying in- To our mind the work of the Char- fant deaths which occurred in North lotte Maternity Clinic represents an Carolina in 1934. In 1933, however, ideal arrangement. Doctor Bradford, about 48 per cent, or nearly one-half, one assisted by Doctor Nance, and with of the infants who died under they were the full cooperation and leadership of year of age died before the Charlotte and Mecklenburg Coun- thirteen days old. This one fact, to that one ty Health Department, has made a our mind, is positive proof notable contribution to current med- of the causes of the high infant death of pre- ical history. They have an arrange- rate in this State is the lack May, 1935 The Health Bulletin

natal and competent obstetrical serv- to learn to refuse to listen to much ice at the time of childbirth. As of the stuff that is proclaimed over pointed out before in these columns, the radio particularly, as well as to a newborn baby is one of the most a great deal of the stuff that is print- perfect machines upon which the hu- ed under the sacred guise of health man eye can look. It is a divine by some newspapers and so-called creation. Provided the parents are in magazines. A skeptical "you must show good health, the normal baby at me" attitude is vitally needed. A good question to birth is a machine which is far more ask one's self, when a golden voice perfect than the finest mechanical comes rolling in over the air proclaiming supernatural device ever executed by the hands of powers of some dirty salts combina- man. So, if nearly half of these tion, is, Who is sponsoring this prep- babies who succumb before the end aration? and What are they getting of the first year die before they are out of it? two weeks old, it is positive evidence There are plenty of authentic that they have been carelessly and sources of information on health mat- ignorantly treated, or they would not ters without people having to place have succumbed so quickly. their confidence in questionable Health education and we — mean sources, only to be betrayed. If you genuine health education, not ac- are in any doubt whatsoever when centuated on a few fads or devices, you hear advice given over the radio but comprehensive health education on medical matters, or when you is the most vital — need of the people read a column in some so-called mag- of our State at present. There is to- azine offering cock-sure advice on day more misinformation and more everything in the world even remote- damaging advice being handed out by ly relating to health education, you irresponsible quack columnists in the can settle the matter by writing a newspapers and by sordid and greedy postal card to your State Board of commercial enterprises over the Health and making inquiry. There is radio than at any previous time in no use in anyone being humbugged the world's history. One of the needs in health matters in North Carolina, of the people in this State today is unless he wants to be.

An Indictment Against Some Fathers

ALMOST exactly one-third of the quate medical service for their wives L\ women in North Carolina who if they really wanted to do so. They **" *" give birth to children have the believe that such service could be services of midwives and never con- secured and paid for if such hus- sult a physician throughout the entire bands were willing to work and make period unless it be for some acute the necessary sacrifice. condition not generally related to We are confirmed in the above their pregnancy. Of the remaining opinion by reading a report for the two-thirds, who are attended by month of January this year of the physicians, about half of them call Red Cross nurse in charge of the the physician at the onset of labor, Cumberland County Chapter. For or engage him just a few days before several years, in connection with her expected confinement. work, this nurse has been conducting Most physicians believe—and not a maternity center in the city of without justification—that a large Fayetteville. In her report for Janu- majority of the husbands of the ary, under the heading "Daily aforementioned classes of women Work," she made the following state- could make arrangements for ade- ment: The Health Bulletin May, 1935

posing as husbands and "The work this month has been scoundrels small mostlv prenatal. This has included fathers—only to be denied the registering expectant fathers who are pittance promised them. they may be on relief work, so that The report of the Red Cross nurse additional day's work each given an clearly proves the deliberate inten- week to secure an order to make tion of some of these men who turn adequate provision for their wives' the midwives for the sole purpose confinements. The reaction of some to interesting. of securing their services free of of these men is very Here they have all the leisure time charge, knowing that those helpless to use in the world, and the chance individuals cannot collect a cent from wives the some of it to give their them. All practicing physicians know some are turning best service; but there is a kind of camaraderie which whom they can back to midwives, exists between the midwives and upon by using free of charge, impose their helpless patients. In such cases rather than work out twenty dollars the midwives serve just as much for to pay for medical care." the sake of humanity as the physi- en- The foregoing statement is cians who give their services free to lightening and at the same time dis- the needy poor. couraging. Unless some of these men, Sometime ago we received a letter those who are not even willing to from a woman stating that she was they work one day in the week, when the wife of a tenant farmer. She said in have nothing else to do, will work that she had given birth to eleven pro- order to save enough money to children. Two years ago she appealed ben- vide medical service for the sole to us for aid. We sent her literature labor and efit of their wives during and suggested that she make an ap- for their own expected offspring, peal to a local physician to attend they should be made to do so, and her during that period, which was the proceeds of the work should be her eleventh labor. The other day we held in escrow for this purpose. received another letter from this Here we have the spectacle of the same woman, stating that she is now relief department, at public expense, pregnant again and expects to be offering men pleasant and easy work, confined soon; that she could not pay with good pay and short hours, the the doctor who attended her two money to accumulate for the sole years ago anything; and that she benefit of their wives; and yet the wants to try to get another doctor contemptible, lazy scoundrels refuse this time. "We wrote and urged that to do one extra day of work in the she and her husband arrange some- week for this purpose, but prefer to how to get some compensation for loaf and sponge on somebody else. the doctor who was good enough to care for her two years ago, go to The files of this office are literally him and pay what they could, and filled with complaints of poor, help- then ask him to come to her this less midwives from all over the State time, the definite understanding of North Carolina, who write here with the doctor beseeching us to help them collect that her husband will pay until he is paid their dues for service to the wives of something each week such men—sometimes one dollar, in full. are thousands of sometimes five dollars. Some of these We know there midwives report that they have such people in the State who have so have served on two or more occasions, little income that they seldom each time being promised faithfully a margin of more than a few dollars that such that they should be paid. They stay in any year; but we think by as many as eight or ten days; they do people could make some sacrifice, the family wash; they wait on the extra work, to pay at least something frequently helpless mothers and their infants; to the doctor who is so they prepare food for the miserable called to save the lives of their wives. May, 1935 The Health Bulletin

Safeguards For Mothers and Infants

Brief Description of the Great Work Being Done At the Charlotte Maternity Clinic

By W. Z. Bradford, M.D., Charlotte, N. C.

THE relative safety to mother its wake a most distorted attention and child of conservative ob- unless the basic truth is reempha- stetrics, provided abnormal con- sized. ditions are recognized and adequate- The application of these principles ly treated during their incipiency by on a somewhat larger scale than pos- intensive prenatal care, has been re- sible in any one physician's practice, peatedly confirmed by investigators but with the same margin of safety, of maternal mortality statistics. That is aptly demonstrated in the Charlotte Maternity the act of child-bearing is a normal Clinic. This clinic offers process upon which the average maternal care to indigents only and healthy woman can embark with deals with the strata of society in every assurance of success in the out- which a high incidence of syphilis, heart come to both herself and her child is disease, nephritis, tuberculosis, a fact that needs emphasis at this and toxemia of pregnancy occurs. In time. The lay campaigns for mater- spite of the increased risk in this nal and infancy welfare have focused class of the public, the clinic during popular attention upon the abnormal, its first two years, 1932-1934, deliv- the neglected, and the mistreated, ered 1,076 patients with a mortality and hence the dangerous phases of rate of 2.5/1,000 in the group of child-bearing. The result has been a 790 women who availed themselves tendency to ignore the security with of the services of this clinic before which the pregnant woman can today delivery. At the same time, in the be surrounded, provided she places group of 286 women who were seen herself in competent medical hands for the first time in labor, the mor- at the onset of pregnancy. tality rate was 18.0 per 1,000 births, raising the rate of the Intelligent prenatal care with its entire series to 6.5 per 1,000. attention to the hygiene of preg- This comparison is most striking and only nancy, with its early recognition of serves to re- emphasize the such diseased states as toxemia, established fact of the value to the heart, blood vessel, and lung disease, patient of medical supervision throughout with its prompt treatment of nutri- the entire period of pregnancy. tional and constitutional defects, followed by conservative conduct of la- Only 38 of the 1,076 patients were bor, the intelligent choice of anal- delivered by operative measures, re- gesia and anaesthesia and a minimum sulting in an incidence of spontane- of operative interference, and finally ous deliveries of 96.5 per cent. The climaxed with proper post-partum infant mortality rate of 4.7 per cent care, supplants medieval midwifery (51 stillbirths), when corrected by with the art and science of Obstet- the elimination of those infants mac- rics. Safety, permanent health and erated at delivery where death oc- happiness are the end result of this curred prior to the onset of labor, science. Education of the masses to was 2.3 per cent. the dangers of the abnormal states Syphilis producing a positive blood complicating pregnancy, to the terri- Wassermann occurred in 198 (IS per ble possibilities of neglect and mis- cent) of these patients. The value of handling, while possibly effectually anti-syphilitic treatment, especially lowering mortality rates, can carry in from the standpoint of the infant, is 8 The Health Bulletin May, 193.5 apparent in the following statistic tality rate can be lowered to that summary of this group: irreducible minimum which is the

Neoarsphenamine 1 Neoarsphenamine 2 to 8 Neoarsphenamine Neoarsphenamine (8) and Bismuth..

The brief summary of 1,076 deliveries above outlined again brings to our attention the fact that even women of the lowest social and economic strata can be guided through childbirth with comparative safety. Or- ganization of available facilities and mass education is required to force this class to avail themselves of medical supervision, but once a community is "breeding conscious" the mor- —

May, 1935 The Health Bulletin

Even this schedule may be lengthened tions of all sorts, and once serious in certain cases when a child requires infection is contracted it may termi- food less often. Feeding of every nate fatally. Mothers as a rule show baby is an individual matter. His considerable concern at this time schedule has to be adjusted to him over any prospective change from the and his needs. breast to some artificial milk formu- Vomiting and diarrhea are less la. They think that the baby in his likely to occur in the breast-fed in- weakened condition cannot stand a fant, particularly if the proper time change, and they never seem to real- is fol- schedule of feeding diligently ize that such a change is absolutely lowed. It is true that occasionally necessary to the child's welfare. the mother's diet will affect the baby Improper foods—those not suited and at times may cause vomiting or to the baby's digestive apparatus even diarrhea. Experience alone will are probably the next greatest cause enable her to know whether certain of diarrhea in infants. Oftentimes foods agree with her baby or disagree babies are fed directly from the table with him. It is well to keep in mind at the amazingly young age of two that an infant is an individual, and and three months; in other words, as such may have individual peculi- their dietary consists of those things arities; in other words, what agrees that the parents eat and in quantities with one may not agree with the that are alarmingly large. Most often is individual other. There no more there is no distinction made in the imposed upon than the baby. Moth- method of cooking these foods, as to ers will force various concoctions whether they are fried or boiled, and into a baby upon the recommenda- it goes without saying that babies tion of some neighbor who has heard fed in such a manner are more prone that somebody else has used it suc- to upsets than would be the case if cessfully. Of course the child is not they were limited to proper milk large enough physically to fight back formulas and cereal and vegetable and cannot defend himself against preparations. such injustices. The sooner the par- Excessive heat that occurs in this ent realizes that the infant's dietary locality during summer is enough is due careful supervision by one within itself to be the primary cause trained in this particular type of of diarrhea in many instances. Of work, the less danger there will be of course, one can readily see that the gastro-intestinal illnesses. combination of the heat, improper In breast-fed infants the same con- food or feeding schedules account for dition may develop, due to the fact a considerable number of cases of that a child is kept on the breast for this particular illness. Even the over- too long a time. It is not uncommon heating of homes and the overdress- for children to be breast-fed consid- ing of these youngsters in winter is erably longer than a year, even up to responsible for a certain amount of two years of age. This is not advisa- the milder gastro-intestinal illnesses, ble and may be more harmful than but of course they do not reach the not. Ordinarily, infants should be seriousness of these conditions as weaned sometime between the ninth when they occur in the summer and twelfth month, and at this time months. It is safe to say that the a baby's diet should be supplemented majority of babies are kept too warm by the addition of cereals, vegetables in winter and would be much better and fruits, and other foods. Those off if this were not the case. babies that remain on the breast for Quite often infections not of the too long a period become pale and intestinal tract will cause vomiting anemic and often will not take any and diarrhea of such degree that the other food unless the child is sepa- real cause of the condition is over- rated from its mother. These little looked and may be entirely missed fellows are very susceptible to infec- for a long time. During the season for 10 The Health Bulletin May, 1935 colds and upper respiratory infec- The second group of conditions are tions the greatest number of gastro- those found primarily in the intes- intestinal conditions are caused by tinal tract, due to infection with the infections of this nature—colds, sore dysentery bacillus. The dysentery throats, middle-ear abscesses, and bacillus is not normally found in nose and throat infections. It is cus- milk. It must be introduced by some- tomary for parents often to insist one who handles the milk before it is upon changes in the diet of the child fed to the infant. This type of infec- in order to correct vomiting and dition is more common in summer and arrhea that are due to these causes. is usually contracted through con- However, when these infections are taminated or infected food, which of cleared up the vomiting and diarrhea course includes milk, or through wa- cease without specific treatment. ter or foods contaminated by flies. Another condition which should All artificially fed babies should have not be overlooked is that of pyelitis. milk boiled for at least three minutes until the baby is years of age. This is particularly prevalent in girl two should babies and is often associated with An infant never be given raw vomiting and diarrhea, sometimes milk. Of course some babies are masking the true cause of the illness. given milk that is not boiled or pas- Alteration in diet for conditions of teurized and never have upsets of a this sort will not have any effect gastro-intestinal nature, but the whatever on the gastro-intestinal dis- chances for serious disturbances of turbance. this sort are much greater when raw Babies who are artificially fed are milk is used than when milk used is more likely to develop diarrhea than boiled or pasteurized. This is partic- those that nurse the breast. Of ularly true in the summer, for inade- course, at the present time there are quate refrigeration is conducive to fewer babies breast-fed than artifi- the growth of bacteria which are cially fed. but we have no control present in milk. Oftentimes milk that over this situation. However, a baby has been boiled and is not kept at receiving inadequate nourishment at the proper temperature in summer will the breast is much better off on an cause vomiting and diarrhea in adequate, correct formula for artifi- children. Also, unclean milk, even cial food. Greater safeguards should though it has been boiled, when be thrown around the baby who is given to babies may result in serious artificially fed than around those who digestive upsets. The bacillus that are fed from the breast. This of causes dysentery grows readily in milk. Especially is this true when course is due to the fact that their chances for developing gastro-intes- the milk is not kept cold. These lit- tinal disturbances are greater than in tle organisms multiply so rapidly the other infant. It is in this group that they are increased, under these of children that the more serious up- ideal conditions, to such an extent sets may and usually do occur. that the milk may become an instru- of clean, It is necessary that the bottles and ment death rather than the feeding containers of these babies be safe food which it appears to be. The kept scrupulously clean. They should appearance, taste, and odor of milk be sterilized each time before being are not indications as to its purity, used. Even though a clean milk sup- from the standpoint of the bacteria illness. ply is available, if the bottles are not that may cause serious clean, or if contaminated water is Water always should be boiled be- used in washing these bottles, they fore it is given to a baby, and in this may still carry infection to the baby. instance we refer again to children Each handling of the milk intended under two years of age. Boiled water for an infant increases the possibili- may be made more palatable by the ties of its becoming contaminated be- simple process of shaking it in a fore it reaches him. sterile container, which dissolves a May, 1935 The Health Bulletin 11 certain amount of the air in it. Wa- mon in summer than at any other ter also may carry these deadly season of the year, and it is neces- germs, and it is for this reason that sary to prevent their entrance into the use of boiled water for babies is the home. Screening will accomplish strongly urged. It must be remem- this. Those who care for babies that bered that the dysentery bacilli are are sick with a condition of this sort found in great numbers in the in- should be scrupulously clean, partic- testinal discharges, and it is from ularly where it is necessary that they these discharges that the infection is handle foodstuffs before it is eaten, always spread. for it is in this manner that other When a child has dysentery or co- cases may arise. One cannot be too litis the soiled diapers should be ster- careful in following out these simple ilized thoroughly and protected from precautions, and may thus avoid the flies. Of course flies are more com- spreading of this disease.

Gift of Health

By Mary S. Batchelob

when the fairies SINCE the days health habits, protection against gathered around the cradle of communicable disease, and adequate the little Sleeping Beauty to medical and dental attention. present their gifts of much joy and To give the baby a good start in a little woe, mothers have searched life the expectant mother should look through the treasures of the earth, to her own health during her preg- choosing and rejecting for their own nancy. Particular attention should children. Whether the baby be the be given to her diet. By the fourth first-born, in all his glory, or merely month of pregnancy the caps of the the sixth in a family of girls, you baby's teeth are forming in his jaws may be sure that the mother wants and their subsequent state of health for her child the best gifts life has depends in a large measure upon the to offer. The wise mother knows materials with which they are built. that the so-called "fairy gifts" of Foods containing calcium, phospho- beauty, charm, gaiety, and grace are rus, and minerals, so necessary for in reality the outward manifestations the building of teeth and bones, of a radiant state of health. She should be plentiful in diet of the ex- knows that health itself is the one pectant mother, for it is through the gift which is most truly hers to be- diet of the mother that the unborn stow upon her child, and that to child draws the substances which are those who possess health all things essential for his growth and well- are possible. With this knowledge being. Consequently, the mother before her, she will strive to build should do all within her power to for her child a strong body, filled keep herself in excellent physical with an abundant vitality, which will condition in order to supply her enable him to meet the demands and baby's needs. problems of life, ward off disease and Following the birth of the baby, death, and take him, with a sure and she should make every effort to nurse cheerful saneness, through a happy him. It is a proven fact that breast- childhood and productive manhood fed babies have a much better chance into a tranquil old age. in life than have babies who are To reach such a state of health, artificially fed. She should also re- there are certain things which the member that as the baby grows and baby must have: A good start in develops he will need additional food. life, proper food, proper training in By keeping in close touch with her —

12 The Health Bulletin May, 1935 physician and following his instruc- As soon as the baby's first set of tions as to supplemental feedings, teeth come through his gums, he she will assure her baby of food suf- should be taken to a dentist and any ficient to adequately maintain his cavities should be treated and filled. small body and allow him a reserve It should be remembered that upon upon which to draw. the care given the first teeth the wel- teeth depends. Contrary to general opinion, it is fare of the permanent never too early to begin training the See to it that mouth-breathing and are not allowed to baby in proper health habits. In fact, thumb-sucking will spoil the shape the sooner the training is begun the continue, for they child's face. See to it that the better for all concerned. During the of the life six-year molars are not allowed to first few months of the baby's care should be taken to help him become decayed and lost. form regular habits of sleeping, eat- The principles of health are the rules are simple; yet, in ing, and elimination. It is all too known; and unvarying appli- true that the baby will form habits their constant of monotony. during his infancy and childhood cation there is much royal road to which will stay with him all his life. Just as there is no is no royal The mother should make it her re- knowledge, there also principles of hy- sponsibility to see that the habits he road to health. The every day. forms are good habits, that they are giene must be practiced is much health-building, rather than health- However, the way made rules are made a matter destroying. easier if the When the baby reaches the age of of habit from birth. long life, a life filled with an six months the natural immunity A abounding sense of well- against diphtheria which has been his aggressive, joy, is a worthwhile life. since birth will begin to leave him, being and alive who and he should be immunized. Unless There is not a mother would exchange for her child other he is protected against diphtheria at doubtful blessings for the this age he may fall an easy victim to and more fulfillment which is brought the dread disease. At the age of actual gift him of health. twelve months he should be vacci- by her own to nated against smallpox. Smallpox and diphtheria are two diseases which RECIPE FOR HEALTH would be wiped entirely out of North By Dubose Cecil, Women's College, in the Carolina if every child born University of North Carolina State were immunized against them Grow, little children, stronger, life. When every mother early in stronger. realizes that early immunization pro- Sleep, little children, longer, baby, and when she deter- tects her longer. that he shall have all the pro- mines Eat fresh vegetables every day. tection which it is possible to give, That will keep ill health away. then smallpox and diphtheria will Have fresh air and plenty of water, cease to menace the lives of the chil- Exercise as children ought to. dren of this State. Do these things, and you will see From the day of his birth the baby How healthy you will be. should be under the care of a competent physician. During the first year Drink rich milk every day, of his life he should be taken to the Brush your teeth, run and play. doctor at regular intervals of once Stand up always like a man, a month. The doctor will then be Do your work the best you can. able to detect danger signals and de- Have your fun—but study, too fects which may cause later trouble. These should not be hard to do. Remember, it is much easier to keep Do these things and you will see a child well than it is to cure him How healthy you will be! after he becomes ill. (Can be sung to the tune of "Glow Worm.") May, 1935 The Health Bulletin 13

The Conquest of Diphtheria

By William P. Richardson, M.D., Assistant Director, State Laboratory of Hygiene

DIPHTHERIA is one of the old- immunization was introduced by Dr. est diseases known. From clin- Havens, director of the State Labora- ical descriptions in the Talmud tory of Alabama. This improvement we know that it existed among the was alum-precipitated toxoid, with Jews several centuries before Christ, one dose of which we are now able to and was greatly feared by them. Epi- protect from 9 5 to 100 per cent of demics of what was most certainly children. diphtheria are described in the writ- I cannot leave this discussion of ings of Roman physicians of the sec- the history of diphtheria without ond, third, and sixth centuries A.D. paying a tribute to Dr. William H. It was first recognized as a definite Park, director of the New York City clinical entity in 1492, and during Laboratory, through whose efforts all the next several centuries it was of these new products except the last widely epidemic in various European were introduced into America and countries, especially in Spain. It oc- popularized here. Furthermore, Dr. curred in America as early as 16 59. Park and his coworkers have also The name "diphtheria" was given made some notable contributions the disease by a French physician, through the improvement of methods Bretonneau, in 1825. Bretonneau of producing and standardizing the was the first to relieve the choking various products. of laryngeal diphtheria, often called This history of the development of membranous croup, by opening the our knowledge of diphtheria and the throat below the point of obstruction, discovery and improvement of the an operation called "tracheotomy." agents by which we can control this The modern conquest of diphtheria dread disease is one of the most ro- began with the discovery of the diph- mantic pages of medical history. theria bacillus by the German bacte- When we stop to consider how com- riologist, Loeffler, in 1884. Since that pletely equipped we are to fight it, time progress has been very rapid, we cannot help but wonder how it and there is no other disease for comes about that diphtheria is still which we have so complete a group a prevalent disease. We can diagnose of specific products by which to de- the disease by finding the diphtheria termine susceptibility, bring about bacillus in the throat. Further than immunity, and treat the disease after that, we can find the bacillus in the it has occurred. throats of those persons, most im- Diphtheria antitoxin was intro- portant in its spread, known as car- duced in 1894 by another German, riers, who harbor the bacillus but are von Hehring, who also introduced not themselves sick. We can deter- immunization by toxin-antitoxin mix- mine by the Schick test those people ture in 1912. The Schick test for de- will take the disease if exposed, and termining whether or not an indi- with toxoid or alum-precipitated tox- vidual will take diphtheria if exposed oid can render them immune. By use was introduced by Schick in 1913. of antitoxin we can successfully treat In 1924 Ramon, at the Pasteur Insti- patients with the disease. And with tute in Paris, developed toxoid for all that, in North Carolina last year, protective vaccination, a product over two hundred persons, most of which immunized a higher percent- them children, died of this disease. age with two doses than toxin-anti- There are some significant facts toxin did with three. In 193 3 the which we must keep in mind regard- latest improvement in our method of ing diphtheria as it occurs in our 14 The Health Bulletin May, 1935

Southern States. The most important we have reached the ideal of immun- of these is the age period of greatest izing every child at six months of mortality. In a study made recently age, we will not have to set any time of diphtheria mortality in five South- for special effort, but we have not reached that state, so there are thou- ern States, including North Carolina, sands of tots six years and younger it was found that 70 per cent of all who are not protected and who would deaths occurred under the age of five probably take diphtheria if they were years. This is quite different from exposed. Therefore, we must think of North- the picture in a group of five having them protected now, when for ern States which were studied there will be sufficient time for com- comparison. In the Northern States plete protection to develop before the only 42 per cent of the deaths were disease becomes prevalent again next par- under five years. We are not. as fall. interested in the ents, particularly Another important fact in regard which may account scientific reasons to diphtheria in the South is that, we are vi- for such a difference, but although the Southern States had a implications it tally interested in the much lower diphtheria mortality rate immunization carries in regard to our ten years ago than the Northern program. States, the states showing the high- From the beginning of our empha- est rates in 1933 were all Southern sis on immunization, a large amount states. This is probably not due en- of our mass immunization has been tirely or even largely to more exten- carried on in the schools, because sive immunization in the North, but, there we had the largest groups al- whatever the cause, it is a challenge ready assembled and easily reached. to us to marshal our forces and see When we consider the fact that that our babies and children are pro- nearly three out of every four chil- tected and that the mortality rate in dren who die of diphtheria die before North Carolina is reduced to the low- they reach school age, we realize that est possible level. Diphtheria in we are practically guilty of locking North Carolina had fallen rather the barn after the horse is stolen, so steadily for some time prior to 1933. to speak, when we wait until the In that year the mortality rate rose children start to school before im- over that of 1932, and it is probable munizing them. We must concentrate that completed figures for 19 34 will our efforts earlier than that. show a rate as high or higher than Immunization should be done as that for 1933. soon after the child reaches six Just a word in regard to the im- months of age as possible. Mothers munizing agent we are using at the have long had a nickname for certain present time, namely, alum-precipi- speaking of of the first set of teeth, tated toxoid. This is a product which teeth. Per- the "eye" and "stomach" in young children gives little or no re- haps it would not be amiss to nick- action, and yet induces protection in a name the very first teeth baby cuts, very high percentage of cases. The calling them the immunization teeth, average percentage rendered immune because they are cut at just about has been 94 to 98 per cent. This the time the child should be immun- product contains no serum and, ized, first against diphtheria, and therefore, does not sensitize the child soon thereafter against smallpox. in any way. The objection used to be scientific, Such a scheme may not be raised to toxin-antitoxin that it but it helps to remind us of the caused the individual to have disa- proper time. greeable and even dangerous reac- The next two or three months are tions to subsequent administrations the season of the year when we of antitoxins or serums, but this is should turn our thoughts especially not the case with alum-precipitated to diphtheria immunization. When toxoid. Its use is simple and attended —

May, 1935 The Health Bulletin 15 with little inconvenience, is harm- reaches six months of age, or at the less, and is effective. time of appearance of the very first To summarize: Our weapons for teeth. This is the season of the year fighting diphtheria are more com- when the immunization of unprotect- plete than those against almost any ed children over six months of age other disease. The agent now used should be pushed in order that their for diphtheria immunization is highly protection may develop before the effective and requires but one injec- disease begins to increase next fall. tion. The most dangerous period of These facts constitute a challenge to the child's life, so far as this disease parents, physicians, and health offi- is concerned, is from six months to cials to see that our children are four years of age; therefore he protected against this dread disease should be immunized as soon as he NOW.

We Do Not Harvest Our Bumper Baby Crop

IT is to be regretted that the Gen- bringing these babies to life as much eral Assembly thinks better of knowledge of cleanliness and sanita- making more liberal the right of its tion as the State requires of the bar- citizens to breed legally than it does bers at the State capital who shave of protecting the State's babies after the legislators' faces or of the sweet they are brought on this earth by the young "beauticians" who lave cos- travail of many mothers who are in- metic mud upon the cheeks of the nocent victims of the liberality of ladies-in-waiting in the hotel lobbies. our statesmen. License fees for mar- It may be, quoting the language of riage have been reduced; the require- Representative Wayland Spruill of ment for publication of marriage Bertie, who let loose some of his bans minors has been abolished; by choice oratory and wit in killing a requiring a physician's the regulation bill for the regulation of the practice certificate showing a person to be of midwifery, that down here in the free from before a contagious disease Roanoke-Chowan section we are pro- marriage license be granted has may lific enough to produce "a twice-a- been repealed. It has become easy to year crop of babies," while our fertile marry and breed children legally in soil, known as the best and most North Carolina. adaptable within the confines of the But it is hard to rear a child to Nation, will give up only one crop of maturity in this State. North Caro- corn or tobacco or cotton. But we lina ranks high among the states in cultivate these crops and bring them its infant and maternity death rates. to profitable harvest. We do not do Thousands of babies born to North as well by our babies. They die by Carolina mothers die before they the hundreds because of ignorance reach one year of age. They die as and lack of sanitation on the part of the result of ignorance and poverty, the midwives who are the only at- and that poverty is not only the lack tendants at the greater percentage of of material things, but the poverty of births. Two of our counties—Bertie, knowledge of proper care and nour- Representative Spruill's own, and ishment of the young. It is the sort Hertford—are rated among the high- of ignorance among our people that est in North Carolina in infant and is shown in magnified form by legis- maternity death rates. lators who make it easy for the ig- In the place of oratory lauding our norant and blind to breed babies breeding capacity, there should be legally, but refuse to pass a law shame that such conditions exist an' which requires of those who assist every effort given, for their corrf mothers at their time of peril in tion. Ledger-Advance, Windsor. THIS SPACE IS SORROWFULLY DEDICATED

TO THE MEMORY

OF THE

NORTH CAROLINA BABIES

WHO DIED DURING 1934 BEFORE THEY WERE ONE YEAR OLD

A DISGRACEFUL SACRIFICE OF INFANT LIFE FOR WHICH THE STATE HAS NO LEGITIMATE ALIBI . 1 MR. JNO. G. BEARD* CHAPEL HILL, H

PuHis\edkj Tf\E,A°RT/\CftRgU/m 5TftTE.5PARDg7\E\Un

This Bu]1etir\willbe 3eryt free to arwj citizen of the State upoi\ reques 1.

Entered as second-class matter at Postofice at Raleigh, N. C, under Act of Jvly 16, 189i Published monthly at the office of the Secretary of the Board, Raleigh, N. C.

Vol. 50 JUNE, 1935 No. 6

Detective Work Against the Malaria Parasite

DOCTOR WHITE OF DUPLIN COUNTY MAKING BLOOD EXAMINATIONS TO LOCATE CENTERS OF MALARIA This important work has been carried on by the State Board of Health through many eastern health officers in cooperation with malaria control activities being sponsored by the North Carolina Emergency Relief Admin- istration under supervision of the North Carolina State Board of Health assisted by the United States Public Health Service. The malaria menace and the mosquito nuisance have been removed and are still being removed from many North Carolina towns and rural centers of population. You can help your community obtain such service by reporting to the State Board of Health any prevalence of malaria. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

S. D. Craig, M.D., President Winston-Salem G. G. Dixon, M.D - _ - Ayden H. Lee Large, M.D _ _ - - Rocky Mount J. N. Johnson, D.D.S Goldsboro H. G. Baity, Sc.D Chapel Hill W. T. Rainey, M.D _ - Fayetteville Hubert B. Haywood, M.D - - - ~ Raleigh James P. Stowe, Ph.G Charlotte J. LaBruce Ward, M.D - - _Asheville

Executive Staff Carl V. Reynolds, M.D., Secretary and State Health Officer. G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Preventive Medicine. Warren H. Booker, C.E., Director Division of Sanitary Engineering. Ernest A. Branch, D.D.S., Director Division of Oral Hygiene. John H. Hamilton, M.D., Director Division of Laboratories and Vital Statistics. J. C. Knox, M.D., Epidemiologist. R. T. Stimpson, M.D., Vital Statistician. R. E. Fox, M.D., Director Division of County Health Work.

Prenatal Care (by Mrs. Max West) Baby's Daily Time Cards : Under 5 months ; Prenatal Letters (series of nine 5 to 6 months ; 7, 8, and 9 months ; 10, monthly letters) 11, and 12 months; 1 year to 19 months; Minimum Standards of Prenatal Care 19 months to 2 years. Breast Feeding Diet List: 9 to 12 months; 12 to 15 Infant Care. The Prevention of months: 15 to 24 months; 2 to 3 Infantile Diarrhea years ; 3 to 6 years. Table of Heights and Weights Instructions for North Carolina Midwives.

CONTENTS Page Notes and Comment 3 Heredity, Germs, Teeth - ~ 6 Need of Infant Care in North Carolina „ 7 Some Items From State Nurses' Reports _ 9 An Indecency 10 Report of Health Officer for City of Concord and Cabarrus County 11 More and More Babies _ _ 13 "But I Only Had One Drink" 13 How a Little Boy Learned To Be Clean 14 The Baby State ~ 14 Two Additional Assistants for the Stork 15 "How Long Shall We Eat Together?" _ 15 Tooth Drama Makes Its Bow To North Carolina Audiences 16 PUBLI5AE10 BY I TML MORTM CAROLINA STATE. BOAIgD °^MEALTH

Vol. 50 JUNE, 1935 No. 6

Notes and Comment By The Editor

19 34 there were 2,114 cases of ported favorably, it was killed on INdiphtheria reported to the North the floor of the Senate. Carolina State Board of Health. Just why any human being with In that year 208 deaths occurred. normal faculties and average intelli- These figures are presented here to gence could object to a baby's being call attention again to the fact that given a harmless preparation that diphtheria is a preventable disease. would protect it from so terrible a With the new toxoid preparation disease as diphtheria is beyond our more than 95 out of each 100 understanding. No one has greater cases could be prevented. Most of respect for religious scruples and these deaths occur in children under genuine religious principles than the school age. A large percentage oc- writer of these lines, and no one has curs under three years of age. When more contempt for people who try to toxoid is given to a baby between befuddle the public under the guise six months and twelve months of age, of religion than we have. it is immunized practically for life. These aforementioned cults would In the recent Legislature a bill deny to a child ill of diphtheria the was introduced in the Senate requir- use of antitoxin. An adult in his nor- ing all parents to have their babies mal faculty has a right to take or immunized against diphtheria be- decline any treatment of any kind tween six and twelve months old. when he is sick or when he is well. The hearing before the Health Com- If he knows the consequences of such mittee on this bill brought to Ra- neglect, he is within his rights and leigh a large aggregation of quacks nobody could or should object. But and the votaries of one or two so- when such an individual undertakes called religious cults. They are the to prevent the administration of an folks who claim that disease germs established preventive to a helpless do not exist, and some of them even baby, then it is time to end such so- deny the existence of disease of any called personal liberty. kind. All of them raised as loud Personally, this writer did not ap- noise as they could against the re- prove the introduction of such a bill, quirements of this bill. preferring to go along with the edu- It was clearly brought out at the cational work, which is a slow proc- hearing that the use of the toxoid ess, but sure in the end. But the could not possibly hurt any baby, objection of the writer to the legis- and science has clearly demonstrated lation was one of methods, and not that it protects nearly all of them of principles. We have always be- against diphtheria; and yet these lieved in teaching by demonstration antis, or objectors, succeeded in be- and example and in the slow process clouding the issue to such an extent of education. We have not believed that, even though the bill was re- in force and compulsion in anything The Health Bulletin June, 1935

when it could possibly be avoided. dietetics, home economics, menus and The net fact remains, however, that recipes, and so on. These people are diphtheria is still with us; and many endeavoring to awaken the American people in this State, as a result of people to a better understanding of misinformation disseminated, will the advantages of fish and sea food continue to see their babies contract from the health as well as other diphtheria and die. points of view. This organization For several years the summer should receive the cooperation of the round-ups, or pre-school clinics, held public agencies in North Carolina. by the parent-teacher organizations We have pointed out in these col- and various health communities of umns several times the desirability the State have insisted on the immun- from a health standpoint of a greater ization of all pre-school children use of fish and sea food in the diet of against diphtheria. This will be kept the average North Carolina family. up. We hope this year before schools The fishing and sea-food industries start in September that every child on the coast of eastern North Caro- entering school for the first time lina is one of the large interests of may present proof of immunization the State. Their greatest handicap against diphtheria before enrolling in has been lack of a market. They the schools. have the potential market here in Diphtheria is not one of the dis- the State of North Carolina if the eases in which an attack confers im- people could be induced to avail munity. A child may have repeated themselves of this plentiful, nutri- attacks, as many maybe as three or tious food. It has been cheaper the four, perhaps at an interval of a past year than ever before, and it year or more. The last attack may seems more plentiful. The fishing kill it. Therefore, when an almost and sea-food industries in this State sure preventive is worked out by re- occupy a position similar to that of search workers and presented to the the dairying industries. The more public, such preventive should be use our home folks make of our utilized one hundred per cent. dairy products and our sea foods, the

$ * 4 more work and the greater prosperity is certain to come to large numbers there has been formed RECENTLY of the State's citizens, and at the in New York City, with head- same time they are consuming food quarters at No. 80 Broadway, a which is nourishing and helpful. corporation known as the "Fish and * * * Sea Food Institute of the United States." Its purpose is to promote a THREE things have recently oc- better understanding of the advan- curred to remind us of a deter- tages of fish and sea food, emphasiz- mination we have had for sometime ing its economic food value. It is to say something here about the de- prepared to supply health officers sirability of physicians and nurses and physicians, hospitals and others and others engaged in treating or "a source of authentic information caring for the sick exhibiting a little on the advantages of fish and sea more sympathy and kindly feeling in food, from the nutritive, the dietetic, their contacts with sick folks and the economic, and the gustatory with their relatives. point of view." The first item was a front-page As its promoters frankly state, it paragraph at the top of the page in is founded by the leaders in the fish The Health Bulletin of the New industries. It has the full support Hampshire State Board of Health and cooperation of the United States for January. The paragraph was the Bureau of Fisheries. They will have following quotation, from none other available information, through bulle- than North Carolina's own distin- tins on fish and sea food, covering guished citizen, Dr. Hubert A. Roys- June. 193-J The Health Bulletin

ter. of Raleigh. Here is the para- ailment, to give ample time for di- graph : rect personal relations between physician and patient and between nurse "Nothing so promotes the hospital and patient. idea among both the rich and the third poor in a community, nothing so edu- The item: Out of the large cates the ignorant to the need, and number of letters received by the the well-informed to the value of a State Board of Health daily there is hospital, as frank expressions of always one or more that illustrate good-will and simple human kind- in one way or another the type we ness within its walls by everyone as- are discussing. We quote from one with the conduct of the in- sociated such letter. This was from a man stitution." who stated that he had had pellagra In the foregoing paragraph Doctor for several years. Last year he spent Royster has said all that could be two weeks in a hospital, and they ad- said on the subject. He has had more vised him that medicine would do than forty years of experience as a him little good, and sent him back surgeon with a large practice, in home with the injunction that he dealing with various types of human- should eat plenty of eggs, red meats, ity. He has clearly stated one of the whole-wheat breads, vegetables, and greatest needs in this field that we fruits, and drink plenty of milk. And know of. He speaks with authority; they told him also to take some and this writer, for one, is grateful brewer's yeast every day, especially to Doctor Royster for his expression, through the spring months. even though we had to go to New This man writes that in the latter Hampshire to get this statement. We days of March his symptoms have are proud of the recognition so ac- come back and he is worse off than corded to Doctor Royster in a far- ever before. He says that he has not away State. been able to work to make anything The second item: During the re- in a long time; that he has no funds, cent session of the Legislature a man and therefore he had found it neces- from Cumberland County who had sary to visit the county health officer recently been a patient in one of the and ask that official to advise him and State hospitals wrote a letter com- to prescribe for him. He stated that plaining of the lack of this very he had been to see the health officer thing. He made no charges of in- several times. He, of course, had told competence or of deliberate mistreat- him that he must eat the food the ment; but he did charge that the hospital had prescribed the previous kindly individual encouraging con- year, and that he should take some tact with patients was neglected. In yeast. He stated the health officer this one important essential the head told him medicine would do him no of the institution readily admitted good, and he would prescribe none the truth of the man's complaint. for him. An overworked doctor, who can have The following statement, however, time for only a glance at most of the arrested our attention above every- individual patients among the hun- thing else in his letter: "But Doctor dreds he has under his charge each Blank doesn't ever ask me how I am day, cannot take time to stop and —whether I am getting any better or give the one most important part of whether I am any worse." his service as a physician to the In this case we happen to know patient who is upset and in sore need that this county health officer is a of direct sympathy, particularly from capable physician and an efficient the physician. There should be a health officer. The county is a large sufficient number of physicians and one, and the health officer is doing nurses on the staff of all these insti- a great deal of work. Many people tutions, and of every hospital treat- come to the health department for ing the sick, no matter what their advice about various matters. Like

"'" " - 1 •-;;/ * The Health Bulletin June, 1935 the practicing physician, he is weary, things, but we are passing along to daily listening attentively to the ills them and the public the fact that of the people who consult him. He such things are essentially necessary for the best results for all con- is probably doing the best he can in cerned. the situation; but the plain fact re- It should be emphasized right here mains that the impression on this that no health officer or health de- is favorable one. one patient not a partment should be required to ex- Pellagra is always accompanied by amine and prescribe for patients of a mental upset, and the mental con- any kind. That is a function which dition of the patient, his attitude, belongs solely to the practicing phy- and his fears, and his hopes—all sicians, and local authorities should should be taken into consideration, not expect or allow their health offi- and he should be given all the help cers to undertake such work. The and encouragement possible. We are health officer should be expected to not criticising any health officer or devote his entire time to preventive any physician who fails to do these medicine in its broadest meaning.

Heredity, Germs, Teeth Factors Bringing About Tooth Decay Are Analyzed

By Waldermar Kaempffert in Neiv York Times RISING before the Michigan sert, pour maple syrup on your buck- Academy of Science, Arts and wheat cakes, gulp down half a dozen Letters, Dr. Russell W. Bunt- cloying ice-cream sodas or sundaes a ing of the University of Michigan's day, and the bacillus flourishes. The Dental School told why he thought old preaching against sweets is justi- that teeth decay. The question is one fied, because the bacillus likes sweets, that agitates physicians and dentists too. Heredity Important alike. Bunting puts his finger on the bacillus acidophilus and gives rea- But Doctor Bunting is just as in- sons for believing that it plays some sistent that heredity is an important part in the decay of teeth. Some factor in tooth decay. About 7 per part, mind you. For the Doctor be- cent of the hundreds of cases that he lieves that half a dozen factors are studied were naturally immune to at play. caries. Their parents and grand- For five years Doctor Bunting has parents had unwittingly seen to that been experimenting in an orphanage by handing on their own good teeth. of 300 children whose diet he could At the other extreme were 10 per control. He found that when the cent whose teeth could be prevented food was low in sugar, tooth decay from rotting only by unceasing vigi- disappeared, except in a few over- lance. Between the highly immune susceptible cases. and the highly susceptible lie 83 per This smacks of the old-fashioned cent who should control their diet. notion that candies and sweets are Whether or not Doctor Bunting's bad for the teeth—a notion which deduction is correct, it is certain that some dental authorities have pooh- many dentists are now convinced of poohed in late years. Doctor Bunt- the efficacy of dieting. Eskimos who ing supports it with some convincing never eat the white man's pap, the evidence. Whenever there is a high inhabitants of Tristan da Cunha and count of bacillus acidophilus in the other lonely isles cut off from sugary mouth, he finds also a high rate of and starchy food have no need of a decay. Heap more sugar in your des- dentist. June. 1935 The Health Bulletin

Need of Infant Care In North Carolina

By R. T. Stimpsox, M.D., Assistant Director of the Bureau of Vital Statistics, State Board of Health

EVERY baby born within the with, there will be no cause for spe- State today is rightly entitled cial campaigns. to have his citizenship record- Interest in the child and child ed. A baby's birth certificate has welfare has been evident at all ages been aptly called its citizenship pa- throughout history, and though we pers. That no child born within the can with reason claim that only in last year might have reason to regret modern times, in fact during the in future years that no record was past fifty years, has the child really made of his arrival, the State Board come into his own rightful place and of Health, with the assistance of the been recognized and treated as the United States Census Bureau and the future hope of every nation, we can- Emergency Relief Administration, not claim that many of the methods recently conducted a "Register Your for his welfare are of modern con- Baby" campaign to secure the rec- ception. We are inclined to think of ord of every baby less than one year the children of ancient times as the of age, and at the same time deter- recipients of little or no considera- mine how completely these births had tion and, in fact, of many wanton been recorded. cruelties. In early Spartan history Many parents throughout North the child was considered worth sav- Carolina, realizing the importance to ing only if he showed signs of being their child of having its name on the strong, but if he was weak and fee- State's record, have taken the time ble, he was exposed to death. In the and energy necessary to make this early days the father had complete inquiry of the State Board of Health. power over the life and death of his We are happy to be able to state that children, and the expression "to raise the great majority of these children's a child" was first used to signify the births had been recorded, and we father's intention to bring up his are endeavoring to secure a record child by raising him in his arms and of all those not on file by sending a invoking the blessings of the Goddess blank to the parents and asking that Levana. they have the attending physician Many of the methods of child wel- make the necessary entries. When fare began developing quite a good this is done, the record will be safely many years ago, but it has been only kept along with those already on within recent times that these meth- file. ods have been practiced to any ex- If there are parents with a baby tent, and these, with the use of the that has not reached its first birth- newer knowledge acquired in medi- day, and if they have not previously cine, has made infant life much more returned a card, they may still do so. secure. But if we could put into prac- Cards for this purpose may be ob- tice all that is known about keeping tained at the postoffice, county relief the infant healthy, the number of office, or from the State Board of infant deaths in North Carolina Health. would be greatly reduced. It is hoped that in the future it Last year there were approximate- will not be necessary to conduct a ly 80,000 births in North Carolina. special campaign to obtain complete How many of these 80,000 will never reporting of births. In the normal survive the childhood infections and course of events the baby's birth afflictions and attain school age? Or should be recorded within a few days what smaller number will never sur- of birth. If this mandate is complied vive to their first birthday? What we 8 The Health Bulletin June, 1935 would more especially like to know is The second greatest cause of in- what can be done to give every one fant deaths is given as congenital of these 80,000 the best possible debility, or an inherited lack of chance to survive the first year, the strength to survive the conditions second, third, etc., and enter school, met on its arrival into the outside and what school health program will world. Almost one thousand infant insure the most abundant health. deaths will be attributed to this con- Before we can know what will aid dition. A stronger body can be given the infant in safely surviving the by a healthier condition of the par- hazards of the first year, we must ents, and more especially the mother. know what those hazards are. In To attain this, the same advice is 1934 there were over 6,000 deaths applicable as was given for the pre- among children under one year of vention of premature birth and ma- age. This meant that if the same ternal death. ratio holds for this year, that 7 out Less than 5 per cent of the deaths of every 100 infants will die, many under one are due to some deformity of them needlessly, within the year. of the baby. This may or may not be Of every seven infant deaths, ap- reducible. proximately two will not survive for Thus, these conditions, the remedy 24 hours after birth. This will mean of which lies largely in the care of of the the loss of around 1,400 infants the the mother before the birth for almost half of the first day following birth. The cause baby, account year of of death of the great majority of deaths occurring the first these will be given as premature life. Forty per cent or approximately within two birth. 2,400 babies will die Whatever is done to Therefore, it is readily seen that weeks of birth. this number must be done if eight or nine hundred infant lives decrease after, for are to be saved, the health measures before birth and quickly must be practiced by the mother be- the time is short. Well-meaning medica- fore the arrival of the infant. In neighborly advice and home pro- some cases prematurity is unavoid- tion will not take the place of able, but in many, with proper medi- fessional care. the babies to cal advice, and the following of this With 40 per cent of one already lost, what advice, it is avoidable. We cannot die under the greatest hope to reduce materially this high condition will demand an- infant death rate until the mother number of the survivors? The seeks and follows the advice of her swer to that is diarrhea and enteritis often physician. This is not a matter to be or "summer diarrhea," as it is remedied by an eleventh-hour appeal, called, with pneumonia vying for but a matter for medical supervision second place—both conditions to a for months before the infant's ex- large extent preventable. pected arrival. The greatest preventive of summer In addition to the lessening in the diarrhea is proper diet. The ideal infant death rate, the same course nourishment for the young infant is, will save many mothers from an un- of course, breast milk, except in the timely death, of which there were exceptional case. When other food is 547 in 1934. This gives us a rate begun, cow's milk is the normal se- considerably higher than for the lection. But to lower the possibility country as a whole. There is little of diarrhea, the milk must be the satisfaction in saying our greater best. Extra precaution must be taken number of maternal deaths is due to during the hot summer months. The the larger number of Negroes in our relation of diarrhea in children to population. It is true that the ma- the milk supply has been a sanitary ternal death rate for the Negro is problem for many years. Studies higher than for the white, but our have definitely traced relationships white rate is not at all creditable. between the condition of milk, dis- June, 1935 The Health Bulletin

ease among children, and infant the best and safest and exercise deaths. Children below twelve every precaution to prevent contami- months are generally especially sen- nation. Pneumonia sitive to the changes produced in among infants and children is largely secondary to milk, and when milk sours, natural- some acute infections, as whooping cough, ly, containing a large number of etc. In so far as these conditions are germs, diarrhea is likely to occur. preventable, pneumonia is preventa- Striking contrasts have been noted ble. in comparison of infants fed on To secure for every child the most cheap, heavily infected milk, with favorable conditions for its survival, those fed on good pasteurized and it is necessary that parents, physi- other clean milk. It is thus of the cians, sanitariums, and laymen alike utmost importance in the prevention work toward this end. When this is of infantile diarrhea to safeguard done, life for the infant in North milk from contamination. Use only Carolina will be much more certain.

Some Items From State Nurses' Reports

director of the work of the condition is met with much less fre- AS nurses staff employed on the quently today than it has been in the of the State Board of Health, past. This nurse states that the prin- the editor of The Health Bulletin cipal of one of the largest schools in receives a great many interesting re- the section she was at work in was a woman ports from the veteran nurses, who who had been in earlier years the teacher of the seventh spend all their time at work in coun- grade. She said this principal had ties having no organized health de- maintained fine order in the school, partments. The files of the division but did not seem much interested in are full of interesting sidelights on the nurse's work for the children, many public health problems sub- such as testing vision and so on. She mitted by these nurses in their let- finally consented, somewhat reluc- ters and narrative reports. We are tantly, for what she probably regard- quoting a few of these comments, ed as a disturbance in the routine which we are sure will be of interest work. There are a few teachers left to people everywhere. who still think that good order and One of the nurses, working in the the subject matter of the curriculum eastern section of the State, reported are the chief objectives of the school that she had worked in one consoli- system. In the routine inspection dated school on the coast of eastern that the nurse carried through, North Carolina. The population of which this teacher, of course, ob- the place is more than a thousand, served, the nurse found that one of and she said that reports were cur- the best pupils in the school, a four- rent that there were only two milk teen-year-old girl, was emaciated, un- cows in the community. The chief derweight, and had a serious visual point in this item follows: She said defect. This pupil was not the only that in the examination of more than one found in serious need of correc- a score of pre-school children on the tive measures. When such defects day of her visit she never had seen are remedied in time it is invaluable, such deplorable conditions in chil- but when such defects are neglected dren's teeth. it often means disaster for the child. Another nurse, working in one of Both of these stories are old ones, the central counties, reports again on and we hope sometime they will be a very old story. Fortunately, this interesting simply as historical relics. — —

10 The Health Bulletin June, 1935

Another nurse, working in a moun- ther needed attention as much as the tain county, reported that the physi- child, but of a different character." cal condition of a thirteen-year-old But there is a much brighter side girl, together with the family his- to all these nurses' reports now tory, caused her to fear the child when compared to those of a few had tuberculosis. The mother came years ago. Everywhere there is more out to see the nurse, and the latter attention to the children's health went home with the mother to dis- needs. More people are public-health cuss the matter with the father. The conscious and more of them have a nurse insisted that they take the sympathetic attitude toward the ef- child to the family physician for a forts of health workers, and it is medical examination and advice. It rare now to find a teacher who fails developed as usual in such cases that to give the State Board of Health they had no family doctor and were nurse a warm welcome when she not in the habit of consulting a phy- visits the school. The teachers now, sician. The father was indifferent white and colored, do everything in and appeared little interested. The their power to see that the children nurse's comment is the point in this have the advantages of these inspec- story: "I left them thinking the fa- tions and profit by them.

An Indecency

HOWEVER chivalrous the purpose to which it as an institution is enti- of the North Carolina Senate in tled. We were attempting to avert its passage of an amendment to the some of the tragedies resulting from marriage laws repealing the require- the propagation of the species by its ment of an affidavit of physical sorriest specimens. soundness on the part of the mascu- But the past two-three Legislatures line member of the matrimonial part- have jested or worse at the ideals nership before the contract may be embodied in the best-contrived mar- entered into, those voting for it have riage law of this section of the United lent themselves to a mighty sorry States. It was thought indelicate to business. require a mother of men to be ex- A few years since this State had a amined by her family physician as to marriage law that, while not perfect, her fitness for motherhood. It was was a testimonial to the intelligent deemed perversive of public interest respect which the more thoughtful to require a notice to the public of our men and women feel for their from those who desired to enter into kind. Publication of the banns, the contract which most concerns the health certificates for both bride and public. groom, protected them and the race. And now it would seem all bride- nice youngsters in a Of course a few grooms, of whatever age or physical as did hurry eloped to other states, condition, must be considered Bay- some could not have been certifi- who ards, sans petir, sans reproche, and cated at home. Marrying magistrates fit for mating at the drop of a hat. Carolina, and per- of Virginia, South Greensboro News. haps an occasional Tennessee or Georgia 'squire, picked up a few dollars which border counties would The amount of publicity the doctor have liked to retain within their who looks after the Dionne quintuplets bounds; but what of it? gets is enough to make you think he is We were making an honest effort the mother of the babies. Reidsville to give to marriage that self-respect Review. June, 1935 The Health Bulletin 11

Report of Health Officer for City of Concord and Cabarrus County

Covering Activities of Cabarrus County Health Department From January to December, 1934, Inclusive

By D. G. Caldwell, M.D., Health Officer, Concord, N. C.

THE activities of Cabarrus Coun- specimens for analysis, skin tests for ty Health Department for 1934 tuberculosis, etc. have been very comprehensive. The county - wide immunization The volume of work done has far program against typhoid fever, diph- exceeded that of any previous twelve theria, and smallpox was very suc- months in the history of the Health cessful during 1934. Babies and Department. young children to the number of 762 The communicable disease situa- were vaccinated against diphtheria. tion in Cabarrus County during 1934 The total number of persons receiv- was more eventful than for many ing complete anti-typhoid treatment years. A very severe epidemic of was 6,254, or about one-eighth of measles during the first few months the entire population of the county. of the year required a large amount Since this represents three injections of the nurses' time. Cases of measles for each person, the total number of to the number of 2,673 were quaran- inoculations amounted to 18,762. tined by personal visit; 386 cases of The smallpox vaccination require- other diseases were visited for quar- ments, carried out in cooperation antine purposes, making a total of with the school authorities, resulted 3,059 quarantine visits during the in the vaccination of 1,041 school year. While only four deaths were children. reported due to measles, it is certain This immunization work is one of that many of the deaths from pneu- the most important functions of the monia during that period were indi- Health Department. It is difficult to rectly due to measles. estimate the number of diseases that Scarlet fever was much less preva- have been prevented, with their con- lent in 19 34, showing 27 cases for sequent economic loss and damage to the year, as against 40 cases in 1933. human life. It is estimated that the There were no deaths from scarlet saving of one useful life and ten fever during the year. weeks of average sickness will bal- No smallpox was reported in 1934. ance the cost of a large amount of Diphtheria again reached the low public health work. Enormous gains level attained in 1932, with only 21 to individual families and to the cases reported. However, five of county as a whole result when we these cases were fatal. prevent disease and postpone death. Typhoid fever showed an increase, The Venereal Disease Clinic, con- with ten cases reported. Only three ducted by the Health Officer, was cases were reported in 1933. Two very active during the year. White deaths resulted from typhoid fever in patients were given 346 treatments 1934. and colored patients visited the clinic Other features of the communica- 387 times for treatment, making a ble disease program were 505 special total of 733 treatments for venereal examinations made for the purpose disease. Each case requires a large of determining the presence of dis- number of treatments, and these are ease-producing organisms. In this mostly intravenous injections of Sal- group is included the collecting of varsan. 12 The Health Bulletin June, 1935

The anti-tuberculosis program, un- In the interest of health education, der the supervision of Miss Naomi almost 10,000 health pamphlets have Moore, included two adult clinics in been distributed during the year which 130 persons were examined. through schools and other agencies; The Preventorium was carried on 81 articles on health have been pub- again for ten weeks during the sum- lished in the local paper, and we wish mer, with thirty children under treat- to acknowledge with appreciation the ment. The Health Officer cooperates fine cooperation given by the staff of by examining these children and giv- The Tribune. Twenty-one talks on ing medical aid while the children health were made by members of the are under treatment at the Preven- department to P.-T. A. and other torium. The tuberculosis nurse made groups. 55 visits in the interest of tubercu- The total number of specimens losis cases. sent to the State Laboratory for anal- As a part of the program for infant ysis in 1934 was 605. and maternal welfare, a series of The sanitation program in the classes was held for the instruction county was enlarged a great deal of midwives. During the year 243 during the year. The early months visits were made by the nurses to saw much sanitary work done maternity cases, for advice and su- through the CWA. While this was pervision. The number of babies vis- not entirely satisfactory as to econ- ited was 2 81. omy or efficiency, a considerable Pre-school clinics held by the amount of good work was done. In Health Officer and nurses during the November, through the United States spring were attended by 522 chil- Public Health Service, a sanitary in- dren. spector directly responsible to the A large volume of work has been Health Officer was appointed. Mr. done in the interest of school chil- Charles V. Morgan is filling this posi- dren. A total of 6,107 children were tion, and it is expected that this work examined during the year. Many of will go forward with good results. these children were handicapped by In relation to the matter of sani- physical defects. As time permitted, tation, I, as Health Officer, would nurses have visited the homes of like to urge that the County Board of these children, urging and encourag- Health adopt a county-wide pigpen ing the parents to have these defects law, to cover congested areas which remedied. Visits have been made to do not come under the jurisdiction of 1,153 homes. the ordinances of the City of Con- These school examinations have cord. been the means through which most The milk sanitation program in of the cases for the large yearly ton- this county has gone steadily forward sil clinics have been found. The in 1934. In my opinion, it has made clinic last June was very successful. much improvement since last year. Two hundred and twenty-nine chil- A recent letter from Mr. Booker, of dren were operated upon. This fea- the State Board of Health, states ture of our work has the interest and that there has been quite an improve- support of the public to a large de- ment over the preceding year, and he gree. It is very valuable in an educa- feels that with a little more time and tional way as well as to the children effort all the ratings can be brought who profit directly by this service. to over 90 per cent, especially when Another agency through which some of the new machinery contem- Mr. many defects were corrected was the plated is installed. However, inspector, dental clinic made possible through John L. Brown, Jr., milk this the generosity of the County Com- will make a detailed report of missioners. It has been a pleasure to work. cooperates in see the good dental work done in this The Health Officer all public clinic for hundreds of children. this work by examining —

June, 1935 The Health Bulletin 13

food handlers. During 1934, 277 County Board of Health, the school food handlers were examined by the authorities, the medical profession, Health Officer and certificated as be- and all other organizations or indi- ing free from syphilis, tuberculosis, viduals who have contributed to the or typhoid germs. public health accomplishments in this The jail and County Home have county during 1934. made frequent calls for medical attention. The Health Officer made 83 [Editor's Note: We are publish- visits to the jail, treating 177 per- ing the annual report of Dr. Cald- sons. The County Home was visited well in full, because it illustrates 81 times, 127 persons having been plainly some of the duties carried on by a modern, treated. full unit combined county and city health department. In closing, Cabarrus County Health % We feel that many of our readers Department wishes to express appre- will find this information interest- ciation of the fine cooperation of the ing.]

More and More Babies r T*HE fact that North Carolina has tion has resulted in fewer and * fewer a tremendously high birth rate births among the higher intellectual and the fact that it increased again types and no change in the rate in March is not a fact over which to among those further down in the in- be either proud or sorrowful; it is tellectual scale. The result, of course, rather beside the point. The crux of is a rapidly increasing preponderance the situation is: What kind of babies of citizens of the criminal, moron, are North Carolinians bringing into and mentally incompetent classes. the world? And the answer is not a The problem of genetics is one beautiful one. which has been studiously avoided, The old saying, "The rich get not only in North Carolina, but in richer and the poor get children," is the country as a whole. The time lamentably too true. This paper must come when the problem will takes no stand on the subject of have to be given attention, and the birth control, but at the same time it sooner that time comes, the quicker recognizes the fact that partial dis- the situation may be remedied. semination of birth-control informa- Tarooro Southerner.

"But I Only Had One Drink"

AX analysis of 119 automobile acci- involved ** only slightly more than one dents, involving the death of person per accident. There is a di- 216 persons, made in Milwaukee by rect relationship between the severity Herman A. Heise, M.D., and pub- of the accident and the amount of alcohol; from which lished in the Journal of the American the only-one- little-nipper may draw the conclusion Medical Association, shows that it is that he is relatively unlikely to not primarily the obvious "drunk" kill anyone, but may merely maim some- who constitutes a major road men- one for life. This knowledge should ace, but the "drinking driver"—the be a relief. man who thinks he can drive as well "Considering a person sober as after a little nip. long as he can still walk and talk is Doctor Heise found that the alco- responsible for the small value of hol accidents, mostly after little nips, present-day statistics regarding the were responsible for injury or death relationship of alcohol to automobile to more than two people per acci- accidents," Doctor Heise states. dent, while the non-alcohol accidents Readers' Digest. ;

14 The Health Bulletin June, 1935

How a Little Boy Learned To Be Clean

By Nell Pool, Women's College, University of North Carolina

There was a little lad, my dears. With rough and woolly towels then Who went to bed one night, They tied his limbs quite tight; His toothbrush hanging high and dry, His eyes and mouth they filled with suds His face, oh my! a sight. His heart they filled with fright. His hands were anything but clean, Old Mr. Toothbrush next approached, But he said, "I don't care; And in his hand he had I'm awfully sleepy," and you see, A giant pail of water His mother wasn't there. He intended for the lad.

So into bed he tumbled, "Oh, Mr. Toothbrush," loud he cried, And before he could repent And sat up straight in bed. He drifted into dreamland, He opened wide his eyes to find And what a night he spent! His mother there instead. A giant toothbrush came So you can bet from this day forth And set himself upon the bed; This little boy was seen, And then a little band of soaps Before he tumbled into bed, Came dancing around his head. To make himself quite clean.

The Baby State THERE may be some in North children of school age than any other Carolina who will stir with pride State, except possibly our southern at the news that North Carolina's neighbor. With more white people long-boasted high birth rate rose in our population, we lead the Na- again in March. This news that North tion, ahead even of South Carolina, Carolinians are having more babies with the highest percentage of total may be a sign of recovery, depending population enrolled in schools. regarded as upon whether babies are We have more children to support news luxuries or necessities. The and educate and fewer adults to sup- may also throw some light on the port and educate them. Assembly's difficulties and General We have more young people to problems of safety and security the drive automobiles on our excellent education in the State. and highways than any other state, Statistics, which may show much which may be worth considering in demonstrate pretty clearly or little, connection with our high highway that North Carolina is the baby State death rate. in the Union. One-half of the popu- Thus, while it is possible that this lation of North Carolina is 19 years high proportion of babies may soften old or younger, while in the Nation the difficulties of North Carolina in as a whole the proportion of such considering old-age pension plans, it young people is only a little more intensifies the State's difficulties in than a third. Only South Carolina almost everything else. has a younger population. On the other hand, North Carolina and We have talked plenty in recent South Carolina have the smallest years about the fact that our trou- percentages of people in every age bles came from piling up debt. We group from 20 years old on up, ex- were not only piling up debts, but cept in one instance. babies as well, and from a State The significance of this infantilism standpoint one is about as expensive is obvious: as the other. Now, as the March fig- We have a larger proportion of ures show, we may be still timid — —

June, 1935 The Health Bulletin 15

about new debts, but we are not at ing its bouncing and increasing all timid about new babies. babies as Mr. Dionne must have had Unlike Papa Dionne, North Caro- in that early morning when Doctor lina has received little publicity out- Dafoe told him there were five of side the State for its baby crop, but them. Name of a name! Mouths the State ought to have very much and minds to be filled. And how to the same feelings today in consider- fill them? News and Observer.

Two Additional Assistants For the Stork

ACCORDING to a study made at ing habit, if any, of newly born in- •*»• Antioch College, unborn babies fants of mothers who follow the prac- of smoking mothers are sensitive to tice of getting a lift by lighting a fag. the toxic properties of tobacco smoke, With drinking and smoking widely the heart action of the unborn infant prevalent among prospective moth- usually speeding up when the pros- ers, it may be that presently Dr. pective mother has taken a few Stork will require two additional assistants whiffs of her favorite cigarette. when he delivers a new citi- No conclusion was reached as to zen—one to stand ready with cigar- whether or not smoking by prospec- ette and match and the other with tive mothers is harmful to the un- a mixed cocktail. born infant. But further studies will Accustomed to the stimulation of be made after the babies of smoking alcohol and tobacco during the gesta- mothers are born, in an effort to de- tion period, the first wail of a newly termine this. born infant may be for a cigarette Leaving learned doctors of medi- and the second for a cocktail. Fail- cine to settle that question, it may ing to get the cigarette and drink, not be inappropriate to speculate on the little thing may cry all night. the extent of addiction to the smok- Upton G. Wilson in Reidsville Review. HOW LONG SHALL WE EAT TOGETHER? 16 The Health Bulletin June, 1935

TOOTH DRAMA MAKES ITS BOW TO NORTH CAROLINA AUDIENCES

''";''. ..'., *? ' MR. JNO. G. BEARD,

CKAPEL KILL, * . C.

Pu"bli 5\edb4 T/\L^°KmCAK?LINA STATE- B7\E\Uin T^w^^i^—1———— —————^^—i1——^— rhis BuJklirwvillbe seryt free to arvq ^cittzer\ of the 5tcrteupo r\ request.|

Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, lS9i Published monthly at the office of the Secretary of the Board, Raleigh, N. C.

Vol. 50 JULY, 1935 No. 7

HISTORIC CAPE FEAR RIVER

PICTURE MADE AT HEAD OF NAVIGATION NEAR FAYETTEVILLE

We are publishing this picture of the Cape Fear, symbol of beauty and power, as a reminder to our people that our State has a heritage from Nature second to none of the others. But unless we bestir ourselves and conserve our natural advantages, by beautifying our roadsides, our towns and our farms, and conserving our forests, we will soon come to the day when travel- ers will look on our system of highways as cement trails to enable them to cross the State quickly. Our rivers will be thought of only as sewage channels. Vacation time affords the opportunity for us to realize that health and beauty are desirable attributes of life itself. ;

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

S. D. Craig, M.D., President -Winston-Salem G. G. Dixon, M.D _ Ayden H. Lee Large, M.D _ _ _. Rocky Mount J. N. Johnson, D.D.S. Goldsboro H. G. Baity, Sc.D „ _ .Chapel Hill W. T. Rainey, M.D _ „ _ „ „ Fayetteville Hubert B. Haywood, M.D „ _ _ Raleigh James P. Stowe, Ph.G _ Charlotte J. LaBruce Ward, M.D _A.sheville

Executive Staff

Carl V. Reynolds, M.D., Secretary and State Health Officer. G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Preventive Medicine. Warren H. Booker, C.E., Director Division of Sanitary Engineering. Ernest A. Branch, D.D.S., Director Division of Oral Hygiene. John H. Hamilton, M.D., Director Division of Laboratories and Vital Statistics. J. C. Knox, M.D., Epidemiologist. R. T. Stimpson, M.D., Vital Statistician. R. E. Fox, M.D., Director Division of County Health Work.

Prenatal Care (by Mrs. Max West) Baby's Daily Time Cards : Under 5 months ; Prenatal Letters (series of nine 5 to 6 months ; 7, 8, and 9 months ; 10, monthly letters) 11, and 12 months ; 1 year to 19 months Minimum Standards of Prenatal Care 19 months to 2 years. Breast Feeding Diet List: 9 to 12 months: 12 to 15 Infant Care. The Prevention of months ; 15 to 24 months ; 2 to 3

Infantile Diarrhea years : 3 to 6 years. Table of Heights and Weights Instructions for North Carolina Midwives.

CONTENTS Page„ „„ Notes and Comment 3 Poliomyelitis (Infantile Paralysis) _ _ 5 Some Practical Considerations of the Rabies Problem 8 New Facts About Healthful Diets 10 Summer Vacation 13 What Matters Most _ _ _ 15 The Trial _ _ _ 16 Vol. 50 JULY, 1935 No. 7

Notes and Comment By The Editor

JULY and August being the handling the eggs got certain kinds months in which most of the of germs in the egg proper through workers of this State take their the cracked shells. vacations, if any, we call attention at As most people know, raw eggs this time to the necessity for the and milk are two good culture media observance of a few simple precau- for many kinds of germs. That is, tions if one would have a successful once the germs enter the egg, they and satisfactory and happy vacation. multiply with extreme rapidity. We do not want to be a kill-joy, but Therefore when the custard was as diseases, such as typhoid, have made from these eggs and not cooked not been completely eradicated, and thoroughly, the germs were not de- sources of infection still lurk here stroyed, but continued to multiply, and there, it is best for people to be and, therefore, the people eating the reminded that there are still some product were simply taking big doses dangers incident to taking a vaca- of the poison. tion, besides automobile accidents. In * * * this issue Dr. J. C. Knox has a short PEOPLE often read of epidemics of article under the general title of septic sore throat. This condition Vacation." sug- "Summer We would has been described in the columns of gest that anyone contemplating a va- The Health Bulletin from time to cation this summer would do well to time during the last few years. It read that article and be governed is a condition which sometimes is accordingly. almost as serious as diphtheria. It * * * frequently has complications which BACK in April and May newspaper involve the kidney and from which readers the country over were death often occurs. It is a serious interested in a report of some serious germ disease. cases of food poisoning which oc- During the last two weeks of April curred in Westchester County, New and the first week of May at Windsor York. Several hundred people were in Bertie County there occurred an made seriously sick from eating a outbreak of septic sore throat. Six- certain kind of bakery product which teen people had the disease. The contained fillers made from eggs and cases all seemed to originate from a milk and sugar and so on. The in- certain drug store in the town that fection in this case was traced down handled milk from one particular to some cold-storage eggs, imported cow. The owner of the drug store from somewhere in the West. It developed septic sore throat, and the seems that some of the eggs were complication of pneumonia in the cracked, and back in the line sometime of it resulted in his death. That where from producer to consumer was the only death occurring during somebody had an infection and in the epidemic. The infection was The Health Bulletin July, 1935

last through- traced from the drug store to the after-effects which may serious cow from which milk was supplied, out life. It is, therefore, a cannot be blamed and the cow's udder was found to be disease, and people fearful when it becomes infected. As soon as the supply of for being is no known milk from this cow was stopped, no too prevalent. There preventing its other case developed in the two method at present of such diseases weeks following, and, so far as we development. Unlike know, none has developed since. as diphtheria and typhoid fever, there has as yet been developed no It will thus be seen how easy it is commonly used serum or vaccine for a little infection that starts from can be administered to chil- one tiny ulceration on the udder of which order to prevent attacks of one cow to travel to many people in dren in disease. Isolation of the patient a short time. People who are not the by physicians and absolutely sure of the purity of their is recommended authorities merely as a pre- milk supply and its safety should boil health matter. the milk before using, when they cautionary cannot obtain pasteurized milk from While we are on this subject we reportable the dairy which supplies them. Raw would like to say that the in infantile paralysis is milk is healthy and palatable, and diseases—and fever, the vast majority of cases in this one, just as diphtheria, scarlet be, be reported im- State is as safe as anything can and so on—should but there always will be some danger mediately on suspicion, to the health from milk carelessly handled or han- authorities. The law requires the the dled by too many people. In the hot attending physician to report months of the year there is more presence of such diseases within danger from the transmission of such twenty-four hours to the county infections than there is in the colder health officer, and it requires the winter months. county health officer to make such * * * reports within twenty-four hours to epidemiologist at Raleigh. AS these lines are being written, the State epidemiologist has /\ about the last of May, there has Unless the State from all of the prac- been considerable disturbance raised a prompt report and the county and on account of an outbreak of infan- ticing physicians city health officers of the State every tile paralysis. The cases reported concerning such diseases, meth- are considerably more numerous than day prevention and information to ordinarily for the time of year. Such ods of public cannot be provided, and cases as have already developed have the negligence results in increased seemed to occur sporadically, few, if such fear and apprehension on the part of any, of the children having been in intimate contact with any of the the public. other children developing the dis- We would like to urge every physi- ease. More cases have been reported cian and every county health officer, in the in Wake County and Pitt County as well as every householder than anywhere else. On another page State, to make prompt reports upon reportable of this issue we are presenting a the appearance of any short article giving information disease. * * * about the disease. This article was prepared by Doctor Knox, the epi- AS we have stated elsewhere, peo- demiologist of the State Board of x\ pie cannot be blamed for being in- Health. It is simply a presentation alarmed when such a disease as of a few facts known about the fantile paralysis occurs in a commu- disease. nity. It is probable that the morbid A large percentage of children suf- fear exhibited in many quarters when fering, especially from mild attacks the disease occurs is due to its mys- of this disease, recover, but in many tery and to the designation of cases the disease leaves complicating "paralysis," which sometimes leaves July, 1935 The Health Bulletin the patient a physical cripple for life. A conservative estimate would be On the other hand, to those of us that at least half of these deaths are whose daily work requires us to take preventable. These babies die from note of deaths occurring from all such conditions as diarrhea and en- causes, we cannot help but be amazed teritis and other strictly preventable conditions; for at the indifference with which the example, in the month of April 418 babies died before majority of people look on other dis- the end of their first year. eases that kill much more frequently, Prevention of all these things is and in larger numbers, every year. comparatively simple and easy. If all Diphtheria, for example, caused the babies between six months and twelve death of more children in North Car- months of age were given toxoid, olina last year than all the cases of diphtheria would soon entirely dis- infantile paralysis since vital statis- appear from the State, and all of tics records have been kept. Diph- these cases of sickness and these theria is also a disease which leaves deaths would be prevented. If the in its wake very frequently after- mothers of young infants would learn effects, such as heart disease, which the simple expedient of boiling all is no less serious than the paralysis the drinking water given to the ba- and deformity resulting from infan- bies of tender age, and either boiling tile paralysis. For illustration, in the or pasteurizing the milk given to month of April in North Carolina babies, and otherwise to learn to put nine deaths from diphtheria were re- into effect the scrupulous cleanliness ported to the State Board of Health. required by a young infant, certainly During the same month 52 cases half of this large number of deaths were reported. The irony of this sit- could be prevented every year. More uation rests in the fact that diph- than one great scientist has repeat- theria kills many more children, edly stated that if all the available causes much more illness than infan- information at present existing in the tile paralysis; and yet people go world could be practically applied by about their affairs every day with the people everywhere, preventable absolute unconcern about the rav- disease would disappear from the ages of this preventable disease. earth and the span of human life Again we may call attention to the could be greatly extended almost im- fact that in North Carolina every mediately. But people just do natu- month somewhere between 300 and rally like to be indifferent and care- 500 babies under one year of age die. less.

Poliomyelitis (Infantile Paralysis)

By J. C. Knox, M.D., Epidemiologist

disease poliomyelitis is during the past weeks about this dis- THEmore commonly known as in- ease and have been more or less fantile paralysis. This is a poor terrified because of its presence in name for the disease, for the reason the State. There are many questions that adults and older children may that physicians and health officers and do have it. It is true, however, are asked, and it is quite natural that the majority of cases occur in that such questions should form in individuals under ten years of age, the minds of the people. most of them in children under five It might be well, then, for us to years of age. The citizens of North answer some of the questions that Carolina have been quite alarmed are being asked daily, so that this The Health Bulletin July, 1935 information may reach a larger num- become ill without any known ex- ber of people than otherwise would posure can be explained in no other know about this disease. manner at this time than that there are healthy carriers of the virus in "What is infantile paralysis? In- the general population and that these fantile paralysis, more accurately carriers play a very important role in known as poliomyelitis, is an acute the spread of the disease. infectious disease that, as most people know it, results in a paralysis of What can I do to prevent my child some of the muscles of the body. from having this disease? This is The paralysis, as most folks know it, probably the most common question remains stationary and the patient asked. Certainly, in times when there rarely recovers completely; and thus is an undue prevalence of a disease such patients require careful ortho- one should keep the smaller children pedic supervision to restore the away from crowds and gatherings of greatest amount of function to the every kind. They should not be al- paralyzed legs and arms. lowed to visit other children who are sick, nor, for that matter, should What is the cause of the disease? adults visit sick persons unless it is The cause is an ultra-microscopic definitely known that poliomyelitis is agent which passes through the finest not the cause of their illness. It is of filters; therefore, it is known as quite possible that a parent in visit- a "filtrable virus." Some other dis- cases of this disease could bring eases caused by these viruses are ing home to his or her children, smallpox, chicken pox, measles, the virus that someone else by visiting sick mumps, and also epidemic encepha- or individuals could thus become tempo- litis or sleeping sickness. This class rary carrier, thereby causing a sus- of agents differs from the bacterial ceptible child to develop the disease. infectious type of agent in that the question is asked as to mingling latter can be seen with a microscope The open air. Here again and grown on various culture media, in crowds in the the advice is to avoid all crowds, for example, the diphtheria bacillus whether in the open air, in homes, and the typhoid bacillus. picture shows, theatres, churches, or contagious? Polio- Is the disease elsewhere. myelitis is mildly contagious in the it all right for my child to go in true sense of the word; however, it Is pool? It is our advice belongs to that class of diseases that the swimming under fifteen years of we speak of as being "communica- that children use public swimming ble," or capable of being transmitted age should not particular time. from one person to another. Only pools at this about one individual in twenty-five Is there anything like drops that I who are exposed to a brother or sis- can get to put in my child's nose and ter ill with poliomyelitis develop the throat to keep him from contracting disease as a result. this disease? This question is frequently asked. At this time we have How is it transmitted? The in- antiseptic to put in the fectious material of poliomyelitis is no known that will prevent this found in the nose and throat of the nose and throat disease. It is even possible that some individual who is ill of the disease, of the stronger antiseptics might and it is presumed that this material infection easier by causing an is transferred from the sick individ- make of the lining of the mem- ual to another susceptible person. irritation nose. The fact that cases develop in indi- branes in the viduals or children who have not Is it safe to take my child on a had any known exposure to an active trip? This is a difficult question to case of the illness causes many ques- answer. It may be perfectly safe, tions to arise in the minds of the and, on the other hand, it may not people. The fact that these cases do be at all safe. Therefore, the only July, 1935 The Health Bulletin

advice that we can offer is that travel lated, put to bed, and the family by bus or train (in which one is doctor called. naturally thrown with crowds and in Isn't there a serum for the treat- which there is therefore potential ment of this disease? A convalescent danger) should be avoided at this blood serum has been given in many time. cases, but when it was administered in series Is it safe for my child to attend a a of controlled cases it was summer camp? In answer to this found to be without particular value in the question, it is our advice that sum- treatment of poliomyelitis. mer camps, particularly for the What about the vaccine? There younger children, be avoided just at are two vaccines being worked upon this time. As we cannot be sure that at the present time. They are still in there is no danger in attending sum- the experimental stage. Their value mer camps, we would advise against at this time is not known, and proba- such attendance, even for older bly will not be definitely known for groups. a few years. This vaccine is very limited in supply What are the symptoms of this at the present time, due to the disease? Poliomyelitis begins often fact that it is made from the spinal as any other mild infection around cords of monkeys. This fact, of course, would limit the nose and throat. It may begin the available quantity. with mild sore throat, fever or gas- There is now no commercial house trointestinal upset, nausea and vom- licensed to prepare this vaccine. Only the experimenters iting, perhaps diarrhea. Headache is themselves are usually present and pain in the mus- making it. It is not available cles of the neck. These symptoms to the general public and probably may last for two or three days, after could not be obtained by private which paralysis may or may not de- physicians, except for controlled studies velop. This resemblance of the early of its efficacy. symptoms to so many other diseases Is there a test for susceptibility to the disease? makes it necessary that parents be There is at this time no practical unusually alert in all of these upsets test to determine who is so that poliomyelitis will not be over- immune or who is not immune to looked. Any suspicious illnesses of poliomyelitis. this sort should be placed under the Can a person have poliomyelitis a care of a physician. Even for one second time? There are no records trained in medicine it is often diffi- of a person having had poliomyelitis cult to make a diagnosis, and cer- more than one time; in other words, tainly the parent should not assume one attack confers a lifetime immu- that responsibility. nity to the disease. How long after exposure until a It is hoped that these questions person becomes ill? This time varies and answers will serve to allay some from about three to eighteen days; of the fears of parents who are very most commonly around ten to twelve much interested in poliomyelitis at days elapse from the time of expo- such a time as the present. We might sure until symptoms appear. add that for the population of the Do all cases result in paralysis? State as a whole we are having very There are a certain number of cases few cases at the present time per in most outbreaks that do not be- 100,000 population. To consider the come paralyzed. There may be mus- most susceptible age, those children cular weakness which may clear up, under fifteen years—and there are and in certain cases there may be no approximately 850,000 children of evidence of any paralytic signs, even this age in North Carolina—we still of muscular weakness or loss of find that there are very few of the function. Due to this fact, all sus- total population affected by polio- picious cases should be promptly iso- myelitis. 8 The Health Bulletin July, 1935

Some Practical Considerations of the Rabies Problem Hygiene By J. W. Kellogg, Assistant Director, State Laboratory of

subject of this paper is The fact that only one person de- THEchosen, not because rabies is veloped rabies is due to the efficiency one of our greatest public of the Pasteur treatment. The rela- health problems, but because of the tively long incubation period enables in exposed need of better information regarding us to establish immunity onset of symp- some of the questions arising daily as persons before the is caused by a to methods of controlling the disease. toms. The disease is secreted in the saliva Perhaps there is no disease about virus which implanted which the general public is more of the rabid animal and misinformed than rabies. Unrea- through the bite of the infected ani- soning fear and horror are responsi- mal. The dog is the natural reser- all warm- ble for the panic which seizes people voir of rabies, although animals are more or less when one is thought to have been blooded the control of exposed to the disease. During the susceptible. Therefore, meas- year 19 34 there was reported only the disease depends in a large the ex- one case of human rabies in North ure on proper provision for This Carolina, although the number of termination of rabies in the dog. animals pronounced mad exceeded could be accomplished by a six of imported dogs that of any preceding year. There months quarantine the lib- were examined in the State Labora- and the proper restraint of together tory of Hygiene during the year the erty of all dogs in the State, of the owner- heads of one thousand eight hundred with the destruction of forty-seven animals suspected of be- less dog. Universal vaccination statute by ing mad, eight hundred and eight of dogs, as provided for by should also which proved to have rabies, of the recent Legislature, which number seven hundred and be a factor in the control of rabies, alone cannot forty were dogs. There were distrib- although this measure the uted by us two thousand one hundred be depended on to exterminate forty-five Pasteur treatments for disease. those persons exposed to the disease, The law which requires all dogs or seven hundred and nineteen more known to have been bitten by a mad rigidly than in the previous year. These fig- dog to be killed should be ures show the prevalence of rabies in enforced. Failure to observe this law spread the State, and the problem of its is responsible for much of the public control. The disease caused a large of rabies. If the weight of to bear on loss of valuable stock, the monetary opinion could be brought per- value of which can only be estimated, those thoughtless or negligent twenty-five horses and cattle having sons who either refuse or neglect to been found by laboratory examina- obey this law, you might be spared oc- tion to have died of the disease. Be- the distress and mental suffering sides this number, there must have casioned by your children having to been many cattle and other livestock undergo the discomfort of the anti- which were attacked by mad dogs rabic treatment. Dogs are very and slaughtered to prevent them susceptible, and even when it is a from developing the disease. This is impossible to discover a wound on an economic problem, and the only dog after he has fought a mad dog, it escape solution is in the strict confinement is quite likely that he will not of all dogs to the premises of the infection. owner. The practice of antirabic vaccina- July, 1935 The Health Bulletin

tion of a dog which has been bitten tion, and this necessitates an animal by a mad dog is a vicious disregard inoculation. A small portion of the of the law, and in itself a dangerous brain of the suspected animal is in- experiment. Dogs bitten by animals jected into a rabbit and develop- known to be rabid should be de- ments watched. Weeks may pass be- stroyed, even if previously vaccinat- fore the rabbit succumbs to the dis- ed. In man}' cases the attempt to ease, and during all this time we immunize a dog which has already are still uncertain as to the diag- bit a will result been by mad dog nosis. But if the dog had been con- in the animal going mad before im- fined and observed for two weeks, munity can be established. With the and remained well for this period of in vogue, one-shot treatment now time, we are sure that he was not in from two to three months is re- the early stages of rabies at the time quired before immunity can be real- the person was bitten, and therefore ized. It is equally dangerous to at- could not have transmitted the dis- tempt to "keep up" a dog which is ease. Thus in two weeks time we suspected of having been bit by a have proven that the animal was not mad dog to determine whether he dangerous or infectious at the time, will go mad. The usual procedure is and there is no need of the patient to keep him up for about three weeks taking the Pasteur treatment. If on and then turn him loose, at the very the other hand the dog develops time when he might be expected to rabies within the period of observa- develop this disease. In fact, a quar- tion, the patient still has time to antine of at least six months would take the treatment and ward off the be necessary to free the dog from disease. Except in cases of bites on suspicion. There are arguments for the face or head it is advisable to universal vaccination of dogs, and delay treatment until symptoms de- from the standpoint of the individual velop in the dog or until a definite owner it is desirable. However, the diagnosis can be made. In such protection obtained is never absolute cases treatment may be started im- and revaccination is advisable at mediately and later discontinued if least every twelve months. In the the animal proves not to be mad. light of present knowledge, such pro- If one is bitten by a dog which phylactic measures, in addition to exhibits symptoms of rabies, or if the the proper restriction of the liberty animal develops symptoms during of the dog, would seem to be the best the period of observation, the head method of control of rabies. should be detached and brought or Regarding what steps to take when sent to the laboratory for examina- one is bitten by a dog, we wish to tion. The dog's head should, in all give the following advice: If the dog cases, be protected from injury and appears normal and there seems to packed in ice to prevent decay. The be no reason to believe that he is brain tissue is extremely fragile, and mad, he should not be killed at once, injury or decomposition may prevent but securely confined and observed a satisfactory examination. The dog for a period of ten days to two weeks, should not be killed by blows on the to determine whether he was in the head or shot in the head. Such a early stages of rabies at the time the mistake may prevent a laboratory person was bitten. Many people are diagnosis. When the distinctive Negri prone to kill the dog at once and bodies are found in the nerve cells of send the head to the laboratory for the brain, a definite diagnosis of examination. This is the wrong pro- rabies can be made, but when the cedure. When an animal is killed in brain is received in bad condition the early stages of rabies, before (mutilated or decayed), failure to definite symptoms are evident, there demonstrate these bodies does not is a probability of the diagnosis being exclude the possibility of rabies, and missed in the microscopic examina- in such cases the question of admin- 10 The Health Bulletin July, 1935 istering treatment to the patient through deep wounds on covered must depend upon the history and parts of the body; 10 per cent in symptoms exhibited by the dog. superficial wounds on uncovered The question as to who should re- parts; 15 per cent in deep wounds on ceive antirabic treatment must be de- the hand or neck, and from 30 to 60 cided in each case, but in general we per cent in more severely bitten pa- may say that only those actually bit- tients, depending on the location of ten by a mad animal, or those who the bite and the severity and char- have had fresh cuts or abrasions ex- acter of the wounds. These figures posed to the saliva of a rabid animal, are all taken from results on un- should receive treatment. This in- treated cases, and taking all persons cludes, of course, those subjected to actually bitten by rabid animals, no exposure to infection from an animal more than 16 per cent would develop suspected of being mad and which the disease if there were no antirabic has escaped, or one in which for any treatment given. The percentage of reason definite diagnosis has not or actual failures of treatment is so cannot be made. small that it need hardly be consid- We do not advise treatment under ered. Human beings are not so sus- the following conditions: (1) Where ceptible to rabies as are animals, and the only avenue of infection might be have a degree of immunity to the through old cuts or abrasions; lighter infections. This fact, as well (2) where the only means of expo- as the possibility of complications sure was through handling or petting following the administration of the the animal; (3) drinking milk of Pasteur treatment, should be consid- rabid cows or eating the meat of ered carefully in making the decision rabid animals. Statistics show that to take the treatment, after a bare there is no exposure through contact possibility of exposure. We do not with wounds over twenty-four hours advise cautery of wounds caused by old; that in contact with recent rabid animals, although when done wounds with infected saliva less than promptly and properly by a physician one in one thousand may become in- it may have a beneficial effect. The fected, and that in those actually wound should be treated like any bitten the possibility of infection is other similar wound and the ques- far less than commonly believed. No tion of the advisability of taking more than 3 per cent are infected treatment decided promptly.

New Fads About Healthful Diets

By Warren H. Booker, Director, Division of Sanitary Engineering

Greeks, you know, usually tains solid nutrition and it is of all THEhad a word for everything, and foods the one with which we are one of them had many sensible most familiar from childhood; it is words on diet. even most pleasant to the sight on This particular Greek was old Doc- account of its whiteness." tor Aretaeus, the leading family phy- Then this able doctor of a past era sician of Cappadocia. He lived and goes on to describe the medicinal practiced some two thousand years value of this unique food and con- ago, but his advice on food is just as cludes with these sage remarks: "If persuasive today as it was when he a person drinks much of this he* gave it. needs no other nutriment; and it is "To take milk," said Aretaeus, "is indeed well that milk is both food pleasant; to drink it is easy; it con- and medicine in ill health; as a mat- July, 1935 The Health Bulletin 11 ter of fact," he says, "there are na- around milk, green vegetables, and tions who live on milk and who never fruits, you will be well nourished and eat any grain whatsoever." possess plenty of vigor. With this Now this is not the whole story of foundation you can leave the remain- nutrition, but it is a good beginning der of the diet to the demands of the for it. Pure milk in liberal amounts appetite, although no one should eat should be the foundation of every entirely according to whims. well-balanced diet. Not only is a There are, of course, many other daily quart of milk or its equivalent valuable foods. Eggs, for example, in other dairy products absolutely are excellent sources of protein, vita- necessary for all growing children, mins, and minerals, and they are but almost as much is desirable for second only to pure milk in nutri- each of the adult members of the tional qualities. Breads and cereals family. Not less than a pint is ad- are particularly useful and inexpen- visable, at any rate, for those mem- sive sources of energy, as measured bers of every family who want to be in those well-known units, the cal- healthy and strong, and well nour- ories. Meats and fish also deserve a ished. And who in this day and age place in any sensible dietary regimen. does not? In these times of general economic Milk is our most nearly perfect stress and strain, the question natu- food, so-called because it contains rally arises as to how a well-bal- practically all of the nutritional ele- anced and adequate diet can be se- ments needed to nourish the human cured with limited funds. The an- body. Milk has also been called a swer to this practical question has protective food, because its routine been given by one of our leading use helps to protect us against the authorities on nutrition, Professor deficiencies of some other common Henry C. Sherman of Columbia Uni- foodstuffs. versity. But milk is not the only protective This expert on food quotes with food. Green vegetables, especially approval tbe maxim, "The dietary the leafy ones, are likewise in this should be built around bread and category, and fruits belong in the milk." He tells us that the lower the general protective group. Milk and level of expenditures, the more one green vegetables are admitted to this must forego other foods and concen- select class of healthful foods, be- trate effort upon these two, supple- cause they supply an abundance of menting them with a little of some the important lime salts needed to inexpensive fruit or vegetable. A build strong bones and teeth and are diet of whole wheat bread and milk also rich in vitamin A, which is es- is, in fact, virtually a perfect fare sential to growth and good health. for anyone and will sustain life al- When Professor E. V. McCollum of most indefinitely. Johns Hopkins University originally Spend at least one-fifth, and pref- proposed that the term "protective erably one-third, of the family food foods" be applied to milk and such budget for milk and dairy products. vegetables as lettuce, cabbage, celery, Devote another fifth to fruits and tomatoes, spinach, beet greens, tur- vegetables, use at least another fifth nip greens, kale, and brussels sprouts for breads and cereals. Retrench, if he did not then include fruits; but you must, on meat, fish, and eggs, fruits should be added to the list, and forego fats, sugars, and unneces- because they supply a number of the sary and more expensive vegetables. necessary vitamins, prevent scurvy, These are the wisest rules for depres- furnish bulk in the diet, produce an sion period diets. alkaline, instead of an acid reaction A well-balanced and adequate diet in the human system, and are gener- constructed around the protective ally nutritious. foods will do much to insure the con- If, then, you build your daily diet tinuous good health of its consumer. 12 The Health Bulletin July, 1935

By thus building sound vital resist- producing foods. Every well-balanced ance, you will be more likely to es- diet will consist of a satisfactory pro- cape such diseases as common colds, portion of fats and carbohydrates for and you will be protected against energy, of proteins for tissue-build- that more serious affliction, tubercu- ing, of minerals for bone-building losis. In the treatment of tubercu- and other processes, of fluids as reg- losis a special diet, high in vitamins ulators, and of vitamins for growth, and rich in milk, is frequently em- strength, health, reproduction, and ployed, along with other measures. long and useful living. You need not concerned about these scientific It can readily be seen what a really be details, however, provided you get simple matter it is to obtain a health- daily quota of the protective ful diet. Many persons seem to want your I have mentioned. Dairy to make a complicated task out of foods which right eating, however, and there are products, green vegetables, and fruits will insure a copious supply of all still numerous misconceptions about nutritional elements. this whole business of eating. Some these of these misunderstandings are due Do not permit anyone to tell you to the false advice given by faddists that vitamins are fads. These acces- who advocate such fallacies as vege- sory food substances have been rec- tarianism, or exclusive diets of raw ognized for only a few years, to be foods, or abstinence from white sure, but a vast amount of informa- bread, or some other equally absurd tion regarding them has been devel- doctrine. oped during this period. The more Among the most ridiculous of the vitamins you can get in your daily for it. ravings of certain food faddists is viands, the better you will be the charge that proteins and starches Six of these invisible chemical sub- will cause trouble if eaten together. stances are now thoroughly familiar In the first place, it is practically im- to us, at least to the experts on possible to consume any reasonable dietetics. I shall spare you the usual variety of foods without getting both catalog of them, and I am not going starch and protein. In the second to bore you with an extended list of place, Nature apparently knew more their functions and operations. If about the matter than the self-ap- you will follow the suggestion to pointed critics of the combination, partake of liberal amounts of the for in her wisdom she assembled pro- protective foods every day, and will tein and starches in a large number indulge regularly in green vegeta- of natural foods. bles, fruits, and milk in some form, need never have any qualms A leading example of a food con- you any deficiency of vitamins in taining both sugar and protein is about your daily fare. milk itself, the one food for which 179 6 Doctor Jenner observed there is no other single substitute in In the the entire human dietary. Bread and that dairymaids who contracted potatoes have both protein and milk disease, cowpox, from dairy cat- the starch, and so do many other com- tle were apparently immune to smallpox. mon foodstuffs. Put no faith in the much more severe disease, faker who condemns mixtures of Acting on this observation, he took these two substances, which separate- some of the harmless virus from the had ly or together are desirable in human hand of a dairy maid who be- nutrition. The function of protein is scratched herself on a thorn and to replace and repair bodily tissue, come infected with cowpox while while that of the starches and sugars milking, and put it in the arm of an is to provide fuel for the human eight-year-old boy. machine. This significant experiment was In addition to the sugars, or car- performed on May 14, 179 6, and was bohydrates as they are more techni- the first vaccination. Later, when cally called, fats are likewise energy- the boy, James Phipps, was exposed July, 1935 The Health Bulletin 13

to smallpox, he proved to be pro- tant. Professor E. V. McCollum has tected from the disease. This test pointed out, moreover, that through- was confirmed shortly afterward by out history the conquerors have al- vaccinating ten other persons, all of ways been users of cows. The pas- whom escaped smallpox. Since that toral peoples of the world who have time millions of persons have been subsisted on milk and dairy products have always protected from this dread disease by been the most virile and long-lived, and have always this simple, harmless, and effective dis- played the best physical development. procedure. In conclusion, remember that sci- Today, then, we pay tribute to entific nutrition is a simple matter, Edward Jenner, as well as to the but an important one, and that a food whose production made possible well-balanced diet offers to everyone his discovery. Milk is the original health insurance which will yield a food of the race, and always has gratifying return on what we invest been recognized as the most impor- in it.

Summer Vacation

By J. C. Knox, M.D., State Epidemiologist

WHAT is more intriguing, more crackerjack, ice cream, and candies. fascinating, more alluring For many such parents there was no than to plan for a summer rest until several days had elapsed, vacation? The word itself brings pic- for following such orgies there were tures to mind that are as varied as are usually gastro-intestinal upsets in the individuals. To some, a trip to the children that at times resulted in seashore epitomizes all that can be serious illness and occasionally in a desired for a summer outing. Others fatality. care little for such a trip and much Times have changed, even though prefer a jaunt to the mountains. there are those of us who yearn for Each place has its peculiar position the "good old days." to fill for the vacationist. Well it is that times have changed, The mere matter of taking a vaca- for these changes have been for the tion has become a topic for discussion betterment of man's lot. the minute it has been mentioned. In planning this summer's vaca- In recent years such trips were not tion, one should be cautioned of the available for the rank and file of the hazards which are attendant upon people that make up the bulk of our such a procedure. Whether one goes population. These folks were fortu- to the seashore or the mountains, nate to be able to take a trip to the there is a necessity for travel. Trains, seashore, to the mountains, or to busses, private autos are the means some inland lake on Independence for the greatest amount of travel. Day or on Labor Day. This day's Of course, there is the "thumb hik- outing began early in the morning er," which is a problem unto itself. hours and ended in the early morn- With the ever-increasing toll due to ing of the following day. It was an the automobile, one must consider ordeal for most folks, rather than his personal safety a matter of prime the vacation or holiday for which it importance. All safety rules should was designed or planned. Weary, be followed closely when one is out footsore parents returned from such upon the highway. The highways are events with the tired, sleepy children crowded on week-ends and holidays, with faces smeared with popcorn, which makes them truly unsafe, and 14 The Health Bulletin July, 1935 positively dangerous in many in- ditional warnings are not out of stances. One has only to read the place. Certain diseases are transmit- morning paper after such an occasion ted by the bite of insects. Malaria is and there in glaring headlines are the more common condition against gruesome accounts of accidents that which the camper has to guard him- have added to an already long list self. All mosquitoes are not vectors the names of someone's friends, of the malaria parasite. It is hardly loved ones, or acquaintances. Such feasible to expect the rank and file of accidents can spoil a vacation for campers to know the malaria-carry- this year, and maybe for years to ing mosquito, but he should know come. something of this pest's habits, so that he may at least erect a barrier The food supplies, especially that will discourage attempts at bit- along the route to or from the point ing. This mosquito is a night feeder of destination, should be above re- and seldom, if ever, bites in the proach from a sanitary standpoint. Drinking water should not be over- bright daylight. Campers, therefore, should use every precaution to pro- looked; its safety should be beyond tect themselves from mosquitoes, all question. Typhoid fever and other from the twilight appears intestinal diseases very frequently moment owe their origin to impure water. until light of the next day is in full When the vacationist camps out, as evidence. Mosquito bar or netting is a very effective and cheap means of so many do nowadays, especially the doing this. young boys, the sanitation of the Recently there camp and its water supply should be has appeared in North definitely safe before one decides to Carolina another disease which is more likely to affect the patronize such places with his pres- camper than other people. Rocky Mountain ence. spotted fever, which, until the past Just what health hazards may few years, was thought to exist only beset the summer outing enthusiast in the mountains from which it gets largely upon the place he depends its name, is found in North Carolina spend his vacation. Most selects to —from the lowlands of the coastal and largely visited of the well-known plain to the foothills of the Appa- resorts are quite safe from such a lachian Mountains. The disease is chances of con- standpoint. The primarily one of small animals, such these diseases in- tracting certain of as rabbits, squirrels, chipmunks, and very definitely with patron- creases the like, but it occasionally occurs age of little known or obscure places in man. The ordinary wood tick or and in the camps, whether run ex- dog tick is the intermediary host that clusively for such purposes or wheth- transmits the disease to man. In- er a camp-site of the individual's fected ticks feed upon man and after selection in an area little frequented. a period of about ten days the indi- The water supplies about these vidual is taken ill. The fatality rate camps may be a very decided menace of this disease runs rather high, and one which to all appearances is about 20 per cent in this State. It is pure. The sight, taste, and odor of a advised that campers remove their water supply is no indication as to clothes and search carefully for and its purity. All questionable drinking remove ticks at least twice a day. It water should be boiled before it is is necessary for an infected tick to used for that purpose. bite an individual for a rather long inoculation against Prophylactic time before the virus is transferred, taken with- typhoid fever should be hence the effectiveness of the above out fail by the summer camper. method. To the vacationist who likes to Care should be exercised in hiking spend such times "roughing" it, ad- through unknown woods, or known —

July, 1935 The Health Bulletin 15

woods, for that matter. Snakes of possibilities of accidents that could poisonous variety fortunately are not occur. Sane thinking and sane and abundant, but the occasional snake safe actions during a vacation may can be as dangerous as another if he determine whether or not it is a should bite an individual. Most pleasurable event or one filled with snakes will avoid man if given the sorrow and remorse. chance to move without being hurried or trod upon. Campers and hikers who are properly clothed and WHAT MATTERS MOST shod for this type of outing are usually adequately protected from snake TT7ITH a thorough understanding bites. W of the viewpoint of the Meck- Contact with poisonous plants may lenburg farmer who intermittently cause one to be sorry that he ever markets native meats, The News can- thought of a vacation. Care should not but be wholeheartedly for the be taken to avoid known poisonous agitation which has as its object the plants and vines. "pre" as well as the "post" inspec- There is nothing that can cast tion of all meats consumed in Meck- such a gloom over a summer resort as lenburg County. the tragedy of a drowning. A whole- It is true that the proposed ordi- some respect for deep water, whether nance, over which the City Council at the ocean or inland, should be up- has backed and filled for years, will permost in the mind of the one who impose some trouble and a modicum is enjoying the pleasure of a swim. of expense upon the farmers of this There are too many who lack the community. The necessity of hauling proper respect for water that is deep- their cattle to the city for inspection er than the average individual's before they are slaughtered, together height. Unknown, shallow water is with the cost of inspection and kill- equally dangerous when youngsters ing at a central agency, is trouble- plunge into it, which may result in some. On the other hand is the testi- a fractured skull or a broken neck. mony of expert witnesses who have Such tragedies as I have just men- told the Council that many diseases tioned are entirely useless, provided of cattle cannot be determined by in- a little precaution is taken. It is a spection after the meat is dressed, long time from one summer till the except through a chemical analysis. next, and the newspaper accounts of It is said, and not denied, that a tu- these accidents are stale in the minds bercular head, for instance, is impos- of those who need them most. sible of determination after the meat More than one vacation has been is ready for the market, except that changed from an occasion of pleasure the suspected food is subjected to to one of misery by over-exposure to laboratory tests, which are out of the the bright sun, especially at the sea- question in the ordinary process of side. Acute sunburn may be nothing marketing. short of torture. Sunlight is benefi- The cost of slaughtering and dress- cial for almost everyone, but care ing, we understand, is comparatively should be exercised in not exposing slight: $1.50 for a full-grown animal oneself for too great a length of time and half that amount for hogs and when the individual is unaccustomed calves. The honest and conscientious to the direct rays of the sun. farmer who sells his meat in Char- A person seldom pictures himself lotte would do well to accept cheer- as the principal character in an fully the bother and the expense to accident. Vacations could be easily avoid the possibility of selling dis- spoiled if one were to think of all the eased meats. Charlotte Neivs. 16 The Health Bulletin July, 1935

The Trial By Kathryn Miller Women's College, University of North Carolina

Something was wrong at Tommy's house. I feared there might be a war; But then I learned how a trial was held, And Tommy was called to the bar.

'Twas a solemn occasion. Judge Health took his seat, And the Health Rules, as jury, filed in. The prisoner was brought, and the witnesses, too. It was time for the trial to begin.

The Judge rapped the table and solemnly said, "Witness One will please take the stand." Sir Toothbrush arose and was duly sworn in. He looked like a very sad man.

"O Judge," said Sir Toothbrush, "I have to report that I haven't been used for a week. With your permission, and if time will permit, There are a few words that I'd like to speak.

"Teeth will be dirty if they are not brushed, And dirt causes teeth to decay. To have strong, healthy teeth I would like to suggest That they should be brushed twice a day."

"Well spoken, Sir Toothbrush," Judge Health did declare; "And now we will hear from the Clock." "My report is, late hours and not enough rest," Said the Clock, with accusing tick-tock.

"And what have the rest of you to say?" Said the Judge, looking down from his seat. "His hair is not combed and he won't drink his milk, And his shoes do not fit his feet."

"He says that he doesn't like vegetables and fruits." "He eats candy all during the day." "He cannot be healthy if he continues like this. That, Judge, is what we have to say."

"Now let us hear the jury's report." "The prisoner is guilty," they said. Tommy well knew that he was all wrong, And shamefacedly hung his head.

"Please, Judge Health, give me a chance; I want to be healthy and strong. Now I know how important health rules are, I'm sorry that I have done wrong."

"O.K.," said the Judge. "We'll help all that we can. It takes strong boys, as you know, To grow into strong men!" Silb'iEkL Published bH ?R&NP>RmV$9Um STATE. B9ARD ^7\B\Uin

This Bulletin will be ser\t free to arwj citizen of the 5tateupor\ request!

Entered as second-class matter at Postoffi.ee at Raleigh, N. C, under Act of July 16 lS9i Published monthly at the office of the Secretary of the Board, Raleigh, N. C.

Vol. 50 AUGUST, 1935 No. 8

SOCIAL DOINGS IN DAVIE

An Unusual Child Health Day Celebration Mrs. Green, an efficient nurse who has, for several years, conducted the Good Shepherd Church Health Center at Cooleemee, an industrial town in Davie County, always celebrates Child Health Day. This year one of the grade teachers revised the Tom Thumb Wedding idea for made this occasion and of it a health project. Mr. Good Health wed Miss Happiness. The central idea was that good health, if maintained in the home, must begin with the home, and that marriage is the beginning of the home. Dr. Lester P. Martin, Davie County physician, made an excellent talk at this celebration on vaccination as a protection against disease. The physicians present examined sixty-seven pie-school children and vaccinated each of them against diphtheria smallpox, or typhoid fever. ' MEMBERS OP THE NORTH CAROLINA STATE BOARD OF HEALTH

S. D. Craig, M.D., President Winston-Salem G. G. Dixon, M.D Ayden H. Lee Large, M.D Rocky Mount J. N. Johnson, D.D.S - Goldsboro H. G. Baity, Sc.D Chapel Hill W. T. Rainey, M.D Fayetteville Hubert B. Haywood, M.D Raleigh James P. Stowe, Ph.G Charlotte J. LaBruce Ward, M.D Asheville

Executive Staff

Carl V. Reynolds, M.D., Secretary and State Health Officer. G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Preventive Medicine. Warren H. Booker, C.E., Director Division of Sanitary Engineering. Ernest A. Branch, D.D.S., Director Division of Oral Hygiene. John H. Hamilton, M.D.. Director Division of Laboratories. J. C. Knox, M.D., Epidemiologist. R. T. Stimpson, M.D., Director Division of Vital Statistics. R. E. Fox, M.D., Director Division of County Health Work.

FREE HEALTH LITERATURE

The State Board of Health publishes monthly The Health Bulletin, which will be sent free to any citizen requesting it. The Board also has available for distribution without charge special literature on the following subjects. Ask for any in which you may be interested.

Adenoids and Tonsils PU5LI5ME1D BYTML HOf^TM CAgOLIhA STATE. BQMgD s^MEALTm]

Vol. 50 AUGUST, 1935 No. 8

Notes and Comment By The Editor

of the central and east- PEOPLE usual. The same thing applies to the central sections of the State have coastal resorts, such as Nags Head, been greatly upset for the past Morehead City, and Wrightsville several weeks on account of an un- Beach. usual increase in the number of cases The State Board of Health has ad- of poliomyelitis, or infantile paralysis. vised the usual activities in the com- During the month of June people be- mercial camps, riding schools, and va- came unduly alarmed in some locali- cation resorts, particularly in the ties. This is to be deplored, although western part of the State, provided it is a natural reaction on the part of they do not accept patrons from the the public. Up to this time there has particular areas in the central east, been reported to the State Board of in which the disease is most preva- Health for the year a total of 257 lent. The Board of Health has also eases of the disease with 24 deaths. advised such camps to open with the Co-operation on the part of the peo- understanding that no one goes or ple generally with the Health Depart- comes for a period of about two weeks. ment officials has been excellent. In Then if there is no occurrence of the the first place, the State Board of disease, the camp may be considered Health has not been autocratic or dog- safe. matic in its opinion or in its advice. There has been and should be no It has steadfastly confined itself to reason why patrons from other states giving the facts to the people day by who are accustomed to spend their day. It has encouraged normal activi- summers in the western area of North ties in so far as safety will permit. Carolina should not come on as usual. It has discouraged the promiscuous All the State Health Officers, of the gathering of young children anywhere South in particular, have been so in- in the area. The church people par- formed. ticularly have been very co-operative. There is one phase of the outbreak Sunday schools have been practically which requires comment. That is the suspended in the areas. Every sensible overwhelming demand which has been person has tried to do everything made on physicians and health offi- known to prevent the further spread cers by the public generally in areas of the disease. involved for preventive vaccines. In So far most of the western section a way this is a gratifying demonstra- of the State has escaped this scourge. tion of the advanced information the The fact is that, with the exception of people generally have concerning the two or three places, at this writing prevention of disease through vaccina- they have not had any more cases re- tion. In this case, however, the pub- ported out there for the year than lic has advanced considerably beyond The Health Bulletin August, 1935 the ability of medical science to pro- The State Board of Health would vide a special immunizing vaccine. In again advise the people to be calm, and the first place, while scientists gener- not to be impressed by wild schemes ally regard the disease as caused by a of prevention or treatment, or by virus similar to smallpox, the actual rumors or unseen dangers and so on. germ has not been discovered. It is The orderly procedure of routine af- thought that the germ is so small that fairs, with the minimum assemblage of it passes through any filters when children particularly, is the best undertaking to isolate and detect it. course to pursue. A good many experiments with vaccines and serum immunization have been made during the past few years "W7E would again call attention to the and discarded as unsatisfactory. fact that this is the typhoid season. At present there are two types of Although typhoid is a disease of all vaccine which seem to promise im- climes, all races, and all seasons of munity. Experiments are being made the year, owing to the greater ease in this State with both types at this with which the disease may be trans- time, one of them under the auspices mitted in the summer months, the dis- of the United States Hygienic Labora- ease, of course, is generally more tory representatives. In simple lan- prevalent at this time. guage, one of these vaccines, that per- One of the names for typhoid used fected in the New York City labora- to be "Vacation Fever." Another tory, and being given by the Public name used to be "Autumnal Fever." Health Service representatives, is com- The reason for that was that when posed of vaccine made from sterilized people went off on vacations in the summertime in the old days, just as virus ; the other is simply an attenu- ated virus and is being used by a few they do now, they very frequently private physicians. Both are obtained came back home and developed typhoid from monkeys imported from India. fever, and about one out of every ten The State Board of Health is at pres- of them died. ent recommending to physicians that Through the excellent work which neither of these vaccines be used by has been done in providing pure water general practitioners or health officers for municipalities and in improving the until further experimentation confirms home water supply of so many farm the success or failure of the pro- people, through the protection of vacci- cedures. nation, and through the improvement One difficulty in general immuniza- in sanitation, such as the installation tion is that so few people are suscepti- of better sewage facilities in the ble to the disease. Doctor Aycock of towns and cities, and the sanitary Harvard, who has experimented a long privies in the country districts, the time in dealing with the disease, says disease has been greatly reduced dur-

that only one person in a thousand is ing the past few years. At present it susceptible. That figure applies to the is only a small item in public health general population, all ages, sexes, and importance compared to twenty-five colors. Other research workers claim years ago. People should realize, how- that of the children under ten years ever, that the same conditions prevail,

of age about three per thousand are and that protection against typhoid is susceptible. Up to now no way has a matter in which it will require been discovered in locating those eternal vigilance. Carelessness in people who are susceptible or those dairy operation, in which an infected

who are immune naturally, ' as can be milk supply might be possible, a re- clone with such diseases as diphtheria. laxation in the matter of protecting —

August, 1935 The Health Bulletin

the public water supply every minute there was an unusually fine musical of the twenty-four hours, every day in program consisting of old spirituals the year, might mean at any time a and so on coming in over the radio. spectacular rise in the cases and About the time the editor got set to deaths from this once terrible disease. listen to some of his favorite songs the Typhoid is a disease which physi- music abruptly ceased, and the an- cians and health officers know all nouncer stated that this program was about. They know how to protect being put on by a certain concern from it in every way. This informa- which concern, by the way, has been tion has been continually passed along selling a purgative formerly used by to the people generally, and therefore physicians as horse medicine—Glau- a case of typhoid fever today indicates ber's salt, in a new and fancy name. carelessness on the part of somebody. But the lying about this particular Up to date this year there has been product reaches new heights. The reported to the State Board of Health editor determined to see it through, a total of 150 cases with 18 deaths. however, in the hope that more good This compares with the same period music would come. Sure enough, this last year of 73 cases and 12 deaths. program was followed by more good musical stuff that he liked. In the middle of the next program, however, \Y/ E cannot discuss such things as the announcer's voice came through infantile paralysis and typhoid with the statement, among other fever without bearing in mind the things, that a dose of a common head- ever-present menace to good health in ache medicine, composed chiefly of the exploitation of the people by the acetanilid, would simply "knock a patent medicine interests and the vari- headache out, cure a patient in less ous quacks. No one can pick up a than ten seconds after it was swal- radio receiver today without listening lowed." to the virtues of some patent medicine To wind up this particular program, for recommended almost any disease it was all followed by a series of fine under the sun, but which is always old songs by a woman singer of con- good for the particular disease that siderable local reputation. It in turn, happens to be more prevalent at that however, was sponsored by an under- particular time. taker, all of which we thought was The radio today is in the position good and proper. What more natural that the newspapers were some thirty than for the undertaker to come along years ago. At that time the better immediately after excessive use of class of magazines and daily news- either of the two foregoing patents papers became disgusted with the ex- advertised so promiscuously over the aggerated claims made by these ex- radio these days. ploiters of human misery, and cleaned out their own columns. This was not done until there was a rising tide of COME time ago writers in the Journal disgust among better informed people ^ of the American Medical Associa- everywhere. Today no concern and tion reported several cases of argyria, no patent medicine is too dirty or too which is a discoloration of the skin or exaggerated in its claims to fail to tissues resulting from the over-use of get an honorable place on the program silver preparations. In this particular of any radio station accessible to the series ten little girls and five little listeners in this section. boys were reported with the prospect Not long ago a member of the edi- of having to spend the rest of their tor's family called and told him that lives, and face the world, with blue or :

August, 1935 6 The Health Bulletin slate-gray complexions. These writers Some months ago we had an article in the Medical Journal reported that in The Health Bulletin by Doctor more than seventy cases of this perma- Root, a pediatrician of Raleigh, warn- nanent discoloration of the skin fol- ing mothers against the use of such lowing the use of some preparation of drops in their babies' or small chil- silver had been located in this country. dren's noses. The disfigurement of all these chil- The human body can retain only so dren, who are under the age of ten much silver. If more than the aver- years, follows the use in the nose and age amount is taken into the body in throat of solutions containing silver any way, argyria develops. Such for the treatment of so-called colds or things as whether a person is a blond allied conditions. Argyrol, collargol, or a brunet are said to be a factor, as and neo-silvol were among the silver well as the amount of fat on the body, compounds involved. according to the medical writers. Many cases among adults have been We pass this information along to traced to the use of silver arsphena- you, readers, with the observation that mine in the treatment of syphilis. The such prescribing is a fine thing to main danger, however, is in the pro- leave to competent physicians instead miscuous treatment of ordinary so- of to the boy who operates the foun- called colds by the drop method of the tain in the drug store or the girl be- usual percentage of argyrol sometimes hind the counter in the department carelessly prescribed. store.

Cause and Effect

THROUGH some peculiar coinci- The next item was a copy of the dence, a few days ago two items Statesville Landmark for June 24. The of material interest reached our item in that paper, which immediately desk on the same morning, side by attracted our particular attention, was side. The first item was a Depart- a paragraph by a regular columnist in of the ment of Commerce, Bureau the paper. The columnist had quoted Census, provisional report from Wash- from a fellow columnist in a daily pa- ington. It contains a summary of per in another city about something, live births, infant mortality, and still- and here is the comment, which we pass birth statistics in the United States along to you for 1934. On the front page, as a sort of prospectus of what was contained "We've never got all bet up about germs, nohow. We've seen a lot of inside, was the following statement: Negro babies grow up to be good work "Infant mortality rates were exces- hands, and from environments that sively high in New Mexico, 132.1 per would seem fatal, if measured by the live births, and Arizona with 103. standards of our medicos. Maybe it's . . . The next highest rates were 86.1, because the colored brethren have not 7S.9, and 77.4 for South Carolina, fear that they Georgia, and North Carolina, re- been taught to germs them so much." spectively." are not pestered with In plain language, Gentle Reader, We now go back to the partial that means that in 1934 the infant mor- phrase, of less than a single-line com- tality in the State of North Carolina ment, of the Bureau of the Census re- was higher than any of the other port : "All Southern States with large states in the Union with four excep- Negro population." This in an attempt tions, namely, New Mexico, Arizona, to excuse the disgraceful position of South Carolina, and Georgia. South Carolina, Georgia, and North —

August, 1935 The Health Bulletin

Carolina in the matter of excessive County, has the largest and wealthiest infant deaths. population of any county in North Car- The Statesville Landmark is an im- olina which has not yet seen fit to pro- portant paper. We do not know the vide for itself a well-organized, modern columnist, but the paper is published county health department. in one of the best of the smaller cities In the teacher training schools of of this State. It is in a county that thirty-five and forty years ago much has had our admiration from boyhood, time was devoted to a discussion of but it is also published in a county what was Cause and what was Effect. that, with the possible exception of Ladies and gentlemen, we leave any Rockingham County and Cleveland further debate to you.

Our White Flower Mothers

(Radio Talk. May 8, 1935)

By Eva H. Dodge. M.D . Winston-Salem, N. C. NEXT Sunday we will all pause to first, and I left it up to Elsie and her honor our mothers. We will wear mother." the white for those who have left "But she'd been bleeding before, us and the bright colors for those still hadn't she?" with us. Some of you may know that in "Oh yes, for about four or five weeks, 1934 we lost 547 mothers in North but she hadn't had any pain, and she Carolina through childbirth. There wouldn't let me call anyone to see her will be 547 more ' white flowers this 'til tonight, when she got so bad. Even year than last, due to this one cause. then she didn't want me to, because Many of these deaths might have been her mother told her she'd have pain, prevented had ignorance—that enemy and so we waited for the pains to of civilization—not been present. It is come. Oh, nurse, save her for me, the duty of all of us to combat ignor- she mustn't die !" snatch ance and from Death's hands "I'm sorry, we'll do the best we can, some of those mothers. Adequate but it was so late—so late. If she'd care care of mothers during — expectant only called a doctor when she first be- the months before the birth of the baby gan to bleed." will do to help this situation. much The nurse walks along the corridor A young man is pacing the corridor to another room, looking in to see about of the hospital—anxious and worried. the condition of the patient there. An- A nurse comes out of the room—he other tragedy of neglect, she thinks, as rushes up to her. Let us listen in : she watches the patient for a few min- "Oh, nurse, how is she? Is she go- utes. The nurse tells her that the ing to die? I can't stand it if she patient has never become conscious does !" having had more convulsions. The hus- "She's about the same, Mr. Brown, band meets her at the door as she weak. But the doctor will do the best turns away. he can, though she came so late. She "My wife, is she no better?" hadn't been seeing her doctor before "No, she is not improving. It looks this, had she?" very serious." "No, her mother said she had never had a doctor, and that she had raised "You mean she'll not live?" twelve children, and so my wife didn't "It looks very doubtful now." need one, either. We haven't much "The baby—what about it? Will it money, you know. You see, this is our live?" August, 1935 8 The Health Bulletin

Birth and Infant Death Rates, 1934, By States (Provisional)

Live Births Deaths Under 1 Per 1,000 estimated population i>talev t „*„ Number 1934 1933 United States 2,158.919 17.1 16.6

63,493 23.4 22.0 A l abama A la I. 8.348 18.3 17.9 Arkansas 34,566 18.4 19.1 78,280 12.7 12.4 Califoinia1 w.9 ie.3 SioraX *:::::::::::::::z:::::z.:. ".839

asS? ==:::= "SH Hi 11:1 «SS-=- ::::;;:: JS5 £S S g"::::::::::::::::::::::::::::::::::::::::::::::: 64.6 6 o 22.2 20.9

Idaho 9 .329 20.8 19.1 13.8 IlHnote 110,225 14.0 Ind"ana 52,349 15.8 15.3

Eas:::::::: 32,416 17.0 16.2 ™~Kentucky 59,410 22.4 20.9 :-::::;::::::::::::::: IBS £S \H

Massachusetts 63,828 14.7 14.7

Michigan 83,926 16.5 16.0 K25L-. 45,921 17.6 17.2

KSiZl'IZ..:. 9,925 18.5 16.7

Nebraska 25,085 18.0 17.4 Nevada - 1.424 15.1 14.5 New Hampshire 7.869 16.7 15. 1 New Jersey - 54,541 12.9 13.4 New Mexico 12,210 27.9 28.4

New York 185,615 14.2 14.4 North Carolina 79,704 24.1 23.0 North Dakota 14,553 21.2 19.2 0hio 99,906 14.6 14.1 Oklahoma 47,077 19.0 17.8

Oregon 13,075 13.2 12.4 Pennsylvania - 160,238 16.3 16.0 Rhode Island - 10,349 14.7 14.7 South Carolina - 42,029 24.0 23.1 South Dakota 12,956 18.4 18.3

Tennessee - 52,394 19.6 18.8 Texas 116,603 19.2 17.9 Utah 12,552 24.1 23.0 17.0 Vermont:'.'.".".'.'.'..'. 6,593 18.3 Virginia 52,375 21.4 21.0

Washington 22,508 14.0 13.1 West Virginia 41,488 23.2 20.4 Wisconsin 51,419 17.1 16.8 Wyoming 4,565 19.7 18.2 August, 1935 The Health Bulletin

Birlh and Infant Death Rates, 1934, By Towns (Provisional)

Live Births Deaths Under 1 Year Per 1,000 esti- Per 1,000 Town mated population live births Number 1934 1933 Number 1934 1933

Asheville 992 18.9 17.9 74 74.6 76.7 Charlotte 1,732 19.6 17.9 166 95.8 80.3 Concord _ 259 21.4 18.9 25 96.5 117.9 Durham 1,365 23.2 21.6 152 111.4 87.2 Elizabeth City 204 20.0 20.0 17 83.3 83.3

Fayetteville 402 29.1 23.3 40 99.5 162.0 Gastonia 539 30.3 22.8 48 89.1 74.1 Goldsboro _ 326 20.9 19.2 47 144.2 143.8 Greensboro 1,156 20.1 17.8 74 64.0 High 64.5 Point 795 19^7 18.7 69 86.8 71.3

Kinston 319 27.5 22.8 42 131.7 132.6 New Bern 245 20.4 20.0 25 102.0 83.3 Raleigh ,.. 823 21.1 18.8 84 102.1 115.6 Rocky Mount 498 21.8 19.4 68 136.5 124.4 Salisbury 335 19.1 19.3 30 89.6 68.2 Shelby 305 25.4 22.8 18 59.0 36.6 Statesville 227 20.8 20.6 27 118.9 84.4 Thomasville 249 23.1 21.4 23 92.4 Wilmington 56.3 798 24.7 24.2 81 101.5 53.8 Wilson 376 28.9 26.2 60 159.6 Winston-Salem 134.9 1,596 20.3 19.4 158 99.0 92.4

'•The baby was very small, and it ing in. You grandmothers, you friends. only breathed a little while."' All of us. But you say how can we "Yes, I know, we didn't expect it so find out just what care for expectant soon. You see, she wanted her doctor mothers is? First and foremost, see at home to care for her and we were that all expectant mothers go to their going tomorrow so she could be with doctors early. In some cities there are her mother—but she'd complained of clinics provided for those who cannot headache so long, and for two days afford a doctor, where any expectant she'd been saying everything looked mother can get the care .*he needs. hazy and dark. Do you think that And secondly, a postal card sent to the was the beginning? Should I have State Board of Health, Raleigh, will had a doctor then?" bring literature for the expectant "Yes. and months before then, too. mother and an outline of just what Her trouble doubtless started before the minimum prenatal care includes. that. Do you mean she'd never seen The minimum care that an expectant a doctor?" mother should have means regular "Oh, no, she wanted her family doc- visits to the doctor, where a physical tor at home, as she'd known him ever examination of the heart and lungs since she was a child. She was afraid will be made early in the visits. At and did not want a strange doctor to each visit the blood-pressure and urine examine her." will be examined ; also the patients And so the nurse goes on with a weight taken. Adequate diets, rest and double tragedy bearing on her heart. exercise will be prescribed. Then six Preventable tragedies. To be placed weeks after the baby comes another at the door of ignorance. The young visit should be made to see that the man didn't know—the wife didn't mother is in a normal healthy condi- know—the grandmother didn't know. tion.

Whose is the responsibility? Yours and Mrs. Smith has been going to see mine, you fathers and mothers listen- her doctor regularly ever since she August, 1985 10 The Health Bulletin

Birth and Infant Death Rates, 1934, By Counties (Provisional)

0> >-^ o u o CD

s a 3 ^5 3 C 01 t* « w .Q 0) «-5 si oS H.3 Entire State 79,556 6,072 76.3 Johnston Alamance 1,077 55 51.1 Jones Alexander 342 16 46.8 Lee Alleghany 143 5 35.0 Lenoir Anson 749 53 70.8 Lincoln Ashe 576 41 71.2 McDowell Avery 441 22 49.9 Macon Beaufort 859 76 88.5 Madison Bertie 75S 92 121.4 Martin Bladen 729 66 90.5 Mecklenburg..., Brunswick 467 36 77.1 Mitchell Buncombe 1,934 124 64.1 Montgomery.... Burke 772 32 41.5 Moore Cabarrus 1,014 94 92.7 Nash Caldwell 966 66 68.3 New Hanover.. Camden 118 12 101.7 Northampton.. Carteret 357 22 61.6 Onslow Caswell 434 19 43.8 Orange Catawba 1,105 64 57.9 Pamlico Chatham 458 33 72.0 Pasquotank Cherokee 442 20 45.2 Pender Chowan 275 40 145.4 Perquimans Clay 151 12 79.5 Person 61 47.6 Cleveland 1281 Pitt 110 94.0 Columbus 1,170 Polk Craven 685 54 78.8 Randolph Cumberland 1,248 86 68.9 Richmond Currituck 127 10 78.7 Robeson 5 45.0 Dare m Rockingham... Davidson 1,167 83 71.1 Rowan 25 70.0 Davie 357 Rutherford 69 70.0 Duplin 986 Sampson 1,686 170 100.8 Durham Scotland 1,257 138 109.8 Edgecombe Stanly Forsyth 2,338 209 89.4 715 50 69.9 Stokes Franklin Surry 2,045 159 77.8 Gaston Swain Gates 219 15 68.5 Graham 153 11 71.9 Transylvania. Tyrrell Granville 753 59 78.4 Greene 581 47 80.9 Union Guilford 2,790 177 63.4 Vance Halifax 1.567 130 83.0 Wake Harnett 1,135 72 63.4 Warren Haywood 838 64 76.4 Washington. Henderson 561 34 60.6 Watauga Hertford 452 52 115.0 Wayne Hoke 354 25 70.6 Wilkes Hyde 173 7 40.5 Wilson Iredell 1.100 93 S4.5 Yadkin Jackson 507 34 67.1 Yancey : : —

August, 1935 The Health Bulletin 11

thought she might be pregnant. Let urine specimen. You see, I did remem- us listen in on an office visit ber to bring it. I hope it will be all "How-do-you-do, Mrs. Smith, how are right this time." you today? Any headaches?" "I'm sure it will be, for the one you "Doctor. I have been feeling fine sent by Mr. Smith showed only a trace until a few days ago—when my head of albumin. Now let me see what the to ache. began There were black spots blood pressure is. Fine. Just what it dancing before my eyes, too." was when you first came to see me, and "Why didn't you call me about it?" Miss Davis reports that thj urine is "Well, it wasn't very much. I normal. You have lost three pounds thought it didn't matter, but as you this week, too. And ail that swelling asked. I thought I'd mention it." has disappeared as well. If at any "Are your ankles swelling?" time you should have any headache "Oh, yes, but Mrs. Jones says every- that persists—or black spots before one expects that." your eyes, or things look hazy, or if "Let's see how much you weigh. Yes, you have any pain in the pit of your 140. Do you realize you have gained stomach, you ar* to let m> know at five pounds in the last two weeks? once." Now I'll have Miss Davis examine the "I surely will, for I can see what a specimen, while we see what your blood difference last week has made. I told pressure is." my neighbor about what you said and "Oh doctor, I forgot the specimen. she went back to her doctor and told You see, I was in a hurry." him about her headaches and swellings. "Now, Mrs. Smith, I'm afraid you do She lost her last baby. She didn't see not realize how important it is for us a doctor and the mid-wife came in at to examine a urine specimen each visit. the last minute. I told her you said You see, it is just another guide post everyone should have the right care for us doctors in watching your general early." health, and also just how your kidneys "Mrs. Smith, you have been a real are reacting to the added burden of missionary—one who carries a mes- pregnancy. I'm sure now that you sage, you know. I wish that every understand, that hereafter, you will woman who knows make it a point to remember to bring what prenatal care it." means would tell her neighbors as convincingly as you have. Now, see "Yes, doctor. I never knew it was Miss Davis and get an appointment important—is my blood-pressure high?" for next week so we can be sure this "No, but it is higher than last time, improvement will be permanent." and that gain of five pounds in two weeks is significant. That means we And so we see that early and careful shall have to put you onto a diet and watchfulness means comfort for the see that you have the proper elimina- mother and safety for her unborn babe. tion." It is necessary for all expectant women And so Dr. Hawks tells her what to see that they have proper care in she should eat and the proper medi- order to prevent these disturbances of cines to take. pregnancy which, if allowed to go un- Let us listen in again to Mrs. Smith's checked, may result in severe illness of next visit the mother—occasional death with the "How are you today, Mrs. Smith?" loss of the baby. Often false modesty "Oh, doctor, I feel so good. No more prevents a woman from going to her headaches—and would you believe it doctor, for she does not want to be ex- my ankles are like a young girl's ! I'm amined. Little does she realize that she sure I'm better now and here is the may be placing a high price on her life, : — ;

August, 19S5 12 The Health Bulletin or that of the child, by her attitude, as you to give this matter serious thought physical examination is an essential and whenever and wherever possible part of prenatal care. It gives her doc- exert your influence to see that our ex- early see their tor a chance to help correct any slight pectant mothers go to disorders which may occur and be pre- doctors, so that next year there will be moth- pared for any emergencies which may fewer white flowers worn for the from prevent- arise. ers dying in childbirth Ladies and Gentlemen, I challenge able illnesses.

Convalescent Care for Poliomyelitis (Infan- tile Paralysis) Patients

By Josephine L. Daniel, R.N., Consultant in Public Health Nursing, Division of County Health Work

has been written about the lowing suggestions must be adjusted to MUCH mother, adjustment of an individual to each individual patient. The or attendant, should be near enough to life to insure happiness and suc- that direct his interests and activities by cess. It is also an accepted fact introduction of different materials. No a single experience in one's early life matter how young the patient is, a such as a serious illness and the treat- wholesome attitude towards his afflic- ment he receives during the convales- tion should always be present. cent period of that illness, may cause maladjustment in later years. Suggested equipment which can be for the Poliomyelitis (infantile paralysis) assembled at a minimum cost Poliomyelitis has an acute period of illness and the convalescent period of a paralysis) patient is listed patient needs constant skilled medical (infantile attention. The convalescent period is a below with a long slow one and the mother, or nurs- 1. Bed Table: Anyone handy can construct a ing attendant, should understand the hammer and nails progress of the disease in order that practical bed table from a wooden inches. Remove the nursing care and treatments will packing box 20 x 12

; ends lessen future disability and at the same the two sides this leaves the two time allow that child to develop into a connected by a board which serves as regu- well adjusted and happy individual. the top. Since the table will have sandpaper The latest prescribed method of treat- lar use, it would be wise to ment for the poliomyelitis (infantile it thoroughly and cover with a coat of frequently paralysis) patient is to achieve abso- enamel in order that it maybe large lute rest of the affected muscles or scrubbed with soap and water. A if the group of muscles involved. After muscle table clip should be provided tenderness has disappeared, re-educa- child does not have the use of both tion of the muscles may be possible if arms and hands. exercises are prescribed by a physi- 2. Assorted colored sheets of paper cian. 10 x 12 inches. However, it is the period before mus- 3. Light weight cardboard. cle tenderness has disappeared with 4. Short lengths of flowered wall which we are concerned. Provision paper. must be made to amuse the child dur- 5. Jar of library paste. ing the long days of absolute rest after 6. Pair of blunt scissors. the acute period has passed. The fol- 7. Colored pencils, or crayolas. August, 1935 The Health Bulletin 13

8. Cut out pictures — Christmas or buildings, or Indian villages, and the picture postal cards and funny papers. people and animals can be made from 9. Toothpicks and unshelled peanuts, • peanuts, fruits, or vegetables put to- button doughnuts, or small fruit or gether with toothpicks. The miscellan- vegetables in season. eous articles can be used in building 10. Wooden beads and bodkin and and decorating the villages. cord. Older children and adults will enjoy 11. Soap-bubble pipe and soap. more complicated amusement such as 12. Molding clay, or carpenter's loom weaving, knitting, etc. Materials putty. for weaving can usually be obtained 13. Miscellaneous: Small pine from any large department store. branches, corks, shells, bits of colored It must be remembered, however, stones, clean chicken feathers, etc. that care must be taken to prevent The above articles can be used in va- fatigue. It is wise rious ways. Scissors, crayola, colored to allow a regular paper and paste can be used in making schedule, first, a short work period,

scrap books, paper chains, cutting sil- followed by a rest period. Frequent houettes, paper dolls, etc. The molding change of materials is also advised as clay or putty can be made into farm a diversion.

Public Health Activities in the Field of Malaria Control

By M. R. Cowper, State Board of Health few citizens ONLY a of the United the Panama Canal Zone under the di- States realize what a prominent rection of General Gorgas. Malaria is part their Government has taken a major medical, engineering, and edu- and is still taking in public health cational health problem to be combated work. One of the major vocations of by the co-operation of public workers any Government interested in the wel- in each of these lines of activity. fare of its people is that of disease Through long and tedious study control, for diseases have played a far world-famous scientists have given to more prominent part in history than is mankind rather complete information recorded in the familiar textbooks on concerning the malarial parasites and that subject. This paper will be de- vectors. Noted physicians have evolved voted to a discussion of one very com- processes for the medication and treat- mon southern disease—malaria. ment of patients, while engineers in a The ultimate control of malaria in more limited field have proved that America is a Herculean task. The their technical knowledge and methods problem of successful restraint, espe- are capable of eradicating the vector. cially in the southern United States, is It is now the task of public health one that requires years of gradual workers to utilize these forces and free effort by the people, with the assist- the southern United States from this ance of trained Government experts in famed malady. that field. However, it is not impossi- The most important feature in the ble. This has been proved by the many control of this disease is, as in prac- successful individual attempts that tically every other real problem, that have been completed. Most prominent of education. One still finds those per- among these is the famous work done sons who will swear that malaria is by the United States Government in caused by contaminated drinking water, August, 1935 14 The Health Bulletin

parasite passes through or that it comes from inhaling the air vidual. The near swamps and standing water. The the digestive tract of the mosquito, mosquito theory to them is a myth and changes in form and finally infects its mosquito in this a good joke, and remains thus until an salivary glands. The epidemic such as occurred in Camden state is then capable of infecting or re- County last year causes them to put infecting the victim of its bite. As in their frantic faith in any one who offers the case of all other mosquitoes, water of the to help. But lessons learned on occa- is necessary for the breeding ma- sions like the one just mentioned are larial specimen. The favorite breeding soon forgotten until another cycle of places of this type are furnished from disease again ravages the neighbor- ponds, lakes, ponded swamps, and their hood. It is only with the impetus of a like, and where vegetation and float- disastrous epidemic that public sym- age are plentiful on the surface. pathy for health work is aroused. An It takes from 10 to 14 days for an encouraging note is the fact that engi- Anopheles mosquito to pass through the neering schools all over the country are four stages of its life history. First, now teaching to technically inclined the egg; then the larva and pupa it emerges an persons the primary points of malaria stages ; from the pupa epidemiology. adult winged insect, having a natural ani- Malaria is perhaps the most general instinct for finding warm-blooded disease now existing in the United mals or human beings, from whom it States, although its prevalence is prac- derives food. The blood thus gained is tically limited to the Southern States. also necessary to mature their eggs. that the It is not a killer, as many of the other It is from this life history diseases, but one which renders its vic- best method of malaria control has tims almost useless, a disease that been derived. The 10 to 14 days men- greatly impairs the mental and physi- tioned above is their period in which and cal ability of persons who have it. Its quiescent water, such as ponds is nec- effect has always been the same, namely, lakes with protective vegetation that people residing in a malarious ter- essary to the mosquitoes. Therefore, to the ritory are very lazy and unambitious. get rid of such areas would break Studies have shown that the ability of cycle of the malaria carrier, the Ano- tech- a person to earn a living when he is a pheles Quadrimaculatus, to use its practically victim of malaria is only about two- nical name. This is most thirds as good as a person similar in accomplished by drainage, which is every respect who does not have the the only permanent solution of the disease. Therefore, one can understand problem.

that it is not the mortality rate which The value of drainage to agriculture concerns health authorities, but rather has long been realized, but its value to the condition of its victims. It is also malaria control is a comparatively re- an economic concern in that the finan- cent development. When draining for cial returns on every malaria control agricultural purposes one wishes to investment have been enormous. lower the water table, but for mosquito Early public health workers have control the purpose is to drain off the carried the fight on malaria through standing water, which is capable of many stages. It was discovered long breeding the Anopheles mosquito. In ago that, although a disease of man, practically every instance good agri- effec- it was spread by a certain type of mos- cultural drainage could have been quito of the genus Anopheles. The ma- tive against malaria had the engineers fact and con- larial parasite is taken from the blood in charge realized this of one person by this mosquito while structed the canals in such a way as to she sucks the blood of an infected indi- keep their water contents from pond- ;

August, 1935 The Health Bulletin 15

iug. The natural conclusion, therefore, protection. Most of these disadvan- is that drainage with its economic and tages are due to the fact that effective health advantages can always be em- screening is too much dependent upon

ployed to solve the malaria problem. the variable personal element, that is, But in many cases it can not. Drainage the care and use accorded them by the is a very expensive proposition ; it often people whom they protect. requires large outlays of money for There are a number of places that labor and dredging machinery. Besides can have ideal protection from the this there is the expensive engineering malarial vector by executing only a item and the legal costs that have small and inexpensive amount of minor always burdened this type of construc- drainage. On the other hand, there are tion work. those places where drainage is not It is evident why persons residing in practicable and cannot be economically thinly populated areas have been and justified. Included under this head are always will be unable to meet the costs the impounded reservoirs of water for of well-designed drainage projects. power and for municipal consumption, These people unassisted are unable to the resort lakes and parks. Here the meet even the initial costs of such breeding places cannot be destroyed, work, and the best designed system of and it very frequently happens that canals will soon fill up and lose its such menaces are in the proximity of value unless maintained constantly. It densely populated areas. Effective con- is only the cities, towns, and densely trol in these instances has been gained populated rural areas that can afford through the application of one of the to protect themselves and their prop- several well known methods mentioned erties with expensive drainage. For below, or a combination of all. The sci- other individuals, there are several less entific variations of water levels under costly methods of control. certain conditions have proved useful, The Anopheles mosquito does the particularly when Gambusia, the larvae- greater part, if not all, of its blood- eating top minnow, is abundantly pres- sucking after dusk and before dawn. ent in the waters. The periodic removal It cannot stand the daylight. The first of vegetation and floatage from the of these less expensive control methods water's surface has also given excel- is, therefore, the proper use uf good lent results in those lakes from which screens. These protect those who have basin all trees and other forms of mat- malaria from infecting mosquitoes, and ter have been cleaned. It has been will in turn protect those who are well found that lakes and ponds with steep from infection by the mosquito. The sides and well-defined margins are not best results from screening have been conducive to mosquito propagation obtained in only those homes which are while those same areas containing nu- tightly constructed and carefully merous shallow flats and undefined screened. If the person protecting him- margins have an opposite result and self in this way should leave his house require a great deal of expensive atten- after dusk his protection is lost. Screens tion to their control problems. In such can be installed at very little cost and places the frequent application of lar- the cracks and holes in the average vicides is necessary. This preventive rural homes may be economically is another less costly method of control. patched. Free literature explaining There are many different types of this type of protection is always avail- mosquito larvicides now sold on the able at the State Health Department. market. Practically all of these com- But screens have many other disad- mercial brands are oil mixtures, be- vantages which will always keep them cause these are effective killers of all from affording anything like perfect types of mosquito larva?. To the experi- —

August, 1935 16 The Health Bulletin eiiced health worker the use of oil is funds for this purpose by the United poor economy unless some competent States Public Health Service through of Health. entomologist has proved beyond the its State agents, the Boards Carolina State Board of shadow of a doubt that the types of The North mosquitoes found in the areas involved Health now maintains an experienced malariologists to are harmful to man. As you may know, staff of engineers and control work. great there are many species of mosquitoes supervise malaria A accomplished, that will not attack a human being. deal has already been but more remains to be done. A report It is also true that the only type having malarial con- any public health significance is the to this department of any Anopheles. In such cases as this it is dition existing in this State and not always the part of economy to use yet known to the State Board of Health Paris Green dust mixtures as the larvi- will bring our co-operation and inter- not aid us in ridding cide. One part of Paris Green to ten est. Will you parts of any fine base dust, such as North Carolina of this disease? hydrated lime or road dust, is sufficient to poison all the Anopheles larvse in a Plain Envelopes given area, because they feed on the surface. These mixtures may be eco- Frequently the State Board of Health nomically and hastily applied on the has requests from some citizens of the windward side of the breeding area State for literature which they ex- with either a hand or power duster, pressly specify must be sent in plain required to and only a gentle breeze is envelopes. To all such people, no mat- all the vulnerable distribute it over ter what the reason for this is, we are amounts of spots, regardless of the compelled to state that we do not have on the floatage and vegetation present any such envelopes. We must send our Oiling is sometimes water's surface. literature out in the official stationery oil is avail- economical where waste of the Board. One of the important amounts and the mixing able in large reasons for this is that so many peo- popular mix- materials cheap. The most ple write without giving complete post- heavy waste oils from tures include the office address, but unless the outside of stations with gas plants or service the envelope bears the address of the of kerosene and oils smaller amounts sender, loss of time and much expense These mixtures are oft- of pyrethum. is involved. To all our friends we wish difficult to apply. The period be- times to say that we shall be glad to send of larvicides on tween the application you promptly any literature that you area varies from ten to any particular write and ask for, which we have listed suitable period fourteen days, the most every month on the second page of being ascertained only after scientific The Health Bulletin, but we cannot tests have been made. Larvicides field send in anything except the official sta- fish life, nor do they are not harmful to tionery of the Board. in any way endanger the water for municipal consumption. Many persons in North Carolina could easily afford to

protect themselves from malaria and Age is a quality of mind mosquitoes by the careful pestiferous If you have left your dreams behind, application of larvicides. If hope is cold, The United States Government, hav- If you no longer look ahead, ing already put an end to yellow fever, If your ambition's fires are dead, is now making a concerted effort to counteract malaria in this country. It Then you are old. has approved the use of Federal Relief —The Kalends. ? » • BE ARD R. JN

Published bM TAE^RmCARgLlrtA. 5TKIE,5?ARDg7\B\Un

This Bulletin will to ar\\j 1 be aery! free citizen of the 5tcrteupor\ request. !

Entered as second-class matter at Postoffi.ee at Raleigh, N. C, under Act of July 16 189k Published monthly at the office of the Secretary of the Board, Raleigh, N. C.

Vol. 50 SEPTEMBER, 1935 No. 9

COLONEL FRED A. OLDS, RALEIGH, 1853-1935

The Beloved Friend of All North Carolina School Children a picture of Colonel Olds, Founder and Director of the North Carolina Hall of History Lti^t }°lt T u , y ^as made when he ' was eighty years of age, October 12, 1933. 1= -fu , During his L™ Ce \Wthe all f H Hlstor h e spoke to groups of school children £~ ^ . J y in one or more places in m the St&t e Plloted many th °usands of teachers - ? - and school Th" Wren RaleLhT7v, CCaS10n hu about th6lr V ' S1 e CapitaL His ins P ir^g talks, packed with important n\storica?^nfn™ t °i ^/° ^ an ap ea f° r dean living and high ideals wil1 be timetim e hv ihT i° L - remembered a long by the present generationf" of? school children. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Winston-Salem S. D. Craig, M.D., President - N. Johnson, D.D.S., Vice-President... - Goldsboro J. -— yde" G. G. Dixon, M.D £ H. Lee Large, M.D Rocky Mount hap H. G. Baity, Sc.D £ ",, Fayettevillefi W. T. Rainey M.D ~ B. Haywood, M.D Hubert «,T , H. James P. Stowe, Ph.G £* Asheville»t J. LaBruce Ward, M.D

Executive Staff

Carl V. Reynolds, M.D., Secretary and State Health OflScer. G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Preventive Medicine. Warren H. Booker, C.E., Director Division of Sanitary Engineering. Ernest A. Branch, D.D.S., Director Division of Oral Hygiene. John H. Hamilton, M.D., Director Division of Laboratories. Epidemiologist. J. C. Knox, M.D., _ R. T. Stimpson, M.D., Director Division of Vital Statistics. R. E. Fox, M.D., Director Division of County Health Work.

FREE HEALTH LITERATURE

Adenoids and Tonsils German Measles Scarlet Fever Cancer Health Education Smallpox Constipation Hookworm Disease Teeth Chickenpox Infantile Paralysis Tuberculosis Diabetes Influenza Tuberculosis Placards Diphtheria Malaria Typhoid Fever Don't Spit Placards Measles Typhoid Placards Eyes Pellagra Venereal Diseases Supplies Flies Residential Sewage Water Fly Placards Disposal Plants Whooping Cough Sanitary Privies

Prenatal Care (by Mrs. Max West) Baby's Daily Time Cards : Under 5 months ; Prenatal Letters (series of nine 5 to 6 months; 7, 8, and 9 months ; 10, monthly letters) 11. and 12 months; 1 year to 19 months; Minimum Standards of Prenatal Care 19 months to 2 years Breast Feeding Diet List: 9 to 12 months; 12 to 15 Infant Care. The Prevention of months; 15 to 24 months; 2 to 3 years; 3 to 6 years Infantile Diarrhea _ Table of Heights and Weights Instructions for North Carolina Midwives CONTENTS PAGE

Board of Trade Epidemiology * School Health Supervision * A Wise Expenditure of Federal Funds » Do Parents Fail Their Children ? 6 Need for Education in This Field •» A Successful Negro Cripple 11 Survey in the Canton North Carolina Schools IjS 13 Health is the Child's Best Insurance A Fair Chance for Our Beginners 14 "He Cried and Cried, But " 1° Milk Laws and Typhoid Fever. - - 16 Vol. 50 SEPTEMBER, 1935 No. 9

Board of Trade Epidemiology

THE purpose of a board of health, state or local, is to protect the people in its jurisdiction, in so far as it is possible to do so, from the ravages of disease. The interests of a health officer are scientific and not political. His responsibility is for human life and not for money. He must paramount health instead of dollars. He must be fair to the point of judicial accuracy. As the science of disease prevention has made progress, it has been possible more and more to protect the people from preventable disease at a minimum cost in time and money. The modern control of municipal water supplies and sewage, together with the protection afforded through immunization has about eliminated most of the scourges of the past. Diseases such as typhoid, typhus and yellow fevers, diphtheria, plague, dysentery, and smallpox are no longer looked upon as the dread killers of the people of whole cities as they once were. There- fore the necessity for drastic quarantine measures are seldom necessary now. One of the few remaining diseases in which the exact cause, prevention, and mode of transmission is not definitely known is acute anterior poliomyelitis, or infantile paralysis. It is a disease rightly feared by people everywhere, and particularly by the parents of young children. The after effects of some cases leaves the crippling marks of its presence for life. During June, July and August central and eastern North Carolina had to deal with an unusual outbreak of the disease. Panic and hysteria has been its ally in many sections, and sordid selfishness has appeared in others. The State Board of Health has been criticised by a few business interests because it consistently gave out the facts daily about the presence of the disease. For the most part, however, people have co-operated splendidly, especially the churches and all State departments. The officials of the Board followed the advice of the United States Public Health Service and other states which have dealt with the disease in epidemic form, and cautioned against the assemblage of persons, especially children for any purpose in the affected areas. But the Board has repeatedly urged people to be calm. Not to become frightened and to pay no attention to rumors. The Board sought and received the assistance of the best students of the disease in the country, and the officials believe that in handling the situation as they have the interests of every individual and institution in the State has been fully safeguarded. In the old days The Board of Trade which was somewhat of a predeces- sor of our present day chamber of commerce and merchants association, insisted on handling all epidemics. Their methods were simple. They suppressed all information about the presence of an epidemic until everything and everybody was ruined. That day ought to be past. The Health Bulletin September, 1935

School Health Supervision

A Pleasant Reflection on Twenty Years State Service feature in the TWENTY years ago this month the The most encouraging writer undertook the first State whole situation was the welcome at- Medical Inspection of School Chil- titude of most of the teachers in the dren ever inaugurated in North Caro- primary and elementary grades. Many cold and indif- lina. The work that winter and of the principals were through the winter following was in ferent, but the teachers who were fac- us a the nature of an experiment. During ing the problems every day gave cher- those two school years appropriations sympathetic welcome which is suflicient to carry on the enterprise was ished to this day. The encouragement secured from local county or city gov- and helpful assistance of the rank and twenty erning boards. The State Board of file of the teachers during these Health had no funds for the purpose. years has been a stimulating exper- Three physicians were employed for ience. They have been apt students of realized the their full time. They were in complete public health. They have sympathy with the views of the writer need for the practical application of the every- who directed the work, and two of public health knowledge in pupils. And they them became from then on his warm day lives of their have valiantly done their full part. In personal friends. They examined all humility we dedicate this issue of school children enrolled in the ele- the Health Bulletin to the teachers mentary or grammar grades in the pub- of North Carolina. Our daily contact schools of twelve counties. A total lic with them for the past twenty years of twenty thousand children were per- has been an inspiration to us. sonally examined. Lectures on public Today public health has an honored health were given in every school and place in nearly all the schools of every as many parents as could possibly be county. In the twenty years gone by induced to come were present. It was many of the county superintendents long before the formal establishment of schools have been strong supporters of the Parent Teacher Association in of the public health cause. They have But it can be said truth- this State. championed the right of the children fully that this was the first real parent- to an education in health as well as in work done in the State. teacher mathematics and English. Conditions in almost every school Twenty years on one job is a rather were found to be appalling. The teach- long time. It affords an opportunity, ers were for the most part overworked however, to measure standards. And we and underpaid. They knew nothing do not hesitate to say that the health of public health in the modern sense. of school children is today incomparably Sanitation and sanitary facilities were better than it was twenty years ago. If notable only for almost complete ab- the coming generation of children now sence. The physical condition of the beginning school will avail themselves most of the children was deplorable. of the information and protection pro- Teeth were terrible, and diseased vided for them by the public health throats were the rule. The buildings State, twenty years were poor and badly designed as to agencies of the they should put to shame the light and heat. In short it was a dis- from now couraging prospect. old Greek ideal at its best. September, 1935 The Health Bulletin

A Wise Expenditure of Federal Funds

Division THE of Sanitary Engineer- forward this enterprise to all sections ing of the State Board of Health of the State in a most commendable reports on the first of August manner. Their effort has been in ef- that a total of 171 cities and towns of fect a campaign of health education North Carolina are contemplating and information in an endeavor to get waterworks and sewer improvements the people of the State to take advantage under the new Public "Works Adminis- of the unprecedented opportunities now offered by the Federal tration and Works Progress Adminis- Govern- ment. tration. The nature of this work is The department either outright installation of water has not confined all and sewer systems in a total of 78 its activities to this effort. It has also towns that have never had any public made every effort to induce the build- system, or an extension in the rest of ing of sanitary privies of an approved

these towns and cities of the present type at every home in the rural dis- facilities to enable larger a percentage tricts of North Carolina which do not of the people to live on water and already have such facilities. The mean- sewer lines. ing of this dual enterprise is that the The fact that some of these towns smaller homes in what has been here- which are contemplating such work tofore termed the less desirable sec- have as few as 150 people is all the tions of the larger cities will have the more significant because in the past availability of water and sewage. For water and sewer facilities have been the smaller towns it means that a still looked upon strictly as a city con- larger number of the same class of venience. When the small towns of the people will have the same protection State are equipped with these comfort and comforts of the larger city dwell- and health-protecting facilities, it is ers. In addition, it means that the only natural to assume that the in- poor man living in the country on the centive on the part of more well-to-do farm or in the outlying suburban dis- farmers in all sections of the State to tricts of the cities and towns will have equip their homes with private supplies the protection afforded by a sanitary will mean the installation of a great privy. many more such systems. There has The most recent general survey never been, and probably never will be proved that about 33 per cent of the again, a more opportune time for these farm homes in this State cities and towns to install and extend have no toilet this work. The Federal Government facilities of any kind, not even a bur- is granting an appropriation of 45 per lap leanto. An inordinately large num- cent of the total amount of the loan, ber of babies still die from the bowel with the rest of it payable at only 4 diseases contracted through polluted per cent interest. drinking water or infected food. This In modern civilization nothing is pollution results from the contamina- more essential to the health and safety tion of colon bacilli distributed through of a family than to have an adequate unsanitary disposal of human dis- and safe water supply and safe charges. Hookworm disease and ty- methods of sewage disposal. The De- phoid fever also remain in many sec- partment of Sanitary Engineering of tions of the State. To control such the State Board of Health has carried diseases a safe water supply and sew- September, 1935 6 The Health Bulletin

Doctor Baity em- age system, either public or private, In the foregoing must be available to every individual. phasized the fact which should be up- In a letter to the State Health Officer permost in the minds of all people en- and the head of the Division of Sani- gaged in the expenditure of relief Dr. H. G. Baity, of tary Engineering, funds, and that is that the expenditure University of North Carolina, who the should be made on projects which are is Acting State Director of the Federal permanent and socially desirable, and Emergency Administration of Public which protect the public health. Works, has stated in few words a Notwithstanding the progress which synopsis of the desirability of this type the last few years in of work. Doctor Baity writes: has been made in the building and equipment of school "Our organization is interested, of course, in providing the means with plants, in North Carolina today only desir- which to do useful and socially about 30 per cent have satisfactory able permanent public works of all supplies, and only about 24 per types. However, owing to their health water promotive character and their influence cent of the school buildings of the upon the standards and enjoyment of State have satisfactory sewage. Thirty- living, I am disposed to place water three per cent of the schools have no and sewer projects at the head of the supplies at all, and 19 per cent list as to desirability and preference. water Everything considered, I can think of of the schools have no toilet or sewage funds may be no way in which Federal facilities of any kind. It seems to us expended as advantageously as in the that work of such importance, from provision of these facilities. I trust that a large proportion of our allot- the standpoint of the public health and ment will be devoted to works of this well-being of the citizens of this State, not expect character, and, if so, I do should receive the active encourage- in the years to come to look back upon ment and assistance of every sensible my experience with the PWA with any regret." citizen in the State.

Do Parents Fail Their Children?

By Margery J. Lord, M.D., School Physician, Asheville

or not at all. We MOST parents want for their chil- tions improperly dren more out of life than they cannot think of the stomach as being themselves had. Their ideas of at all particular about what is poured developing their children lean far to- into it or of how full it is packed until maltreated ward the educational, social and cul- that stomach refuses to be find ourselves very tural side of life. All these are well any longer, and we possess a worth attaining but it is my desire to much aware that we not only convince you that they are of only sec- stomach but a very sensitive one. ondary importance. An Arabian pro- Even if parents have broken every verb gives us the proper idea most rule of health themselves and failed in simply and emphatically: "He who hns protecting themselves from certain dis- HEALTH has hope, and he who has eases, if my first sentence is correct, hope has everything." they will plan a different life for their children. Because of this it is essential We scarcely realize that our bodies receive help in training are made up of various functioning that parents children from early infancy how organs until one of these organs func- their September, 1935 The Health Bulleti N

to lead healthy lives. Many books are idea of preventing accidents and loss written to help the busy mother cor- of life. A law to try to save babies by rectly care for her child, but the child preventing them from having diph- specialist is her best adviser. The child theria was voted down in our last is an individual, not a machine, and Legislature. no book can possibly be specific enough There are some parents who are un- to cover all the necessary points. Your fortunately indifferent to this form of doctor may advise you to read certain protection. There are others who have

books and pamphlets ; and he wants been misguided into thinking harm you to be sure that what you read is will be done rather than good. Still of real value when put into practice. another group are the procrastinators- As with all growing things, either that put it off from day to day until

plants or animals, it is in the early alas too late ! The suffering, the anx- stage we have the greatest mortality. iety, the expense of illness, the little

Parents should realize that if their grave on the hillside ; all could have children survive early childhood, they easily been avoided. Mothers and have a fair chance of continuing to fathers don't fail your babies. manhood or womanhood. Contagious At the same time you are preventing diseases of childhood are much more your child from having diphtheria you apt to be fatal in the first five years of may be saving him from another much life than in the later years. Do you dread disease of childhood. An au- as parents consider this when you pick thentic report coming from the Illinois up your baby and rush away to visit State Health Department says that the with a sick neighbor? You do not know danger of children contracting infan- what disease is in this home, yet in tile paralysis seems to be less when you go and your own children with these children have been immunized you. Possibly you spend the entire against diphtheria. afternoon. When your child is two years old In the first place really intelligent have him vaccinated for smallpox. No mothers try in every way to keep their need to wait until he is entering school. young children from being exposed to He may be given the typhoid vaccine any contagious disease. Secondly, they at any time your physician thinks best. will protect their children by vaccina- Also talk to your doctor about the tion or immunization wherever pos- scarlet fever toxin which has been sible. Many have the erroneous idea used rather extensively in some of the that school is the place to have all this northern states. The tuberculin skin work done. In reality it is the last test—called the Mantoux test—should resort. Any wide awake health de- be used to determine if your child has a partment will try to inform all mothers tuberculous infection. The childhood that their babies should be given toxoid type of tuberculosis cannot be diag- when they are six months old. This nosed by chest examination. A nega- will protect 95% of them from diph- tive skin test will relieve your anxiety. theria. The up to date general prac- A positive one should set the machin- tioner and pediatrician will emphasize ery operating necessary to determine the need of this protection being given whether your child has tuberculous these babies. Why ever take a chance disease. when there is certain protection? Law From the contagious disease stand- demands that you have brakes on your point parents can protect their child- automobile and specified type of lights dren, especially in infancy and early and that you travel no faster than a childhood, by keeping them at home, certain rate of speed, all this with the away from all crowds and any known 8 The Health Bulletin September, 1935 diseases. Will they of their own free never having had a thorough physical will, because of a desire to save their examination and with a mouth full babies, have them immunized or vacci- of decayed teeth. nated against these diseases? A law He has to adjust himself to a com- which will help us to remember to pro- pletely new environment. Physical tect our children should be welcomed handicaps frequently cause loss of time rather than rejected. from school and inability to adapt him- read much about the yearly We self to new surroundings. This results health examination. We think "what at the end of the term in retardation a grand idea." We forget to carry it instead of promotion. He is a repeater. out. Tour child should not wait until This may mean such disgrace that he he is eligible for the pre-school clinics brands himself as a failure, as mentally to have his examinations. You should insist that your own doctor give him a inferior to his classmates. Let me il- careful examination not less than once lustrate my point. Charles, a fine well a year, even though he seems to you nourished alert boy of six enters school to be a well child. When he arrives in September. He is keen on going to at school at the age of six he should school. You, his parents, are justly be ready physically to undertake his proud of such a child. Physically and tasks. mentally he is perfectly normal. His satisfactory. The health officer, school physician, progress in school is very sore throat. A school nurse and interested teacher In November he has a diphtheria placard is seen on your want to aid you in keeping him well. house. Inside Charles lies critically The school is not the ideal place to ill. His life is saved but his heart is have him immunized against diph- so damaged that the doctor says "no theria or vaccinated for smallpox. It more school for Charles this term." is not the place to discover badly dis- This perfect specimen of childhood has eased tonsils which have existed in become a damaged one. The following that child's throat for several years September Charles, still in the first and have already done permanent grade makes another start towards his damage to the valves of the heart. It education. Can this be the boy of a is not the place to determine the child's year ago? He is undernourished and nutritional status and determine whe- pale ; he seems tired and listless. By ther he is gaining or losing weight. February another placard is on your All these things should have been done house. Charles has scarlet fever. An- before school age. The school house, other term of school is lost and Charles however, is the last resort. It takes has become so discouraged he refuses the child at six years of age and does to attend school again. With much the best it can. continued persuasion you finally induce Pre-school clinics have been organ- him to go. His entire attitude is so ized to try to help you get your child changed he has become a different ready for school in the fall. To try to child. A child discouraged and indif- do in three months what should have ferent to an education is the result. been done for these children over a He realizes he is over age for his period of nearly six years. Do you grade. His friends and playmates are fail your children here? Comparatively two grades ahead of him. Already he few of you take advantage of these is classified as a repeater and a re- pre-school clinics and your child enters peater he continues, due to physical school not immunized against diph- handicaps which later become mental theria, not vaccinated for smallpox. as Charles' discouragement makes him :

September, 1935 The Health Bulletin 9

stop trying. Can you afford to have realize, and mental health is more your child take this attitude because necessary even than physical. Practice of your neglect? emotional control and interparental The school physician and the school harmony. nurse take up the work. Your child Let me sum up my main points. needs certain medical and dental at- Institute in your home a proper tention. A slip of paper notifies you health regime from early infancy for of this need. Later the nurse calls and your child. Tour guide should be your talks to you about it. Nothing is done. doctor. Make the atmosphere of the Four years later your boy is not per- home, by your own habits and emo- ball mitted to play on the school basket tional control, such that the child is team because of a heart condition not irritated or over-stimulated. Look caused undoubtedly by diseased tonsils upon early immunization or vaccina- of which you were informed many tion as imperative. See that your child times during these four years. Have has a complete physical examination you failed your child? at least each year followed by proper Surely educating and clothing your attention to any defects. children, sending them to Sunday Our pre-school clinics in May, 1935, School and seeing that they select revealed that proper playmates is not enough. The 89% of the children were not vacci- child's health must come first. See nated for smallpox. that all the organs of his body are 69% had not been immunized against sound and that his mode of life is such diphtheria. as to keep them so. Give him a well 84% had some physical defect. balanced diet, with regular meals and Parents don't fail your children. It plenty of time to eat. Have meal time has been said "ignorant mother love a joyful time, with no quarreling or has probably slain as many babies as matters of discipline brought up. The disease." Intelligent mother love can child is very sensitive to the atmos- save our babies and make them men- phere of the home. He will absorb tally and physically fit for lives of your anxieties and fears more than you usefulness.

Need for Education In This Field IN the recent epidemic of infantile for a better informed public and a paralysis, or poliomyelitis, the of- more discriminating one when it comes ficials of the State Board of Health to appraising the value of the thousand have learned a good many things. Some and one remedies, offered for the most fundamental scientific facts were re- part by people who are totally ignor- emphasized and stressed anew, and ant of the diseases for which they have some old fakes which have been operat- cock-sure cures.

ing for many years took on new life. For the entertainment as well as in- Out of it all one thing seems clear, and formation of the readers of the Health that is the need for better scientific Bulletin, we herewith set forth briefly education in the high schools of the some of the cure-alls urged upon the State on such matters of every-day im- State Board of Health by people of portance as the prevention and the this State and in many other states. spread of disease, also the great need It must be understood clearly that the September, 1935 10 The Health Bulletin

has been shown up by officials of the State Board of Health man, of course, Association sev- nor the physicians anywhere can af- the American Medical being an unmitigated ford to laugh too loud and too long at eral years ago as these fakers when they offer "sure faker. cures" for infantile paralysis, because One good, honest soul down in Edge- we know so little about it ourselves. combe County writes in that he is sure We do, however, know enough to know that the whole thing is caused by that there can possibly be no merit in using self-rising flour. This writer fur- ninety-nine out of a hundred sugges- ther states that everybody's health tions offered for the prevention and the would improve, in his opinion, if peo- cure of this disease. ple would quit using self-rising flour We were bombarded by telephone, and do their own mixing. telegraph, and by mail, as well as by A jeweler away down in South personal calls at the office. First day Florida wrote in that the sure cure, as that the newspapers carried reports he proved in his own case, was a mix- that an epidemic of poliomyelitis might ture of black pepper, witch hazel, and be possible and that it might assume ammonia. proportions before it was alarming Another good, honest friend from over with, a man came to the office for Wilmington wrote in to suggest that the purpose of bringing a pamphlet in everyone should keep "vaseline grease" order to show the officials here at the up his nose all the time. He stated, Board the fact that eating food cooked germs cannot pass it." in aluminum utensils was the cause of "The not only sends it all. Thus the homeopaths and peo- A woman in Alabama cures^ ple interested in selling other kinds of in her suggestions as to sure cooking utensils have tightened their preventives, and so on, but she sends the oint- belts and opened a war on aluminum a liberal supply of samples of cooking utensils anew. ment which she sells. Not only will cure infantile A fellow from Washington, D. C, her ointment, she says, paralysis, but it will cure diphtheria, writes in on the letterhead of a grease pneumonia, as well as tuberculosis. Her company, with a purported capital ointment, she says, also will cure snake stock of one hundred thousand dollars, bites, running sores, and milk legs. In to assure us that all of this trouble addition, it is claimed to knock out could be prevented if every baby born convulsions, no matter what the cause, was bathed every day from birth until and, to cap the climax, put on twice a ten years of age in oil. He did not day, it cures corns. Of course, such an say "boil" them in oil, but it was as- ointment was too valuable to remain sumed, of course, that the particular in North Carolina, and so we sent it kind sold by his company would be the back to Alabama. proper oil to use. man in Georgia, who puts M.D. Another concern writes in from Phil- A after his name, was one of the early adelphia that the only way to treat ones to write in and suggest that he this disease is by "combining colors." has "cured" one hundred and fifty The head of the concern there signs patients by the use of a combination of his name, which is an unpronounceable minerals suspended in alcohol and in- one, and adds the following titles after jected hypodermically into the muscles- it: M.D., M.E., D.C., Ph.D., LL.D., to of the patients. which imposing list of titles a Cali- fornia doctor some years ago suggested Finally, just as soon as the news- that B.V.D. should be added. This papers began to publish the names and* ;

September, 1935 The Health Bulletin 11

addresses of these victims, for the cover the cause for many years. Up most part small children, there was a to now it has not been done. It is great stirring among the chiropractors hardly necessary to add that in this in this section. One Raleigh man was very learned circular from this Ra- right on the ground, well in advance of leigh D. C, the cause is attributed to any of the patent medicine cure-alls. a "twist of the spinal column." He had his circular all ready to mail We are publishing the foregoing in to the patient, with his name and ad- tbe hope that those who lay down the dress and his telephone number all — curricula to be taught in the public very properly printed in, along with schools of North Carolina in the fu- symptoms and a big black headline ture will have more respect for gen- over a paragraph describing "the cause uine science, and teach the children of infantile paralysis." It is all down there for the gullible reader to see for while they are young to disregard ad- himself. Nothing is said, however, vice through channels so freely given about the fact that the cause of infan- at all times by people who know little tile paralysis is not definitely known. about what they are talking about, Some of the foremost scientists in the and who generally have something to world have been doing their best to dis- sell for the sole benefit of the seller.

A Successful Negro Cripple

By Atwood Connor, Windsor, N. C.

THE accomplishments of invalids When he was taken to bed in the are in most cases insignificant. But spring of 1889, he could not read very an ambitious invalid may accom- well, but to pass away the time he took plish worth-while projects. The usual to studying. Finally, by the time he failing of those who are physically was able to go on crutches, he was able handicapped is they lack the confidence to pass the teachers' examination and in themselves to try something worth obtain a first grade certificate, and for while. To inspire other cripples I am twenty years he was one of the best going to tell you about a colored man colored teachers of Bertie County. Dur- that I know personally. ing this time he saved enough money

Starkey Eason is sixty-five years old, from his salary to buy a farm and build and for forty-six years he has not a home. While he was teaching, he learned walked a step except with crutches. enough about woodwork to become a As a child he was weak, and a great successful cabinet maker. When he part of his childhood was spent in bed built his home, he did all the work and at the age of nineteen he was himself. Today he has a comfortable confined to his bed with rheumatism, house and a good farm. His farm has and for about two months was in great supported him to the extent that he is pain. As the pain left him. he became one of the few colored men of Bertie paralyzed from the shoulder down. County that did not need any help from For fourteen months he lay upon his the Government during the late de- back, until his muscles became strong pression. and hard enough to hold up his weight, In the past "hard times" the colored so that he could go on crutches. people of Bertie could not bury their : :

12 The Health Bulletin September, 1935

dead. Eason at once saw what they scholar in science, history, and mathe- needed and organized a burial society matics. that buried a number of people, and I asked him if he thought he would after paying all expenses it has twelve have been as great success if he had

hundred dollars in the treasury. Under had the use of his legs. He said : "I Eason's management, all the money think I would have been a greater man was made without any outside dona- because I have the ambition. But I tion. He is looked upon by his race do not believe I would have been as as a leader. They come to him for ad- great thinker because being handi- vice and he gives the best he has. capped physically often stimulates one's He has studied until he is a good mind."

Survey in the Canton, North Carolina Schools

A. J. Hutchins, head of the school, there is an additional economic SUPT. loss of $27,620 because of physical de- Canton Schools, three years ago fects and disease, making a total of "to deter- made a small survey $100,060. mine the relation between physical "This, further, does not take into ac- defects and disease and failure of chil- count the personal pleasure and effi- individual. dren in the grade schools," to use the ciency of the "My figures do not take into account Superintendent's own language. Last the further years of loss resulting from thorough sur- spring another and more failure to give proper health attention vey was made for the same purpose. to the children." The survey this time was in co-opera- The survey that Mr. Hutchins car- health tion with Dr. C. N. Sisk, district ried on really covered three full years. which includes officer for that district, His first tabulation was made three Haywood County. Mr. Hutchins, at years ago. In this completed tabula- the conclusion of the survey, made a tion Mr. Hutchins stated that they complete report to Doctor Sisk. We listed as organic troubles such things his sur- herewith present a synopsis of as eye, ear, tonsil, teeth, and adenoid vey. Mr. Hutchins says in his letter troubles, and classed as periodic whoop- "As was true three years ago, this ing cough, measles, mumps, scarlet that a large survey shows conclusively fever, diphtheria, influenza, colds, etc. per cent of those who fail in grade There was a total enrollment in the schools fail for reasons not their fault. At least 50 per cent of all failures could Canton district of 2,382. The results of be averted if children were given prop- the examination made in this district that 40 er health attention. Assuming resulted in the following findings per cent of failures are attributable to physical defects and disease, the cost "One hundred and ninety-one chil- to the State is about $6,120 per year for dren suffered from eye defects, 40 ear this district. A smaller amount of trouble, 383 bad tonsils, 312 decayed money would have removed the defects teeth. A large number of children lost or prevented the disease. time during the year on account of "This does not take into effect the measles, mumps, scarlet fever, diph- economy of the child's life. Assuming theria, and respiratory diseases. that his first year of employment after "Two hundred and seventy-one failed leaving school will be on the basis of on only one subject, while the others, $40 per month, the boys alone have lost 561, failed on more than one. Greatly through delay in finishing school, and, to be deplored is the fact that 69 first therefore, delayed time of employment, grade children six years of age were $72,440 per year. Assuming that only entered and withdrawn before they half of the girls are employed at a sal- completed their grade. Two bad habits ary of $30 per month after leaving may result, failure habit and that of : :

September, 1935 The Health Bulletin 13

irregular attendance. Ninety - three of his own, the child was defeated be- children had insufficient books and ma- fore he started. terials with which to work, some of "We grease the old car regularly, these coming from homes able to pur- check the water daily, watch the oil chase books. One father refused to hourly, and hurry to the garage if it is purchase a single book, but kept his missing on one cylinder or if it de- first grade boy supplied with ciga- velops some mechanical defect, yet we rettes. Of those failing, 53 were known allow the child to run along with nu- dissipaters, 59 consistent loafers at merous defects as damaging to his hours when they should have been at physical mechanism as running the car home, 122 were absent more than justi- without attention to the car. The car fied, and 147 could have finished the must be hitting on all cylinders and grade within nine months. Ten chil- mechanically correct, while the child dren were mentally below par and may be missing on three cylinders and twenty-one had all." no excuse at headed toward physical wreck. It is significant to note that in the "Let us give our physical mechanic, the family physician, an opinion of this experienced school su- opportunity to keep our bodies running properly perintendent that only ten children instead of waiting until disease has were mentally below normal. made a wreck and then call the doctor to act as salvage man." "A significant fact—proper medical attention at the right time might have It is to be hoped that this year an ad- saved most of these children one or ditional number of schools in this State, more years failure, and would have particularly in the industrial prevented a mental attitude that ac- and cepts defeat or failure as unavoidable. strictly rural sections, will follow out Eye, ear, teeth, tonsil, and adenoid de- the Canton idea and make an accurate fects could have been removed. Medical survey, science can prevent whooping cough or getting physicians who are com- lessen its effects in most cases. Scarlet petent to make diagnoses to act as ex- fever can be prevented from too great aminers so that the State may have be- ravages, and diphtheria can be pre- fore it by the time another Legislature vented. Even flu and colds can be greatly lessened in effect by attention meets exact information of this char- at the right time. acter so that the educational commit- "Of note, too, is the fact that more tee in the next House and Senate may than five hundred children had more act intelligently on such pressing than one disease or defect, and some prob- had as many as ten. Through no fault lems if they want to.

Health is the Child's Best Insurance IN an excellent editorial in the July tile paralysis, which we hope reached number of the Agricultural Review, its peak in July. Mr. William H. Richardson has put The editorial called attention to the in few words so many important and readiness with which the Commissioner fundamental principles concerning pub- of Agriculture agreed to cancel all of lic health work in general that we are the large gatherings generally held by quoting below a few paragraphs that department in various sections of the State in June, Mr. Richardson says in the begin- July, and August, as a measure of safety, regardless of cost ning of his editorial : "Health is man's or inconvenience. This spirit of co-op- greatest asset, the child's best insur- eration on the part of another State ance." department is fully appreciated by the The editorial is an argument for State Board of Health. care and protection of children during Following are the paragraphs which the outbreak of poliomyelitis, or infan- we pass along 14 The Health Bulletin September, 1935

"In the fight for the health of the paralysis ! It's all poppycock to para- generation which shortly will develop mount pleasure over health. At best, into maturity, it will be necessary for it is a short-sighted policy, bordering some to forego pleasures of various on criminality. sorts such as the giving up of long- — "There is no need for North Carolina anticipated trips, attending gatherings to get excited. The thing for our peo- of various kinds, and other forms of ple to do is to hold their nerve, put up amusement. a game fight, and if necessary, forego is day's pleasure compared "What a some of the pleasures of life that the with the life and well-being of any children may have a chance. We be- normal American child? Nothing should lieve the farmers are doing and will enter in to deter the fight on infantile continue to do this."

A Fair Chance For Our Beginners

By Mary S. Batch elob

is September ; throughout the eyesight poor, his body undernour- ITland school house doors are swing- ished. We fail to consider that, because ing open to admit an army of of physical defects, lessons may fall six-year-olds, beginners at the business on deaf ears and that the brilliantly of learning. They come on eager feet, colored pages of learning may appear buoyed up by dreams of future great- dull indeed to a child whose eyesight is ness and bristling with a sense of their defective. There are so many lessons own importance. Their dreams may which they must learn, but how use- prove to be, in reality, only dreams, less it is to cram a tiny brain with but they are emphatically right in the knowledge when the undernourished assumption that they are important. body beneath may be scarcely compe- For they are important. Upon their tent to worry along with living with- small shoulders, all too soon, we will out adding the extra strain of learn- shift burdens that have grown too ing. Yet learn they must. heavy for ours. We will bequeath to We are prone to depend too much them the problems which have proved upon the words that we hear so often, too intricate for our own brains to "an equal chance for all." It is time solve. for us to realize that while the schools We have high hopes for our army of are open to black, white, yellow, and beginners (this strange army, which, brown, the Irish, the French, the Ital- like no other on earth, numbers among ians, and the Poles, the physically de- its recruits a goodly portion of the fective have far from an equal chance. physically unfit—the modern counter- It is time for us to see to it that each part of the lame, the halt, and the child who enters school is as free from blind.) We expect them to do great physical defects as it is possible to things. We provide for them good make him. schools and good teachers. It is well It is a much better plan to have the that we should yet, we fail to com- physical condition of a beginner care- ; prehend that no child can give his fully checked before he starts to whole attention to his studies if he is school. There is more time during the sick, if he has headaches, backaches, summer months to have corrections toothaches, and the like, if his tonsils made. After the child enters school he are diseased, his teeth decayed, his will be busy with lessons during school September, 1935 The Health Bulletin 15

hours and he will need some time in which may cripple a child for life if which to play. He will have little op- they are neglected. portunity for visits to the physician One of the principal lessons which and the dentist. However, if he needs the beginners must learn is that of fair medical or dental attention, and has play. They learn it quickly enough. not had it before the opening of Soon the six-year-old, who was yester- schools, he should not be allowed to day only "mother's baby," asserts in struggle along because of the fact that his staggering, new-found independence, his days are very full and an interrup- "So and so's no good. He doesn't play tion in his studies might cause him to fair." A terrible stigma, that of not fall behind. You can be sure that the playing fair, and one to shun. If we time lost in correcting physical defects are to proudly claim as our birthright is small compared with the time lost "an equal chance for all," then we must because of such defects. It is unfor- play fair by making the words really tunate, but nevertheless true, that true; in addition to providing good minor defects which are allowed to schools, open to all, by seeing that continue sometimes result in permanent every child who enters school is free impairment. While many of them may from remediable defects and able to be corrected easily if they are detected compete on an equal footing with his in the early stages, there are many classmates.

44 He Cried and Cried, But "

the opinion of this veteran health planatory attitude she exclaimed, 'He IN cried officer and amateur editor the edi- and cried, but it wasn't any use,' and she was really disappointed torial quoted below from the Smith- that the weeping and wailing had been of field Herald is one of the best of the no avail. year. It is a fine little news note on "The little girl had doubtless seen the practical preventive medicine as well weeping stunt tried upon a hard- as a sound lecture on psychology and hearted parent who relented when the screams philosophy. If all parents and teach- became severe enough. But the stunt had failed with the vaccinating ers were as wise as the little girl, the doctor. The little boy's sleeve had been record of many a student in school and rolled up, the splash of iodine adminis- later in life would be much better. tered, and the needle with its shot was "The typhoid clinic was in progress. poised in the air. The boy's screams Ye editor had occasion to visit the grew louder but the doctor did not seem clinic which was being held in the to hear his cries. The dose was ad- commissioners' room of the courthouse, ministered. For once the boy's psychol- and as we neared the building, shrieks ogy had failed him. His feelings were issued from the upstairs windows as outraged and he continued to yell. In though something awful was being a short time, however, his sobs sub- done to some youthful recalcitrant. The sided — another philosophical conclu- shrieks continued as we mounted the sion. The thing was done and there stairs and it was not until we were was no further use of crying about it. well within the room that we saw the "Adults are only little boys grown tiny little fellow with such lusty lungs. up. They howl over unpleasant things "And then our attention shifted to that arise, but when the inevitable un- the little boy's sister, just a half a pleasantness is faced and is over, they head taller, who in a single sentence look up and smile again the only expressed — ob- the situation. With an ex- vious thing to do." September, 1935 16 The Health Bulletin Milk Laws and Typhoid Fever

This man is a farmer A few days ago news dispatches from typhoid bacilli. and engaged in the very commendable Rome, in far-away Italy, appeared in practice of adding to his income by the many American newspapers describ- sale of such products. Unless such a ing a recent epidemic of typhoid fever man is willing, however, to comply epidemic appeared in that city. The with the regulations which science and the in the middle of June, and up to experience has demonstrated to be time of the reported dispatches, about necessary, he should not be allowed to the August 1, 4,011 people had had sell his product and endanger the lives it. The disease, and 133 of them had died. of people who buy and drink was acquitted in According to the Italian authorities Harnett County man the Recorder's Court, although it was this epidemic was caused by contami- proved that he had clearly violated the nation of milk. They have in that city law. This was a monstrous miscar- what is called a Milk Producers Board. riage of justice, and sooner or later, The Roman courts have ascertained if allowed to stand, will jeopardize the some of the members of this board that lives of every person in his section establishments accepted bribes from who consumes his product. In the case retailers retailing milk and let such of the Bertie man who was arrested sell milk which had not been produced for violating the same kind of ordi- under the sanitary regulations and nance, he was very properly convicted appeal standards governing the production at the first trial, but took an to the higher courts. and sale of milk in that city. The Milk is one of the most necessary dispatches stated that many of the and essential foods in the dietary of members of the board have been ar- the people in any country at any time. rested and charged with willful negli- People in North Carolina do not con- As an indication of the ser- gence. sume as much of it as they ought to offense, in the iousness of their do. More of it ought to be consumed bail opinion of the Italian authorities, daily, but literally hundreds of people has been refused them, and they are in in the State have refused to drink milk

jail awaiting trial in the courts. on the sole ground that it is dangerous To Very recently in the State of North from the standpoint of infection. feeling, and to aid in Carolina in two separate counties, one overcome such a and consumption of case in Harnett County and one in the production lower the case Bertie County, milk producers have milk, as well as to record from such been arrested for violating the milk incidence and death the State Board ordinances in those counties. The ordi- diseases as typhoid, and put in opera- nances have been established for the of Health has devised possible restrictions protection of the people who buy and tion wherever producers consume the milk. In the Harnett which would aid the safe the increased con- County case a man who had been and also encourage promiscuously selling milk for several sumption of milk. be no dallying with the years from a small herd was arrested There should requiring clean and safe produc- for failing to comply with the law law the people should requiring certain equipment and tion of milk, and any official anywhere who methods of production, devised solely not tolerate to uphold the validity of these for the prevention of the contamina- fails laws. tion of the milk with such germs as 1

Published bij T/^fl°KfflCflR9LIflA. STXTLDPARDs^Amun fhis £iu]1elir\willbe ser\t free to ar\\j citizen of the Stale upor\reque5 1.

Entered aa second-class matter at Postoffi.ce at Raleigh, N. C, under Act of July It, 189k Published monthly at the office of the Secretary of the Board, Raleigh, N. C.

Vol. 50 OCTOBER, 1935 No. 10

North Carolina State School Dentists Doing Post-Graduate Work at Forsyth Dental Infirmary for Children, Boston, Mass. )

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

S. D. Craig, M.D. , President ... _ Winston-Salem J. N. Johnson, D.D.S., Vice-President Goldsboro G. G. Dixon, M.D - Ayden H. L.EB Large, M.D _ Rocky Mount H. G. Baity, Sc.D - Chapel Hill W. T. Rainey M.D _ _ - Fayetteville Hubert B. Haywood, M.D Raleigh James P. Stowe, Ph.G Charlotte J. LaBrucb Ward, M.D _ Asheville

Executive Staff

Carl V. Reynolds, M.D., Secretary and State Health Officer. G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Preventive Medicine. Warren H. Booker, C.E., Director Division of Sanitary Engineering. Ernest A. Branch, D.D.S., Director Division of Oral Hygiene. John H. Hamilton, M.D., Director Division of Laboratories. J. C. Knox, M.D., Epidemiologist. R. T. Stimpson, M.D., Director Division of Vital Statistics. R. E. Fox, M.D., Director Division of County Health Work.

FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which will be sent free to any citizen requesting it. The Board also has available for distribution without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Scarlet Fever Cancer Health Education Smallpox Constipation Hookworm Disease Teeth Chickenpox Infantile Paralysis Tuberculosis Diabetes Influenza Tuberculosis Placards Diphtheria Malaria Typhoid Fever Don't Spit Placards Measles Typhoid Placards Eyes Pellagra Venereal Diseases Flies Residential Sewage Water Supplies Fly Placards Disposal Plants Whooping Cough Sanitary Privies

Prenatal Care (by Mrs. Max West) Baby's Daily Time Cards : Under 6 months ; Prenatal Letters (series of nine 5 to 6 months ; 7, 8, and 9 months ; 10, monthly letters 11, and 12 months; 1 year to 19 months; Minimum Standards of Prenatal Care 19 months to 2 years Breast Feeding Diet List: 9 to 12 months; 12 to 15 Infant Care. The Prevention of months ; 15 to 24 months ; 2 to 3

Infantile Diarrhea years ; 3 to 6 years Table of Heights and Weights Instructions for North Carolina Midwives

CONTENTS PAGE Public Health Dentistry 3 Notes and Comment 4 Conservation and Development of Child Health 5 Health Education - - 6 How I May Know When I Have Selected a Good Dentist 7 Mouth Health Teaching Revolutionizes Dentistry in Wake County 8 Parents and Teachers Co-operate With the State Board of Health 10 North Carolina Dental Society Endorses Mouth Health Teaching 11 Our Present Mouth Health Program in North Carolina 12 Correlation of Mouth Health With Everyday Teaching 13 Improved Mouth Health Reflects Monetary Saving to School Budget 14 Mouth Health and Body Health - 16 The Value of Mouth Health Education in Rounding Out a Public Health Program 17 Mouth Health Teaching Popularized Public Health in Pitt County 18 The Dental Approach to the Child -. 19 PUBLI5/AE.D BY 1 TML P10R.TM CAgQLiriA STATE. BQAfgD ^HEALTH

Vol. 50 OCTOBER, 1935 No. 10

Public Health Dentistry

WHY NOT? We have preventive medicine as a distinct specialty in the medical profession. It is true that a great deal of the work of a medical officer of health, as our British friends call him, is

concerned with administrative duties ; but the greater part of his work, if it is to be effective, must be devoted to health education. In what field then, may we ask, has health education always been more needed thau in the specialty of mouth hygiene? Just as the work of the medical health officer is intimately related to the private practice of medicine and each must merge into the other at innumerable places, so the work of a public health dentist must coordinate closely with the private dentist. There will always of necessity be a sharp enough line of demarkation between the work of the private physician and dentist and that of the public health physician and dentist to assure distinction and dignity for both fields of labor. For the past seventeen years the North Carolina State Board of Health has recognized fully the important place the profession and practice of dentistry holds in our public health program. It has also realized with equal clarity that the work is essentially educational. So, the emphasis

has been placed where it belongs, viz. : In work with expectant mothers, pre-school children and in the public schools. Beginning in 1918 a group of competent young dentists were employed for their whole time and paid entirely by the State Board of Health. They were properly equipped and sent out to teach mouth health by precept and example. From that first day, July 10, 1918, there has never been a day when the work was not going on in at least a half dozen sections of the State at once. During these years at least two million of young school children have sat in the simple folding chairs of the "State Dentist" and received an examination and the urge to care for his or her teeth through life as one of their priceless possessions. In the past year a number of well-known dentists, teachers, school officials and health officers have prepared for publication in many of the papers throughout the State their opinion of the need for this kind of work and the success with which it has been conducted. The symposium is such a valuable contribution to the public health literature of the year that we are slightly enlarging this issue of the Health Bulletin in order to publish at one time all of the special articles. We are doing this particularly so that the teachers may require their pupils to make a special study of each one of these excellent articles in their work this fall. :

October, 1985 4 The Health Bulletin

Notes and Comment

editorial statement our August issue, under the above heading, we made an Ridge of INcriticising the radio for advertising patent medicines. Mr. Edney North Carolina Station WBIG of Greensboro, "owned and operated by the unin- Broadcasting Company," has challenged our editorial as being "unfair, correction formed and unjust." Further, he has demanded that we "publish a blame where it belongs." of your article, or at least facts ; and place the mind any par- We take pleasure in hastening to say that we did not have in ticular radio station. our comparison to What seems to have so aroused the ire of Mr. Ridge was that we newspaper advertising. We did not think it necessary to explain years ago, forbid- referred to the Federal law, enacted some twenty or thirty news or editorial ding newspapers to publish paid advertising in the guise of often matter without being so designated. We have criticised the newspapers so. But the adver- for "patent medicine" advertising and shall continue to do as news. tisements are printed as advertisements and not on their front page killers; viz., By "dirty" patent medicines we meant the two great classes of the laxative or the pain relievers, most of them heart-depressant drugs; and evening hours. purgative drugs. By "honored place" we meant, of course, the our Advertisements of the two above classes of drugs surely come to us over carrying great radio nearly every evening, accompanied by musical programs warning that if the listener has appendicitis emotional appeal ; and no word of "Magical" crystals that which is causing his pain a dose of the "Natural" and moment being advertised, may cause a ruptured appendix and death. Judging from Mr. Ridge's protests, we assume that Radio Station WBIG of Greensboro has not in the past and does not now broadcast any advertising of music and so we here- headache remedies or laxatives, sugar-coated with good ; hurt he might with extend to Mr. Ridge and his company an apology for any have felt as a result of our editorial. Station WPTF, In behalf of our friend Mr. Richard H. Mason, Manager of Raleigh, we take pleasure in publishing the fact that he showed us a letter, con- under date of August 29th, in which he turned down a large and lucrative concerns. We tract from a group of five large and wealthy patent medicine commend Mr. Mason's action in the highest terms. passionate fan than It is not amiss to state here that the radio has no more we were denied the we are. Owing to progressive deafness for several years up a new joy of good music. The radio has brought back that world and opened one. Hence our criticism is that of a jealous friend. mem- For more than six years we have either prepared or obtained from other in bers of our staff a weekly radio broadcast, delivered over Station WPTF Raleigh, copies of which have been sent to the following stations at their request Charlotte, Winston-Salem, Gastonia, and Durham. We appreciate the courtesies which have always been extended to us by the above named stations and we shall continue our co-operation with them to the best of our ability. Finally, let us repeat once again, our criticism in the August Health Bulletin was not intended for any particular radio station. (Signed) Geo. M. Cooper, Editor The Health Bulletin. :

October, 1935 The Health Bulletin

Conservation and Development of Child Health

By Cael V. Reynolds, M.D., State Health Officer

I have ALTHOUGH been State the teeth is one of the surest signs of Health Officer for only a short undernourishment, and an unclean time, I am well acquainted with mouth and a mouth with decaying the mouth health program as con- teeth and gumboils means a sick child. ducted by the State Board of Health, due to the fact that before I became Health Officer I was officially associated with the State Board of Health. It has been said that the North Caro- lina State Board of Health has the outstanding mouth health program in the United States. This is indeed a compliment and stimulates us to press forward. However, this could not be true were it not for the loyal support and cooperation of organized dentistry in the State. When we think of what organized dentistry has done for public health in the State and the way it has stood by the State Board of Health every time it needed assistance, we cannot help but take our hats off to the dental profession.

The mouth health program conducted in the public schools of the State on the 20th and 22d of February, Db. Cabl 1934, by organized dentistry was un- V. Reynolds usual and unique in that the dentists These facts are evidence of the of the State closed their offices and great importance of mouth health teaching gave their time on these two days to in every public health program. making an inspection of school chil- "I wish to congratulate dren's mouths without any financial organized dentistry in North Carolina remuneration whatsoever. I am quot- upon this ing thorough organization and an interview relative to this sur- unstinted support of public vey given to the press by Dr. James health and the splendid manner in which M. Parrott, former State Health the mouth health Officer survey has been carried on. The Old North State is under lasting obligation "The dental profession had an un- to the dental profession for this unusual opportunity to discover under- selfish dedication to humanity. The nourishment, as it is now agreed by magnitude of this activity on the part every branch of the medical profession of the dentists (700 men in the schools that undernourishment of the child is at the same time, doing the same thing reflected in the teeth, among the first in a public health endeavor) is some- places; improperly calcified enamel of thing never heard of before in this October, 1985 6 The Health Bulletin

State or any other. I wish to express Superintendent of Public Instruction, to them the sincere appreciation of the the Executive Secretary of the State State Board of Health." School Commission, Superintendents of I wish to pay my respects to these the schools, principals, and teachers. gentlemen here and now, and also to However, we wish it to be definitely say that the splendid success of this understood that the correction of physi- mouth health survey could not have cal defects of the child is the parents' been possible were it not for the co- problem and that the State Board of operation of the school people of the Health's responsibility is the teaching State, all the way from the State of prevention.

Health Education

By Clyde A. Erwin, State Superintendent Public Instruction North Carolina Department of Education

HEALTHY body is recognized as the children who enter school for the the essential by which the in- first time is made. Through the A Hygiene, mouth ex- dividual effects proper and satis- Division of Oral fying adjustments necessary to making aminations are made and corrective a happy and successful living. Happy living is not possible without healthful living. In order, therefore, to attain happy and healthful living a program of health education has been included in the course of study for the benefit of the children who are the future citizens of the State. This course in health education is one of the basal subjects taught in the public elementary schools of the State. It is the purpose of this course to give the child such information about health as will assist him in protecting and improving not only his own health but also that of others in that both the individual and community life of the future will be healthier. It aims to promote and organize the sum total of Clyde A. Ebwin all experiences concerning health in such a way that beneficial and lasting measures are recommended for those results will be established in both the children who have had teeth that need physical and mental lives of the chil- attention. That Division also gives dren. valuable information concerning the The State Board of Health has co- proper foods and health habits for operated with the schools in a very school children looking toward the pre- practical way in giving health instruc- vention of physical defects. I am in- tion to school children. Each year in formed that 39,350 children were given cooperation with the county health dental corrections consisting of tooth authorities a physical examination of extractions, fillings, and other dental October, 1935 The Health Bulletin services during the school year 1934-35. be classed as backward. On the other As a result of the examinations made hand, a physical defect remedied in its by the Board of Health officials many early stages removes handicaps which other corrections were made by the may prove serious to the child, some- family dentist of the child. times even changing his whole outlook I am heartily in sympathy with the on life. work done among the school children From personal observation I have in this respect by the State Board of noticed remarkable improvement not Health. I am convinced that the cor- only in the physical welfare of those rective measures made and recom- children attending the clinics held by mended by this Board are having much the Division of Oral Hygiene, but also to do in the improvement of teaching I have observed rapid improvement in situations within the classrooms. Many the academic progress of such children. boys and girls who were classed as The principals of my schools have of- backward before such corrective meas- ten remarked to me that there has ures were effected have been known to been a noticeable improvement in class- be excellent students after certain de- room efficiency as a result of these fects in their physical makeup were clinics. corrected. Perhaps the most far-reaching effect It is particularly important that of the corrective work done in this con- these corrections in the physical make- nection is in the safeguarding of the up of the child be made when he is future health of these children and in young, when nature can aid most in assuring them of an opportunity to the change, and while his mental make- grow into strong well-developed adults, up is still in the formative stage. If a fitted healthfully to enjoy successful child enters school with a physical living. I wish to go on record, there- handicap, his mind is often unable to fore, as favoring the continuance of grasp the lessons which are presented this service in the schools, and I hope to him day by day. Oftentime a poor that it may be extended as rapidly and start in school on account of a physi- as frequently as possible to all the cal defect may cause such a child to school children of the State.

How I May Know When I Have Selected a Good Dentist

By J. N. Johnson, D.D.S., Dental Member, N. C. State Board of Health

Y membership on the Board of The State Board of Health of North M the State Board of Health has Carolina is doing a splendid piece of given me an unusual oppor- public health work and the Division tunity to have the question "How may of Oral Hygiene is carrying on an un- I know when I have selected a good usual mouth health education program. dentist?" asked me a number of times. It can be truthfully said that this pro- This is an important question and gram is making thousands upon thou- has been and is bothering a great many sands of our people "tooth conscious" people in this State and nation. How- and "health minded." Numbers of these ever, it is the welfare and the health people are learning more about the of the people of North Carolina that relation of an unclean mouth to sys- we are interested in at this particular temic disease than they have ever time. known before. Mouth health is being ;

8 The Health Bulletin October, 1935 taught in the public schools, the col- whole thing is summed up, there is leges, the Parent-Teacher Associations, something within you that causes you and civic clubs. With this newer to approve or disapprove your den- knowledge the public is demanding an tist within a few minutes after you adequate service—adequate not only in supply but an intellectual service as well. With all this going on in the State and in the minds of the people, you and I are not surprised that this legitimate question is asked. There are several ways by which you may be reasonably assured that you have selected a good dentist. Among these are : a good dentist is recommended by his patients; his office will be clean and the approach to his office will be clean ; his office will be tidy and this includes comfortable furniture ; his equipment will be adequate; however, it will not necessarily be too elaborate. The old saying of "clothes do not make the man, but help him to look like a man," applies here also ; he will be pleasing in manner, clean in person, a kindly disposed gentleman with the interest of his patient at heart, and this interest will be manifested by his Db. J. N. Johnson sympathetic manner ; he will conserve the patient's time as well as his own have visited his office. This latter ap- his fees will be in keeping with the proval is one of the surest signs for class of service he is rendering, at the you to depend on. Without it you can- same time considering the ability of not have utmost confidence in your the patient to pay. In other words, dentist and confidence is absolutely when all is said and done and the necessary.

Mouth Health Teaching Revolutionizes Dentistry in Wake County

By Dr. J. Mabtin Fleming, Dental Member, Wake County Board of Health SOME writer has said that "com- you immediately see that comparisons parisons are odious," and the are not odious, but rather that they phrase has been often quoted, become a matter of pride and a cause especially where a steady improvement of congratulation. has not been accomplished nor the old My boyhood, more than fifty years ratio of progress maintained. But when ago, was an average boyhood of the you compare the rapid improvement in country boy of that time. I knew noth- mouth health conditions in Wake ing of dentists nor of dentistry. The County with conditions some years ago fact is, I doubt if I knew there was October, 19S5 The Health Bulletin 9

such a profession as dentistry. My They will take a chance. We will first knowledge of teeth even was when probably have such parents as these an aching six-year molar literally drove with us always, but they are not in me to a physician to have the tooth the majority. Numbers are taking ad- extracted. It was a rough experience, vantage of all health information given the memory of which will continue to linger with me, but I was told that I should see a dentist ; that, probably, was my first knowledge that there was such a profession. My home was in Wake County, a county supposed to be an average county, of average intelligence, and this experience was not different from that of other children of that same day and generation. Can you imagine such ignorance in any child of today, even in remote sections of the State, not to mention the counties more centrally located ! And what has caused this change? The awakening has been almost wholly the result of mouth health teaching in the schools. For some years Wake County has maintained a whole-time school dentist. He has worked faithfully and well, and, together with the work of the State Board of Health, it has now become Db. J. Martin Fleming almost impossible to find any child in the county who has not been told some- them and thanking those who give it. thing of mouth health and the general They know that neglect leaves its care of the teeth. permanent mark not only in the mouth From gross ignorance of tooth prob- of the child, but on its general health. lems the children have become "tooth Probably in no line of health work wise," if I may use that expression, has so much progress been made, nor and have talked teeth so much at home with such far-reaching results, as in that tbeir parents are becoming "tooth mouth health teaching in Wake Coun- prudent." No truer word was ever ty. And the beauty of it is we are said than that "A little child shall just beginning a realization of its ulti- lead them." Not only have they been mate results. It is something you can- led in a general way, but the actual not measure with ordinary compari- conditions in each individual child's sons. mouth have been brought to their at- The health of future generations is tention. bettered by the health of this genera- This does not necessarily mean that tion, and the next by the next, in an all parents have taken advantage of ever-increasing ratio of improvement. this knowledge. Some will always It is difficult to tell what another fifty neglect the most urgent needs of a years of mouth health progress will do child—vaccination against smallpox, for this county. We have no reason to typhoid vaccine, diphtheria antitoxin. think there will be any step backward, 10 The Health Bulletin October, 19S5 while an equal pace forward would You may say that is an Utopian carry us a long way towards the ap- dream, but it is a worthy one, and we proach of a preventive rather than a should use our best endeavors to make curative practice of dentistry. such a dream the program of our lives.

Parents and Teachers Co-operate With the State Board of Health

By Mrs. J. Buren Sidburt. Chairman, Summer Round-Up Campaign, N. C. Congress of Parents and Teachers THE health of the child has been the physical health of the child, he will one of the major interests of the make greater mental progress. To Parent-Teacher Associations of the accomplish this we must have more State. Parents and teachers agree on the vital necessity of having children physically and mentally fit before good school work can be expected. We are stressing through our Sum- mer Round-Up Campaign the importance of having every remediable defect corrected before the child enters school for the first time. This Summer Round- Up Campaign was inaugurated by the National Congress of Parents and Teachers in 1925, as their major health activity. From a very small beginning we now have thousands of children examined each spring, and remediable defects — teeth, tonsils, eyes, ears, posture, etc. — are brought to the attention of the parents. These defects materially retard a child's progress in school. We are endeavoring, through education of the parent, to stress the truth that these physical defects must be J. Buren Sidbury remedied. We are also urging the Mrs. medical and dental professions to give due consideration to the defects of the and better co-operation, not only from school child. Even though they be the parents, but from the teachers, and slight at the time of examination and from the medical and dental profes- inspection, we are urging that they not sions. It is true that the State Board treat these defects with indifference, of Health is rendering a splendid serv- but that they give them serious con- ice in its health programs in the coun- sideration and co-operate in every ties and its mouth health programs in possible way with the parents, with the schools, but they could do more the school officials and with the health and render a better service if the pub- officials. If we will work together for lic had the proper understanding of October, 19S5 The Health Bulletin 11

the work they are endeavoring to do two or three health plays, in which the and would give unstinted co-operation children take part, be included in their in season and out. We ask of the as- Parent-Teacher programs during the sociations throughout the State that school year. This will afford an un- they lend every possible aid in improv- usual opportunity for health truths to ing the health condition of our chil- sink deep in these young minds and dren. We would suggest that at least bear much fruit in their lives.

N. C. Dental Society Endorses Mouth Health Teaching

By L. M. Edwards. D.D.S., President, North Carolina Dental Society AS one interested in the need and This being true, we are having more value of dental health education children come to the offices of dentists in this State, it gives me pleas- who do not require dental attention ure to say that the North Carolina Dental Society has given its approval and support to the North Carolina State Board of Health in its mouth health education work in the schools of North Carolina since the inception of the activity under the direction of Dr. G. M. Cooper, a physician connected with the State Board of Health, who directed the program in the schools for a period of about eight years. Dr. Cooper laid a firm foundation for this work and it has not been necessary to change the structure of the program during these years.

The purpose of the program is one of mouth health education and this is what the State Board of Health has been doing. It has stimulated an interest in dentistry on the part of the laity that could not have been done otherwise. A natural sequence to this demonstration is that more people are having necessary dental work done De. L. M. Edwabds than they have heretofore. The good than has ever been known. However, derived from this educational program we find that in this good State of ours is that the public health is improved, there are still more than half the chil- but greater still is the preventive side dren enrolled in our schools who have of the work. Thousands and thousands yet to visit the dentist for their first of children are being taught to eat time. proper foods, to keep their mouths With this knowledge in mind, we clean, and to visit their dentist for in- realize that the good work of mouth spection rather than for correction. health education which is being so well ;

October, 19S5 12 The Health Bulletin

done by the State Board of Health is can have this educational work con- Health, still in its infancy, and we, as dentists, tinued by the State Board of are glad to offer them every encourage- and the dentists will co-operate with ment, assistance, and aid in forward- each other and the people in solving ing this great work and we bid them our dental problems, there will be no Godspeed in the undertaking. If we excuse for panel or state dentistry.

Our Present Mouth Health Program In North Carolina

By Paul Jones, D.D.S., Chairman, Executive Committee, N. C. Dental Society

is most gratifying to know that because of being seen. (Pride is a ITNorth Carolina is greatly interested driving monster.) Sometimes the fin- and awake to the necessity of a gers and toes came into contact with mouth health program, especially among the children of our State. A few years back only the most alarming evidence of disease invasion was ever called to the attention of our government. In fact, those in authority were more attentive to the problems of agriculture such as hog cholera, cattle tuberculosis, and tick fever. Even now our farmers are ordered to destroy the farrowed hogs and turn under crops, showing the changing viewpoints under different stresses. But miracles never cease, and the dawning of a new thought takes hold today the health of the human animal is predominant. His bodily predisposi- tion to disease and deterioration is of so much concern to our State government that today North Carolina has on the statute books laws insuring the rehabilitation of diseased bodies and the proper observance of hygiene, and our commonwealth is recognized as a most Db. Paul Jones enthusiastic exponent of health for its Hid- citizens. soap and water ; not so the teeth. The indifference to oral health is den from public display, they chopped to sustain the still more noticeable than its observ- and ground the material ance or correction. Teeth, in the days body. With their duty done, the clean- past, were considered a gift from the ing of the teeth was deferred to that Creator, like the fingers and toes, and more convenient time which never ap- like these should give no more trouble. pears, and the mouth's arch enemy, In fact the digital organs were more fermentation, commenced its destruc- fortunate and, consequently, healthier tive work. October, 19S5 The Health Bulletin 13

This, basically, with the attending people health conscious as well as evidences, was the cause of the begin- healthy. ning of mouth hygiene and health as It is with much pride that I mention we know it today. Persistently and the present fulfillment of these aspira- effectually the sponsors of this health tions in the operation of our mouth movement have labored for recognition. health program. Through the Dental Our statesmen had to be educated in Division of the State Board of Health Dr. Branch and his staff of the belief that childhood was the be- dentists have done ginning of manhood and womanhood, a noble and glorious piece of work solely in the interest of the health and that their health had to be con- of our people. They have emphasized sidered before that of cattle, swine, the need of mouth care among our and horses. Co-operation with the school children, and they have carried ones seeking a mouth health program the story of healthy teeth in healthy for our children was a demand not to mouths in a telling and most effective be denied—a utilitarian as well as an way, so much so that we in private altruistic service. We are greatly in- practice can note the improvement in debted to those in our medical society the mouths of our young school boy and and our dental society for this vision girl patients. that seized and held them during the I am heartily in accord with the formative period of this movement dentistry program as directed by Dr. which is now so well grounded and Branch for North Carolina, and should sponsored through our government. like to see the activities of this depart- Often I have wondered if our intelli- ment enlarged rather than any part of gent citizens, as well as our State gov- them delegated to inexperienced local ernment, fully realize the debt owing units. I would like to see North Caro- the two professions of medicine and lina the healthiest State in the Union dentistry in their sustained efforts and its people possess the best-treated through all these years to make our teeth in the world.

Correlation of Mouth Health With Everyday Teaching

By Mrs. Ruth Heilig McQuage, Principal, John S. Henderson School, Salisbury, N. C.

SINCE a child must be healthy to on account of lack of money in the in- learn, we have found from experi- dividual homes. The task has been ence that the oral hygiene pro- not only to do a thorough job of mouth grams conducted by the State Board cleaning, but also to instill oral hygiene into the youthful child of Health have been of decided assist- by actual demonstration. The teacher, while this ance in solving the problem of the subject was habitually stressed, could development of the child in our schools. not solve the problem alone. Dental work in the schools, as supplied Dentists in the public schools have by the State Board of Health, in co- been able to visualize to the child the operation with local county and city things the teacher sought to impress, authorities, has enabled many a child such as teaching food values, proper to remove a physical handicap that health habits, and the necessity of a otherwise would have been prolonged clean mouth. 14 The Health Bulletin October, 1935

Children, as well as parents, have The tribute to the usefulness of this listened to the dentist, since he has a work done by the conscientious group medical background from which to of State dentists under the direction speak with authority, and the result of Dr. Ernest A. Branch is seen not so has been that the teacher has been much by the thousands of grinning able to correlate this information with all the subjects taught to the child through the elementary school. The natural result has been a continued emphasis on health in all of the work taught which tends naturally to produce on the part of children a more wholesome attitude both towards study and their classmates. It has not been so many years ago that it was impossible for parents of limited means to have this portion of the health of their children handled through the schools. Many children were thus denied treatment of a condition which grew progressively worse and handicapped both the teacher and community. The splendid widespread work which has been done through the State Board of Health has aided in helping children regain normal health, and has improved the morale of the classroom. At the same time, the thorough work has spread the gospel Mrs. Ruth Heilig McQuage of good health to other children, and youngsters who are yet unable to ap- the cost, being divided between the preciate their betterment, but by the local communities and the State, has fact that in communities where the been very little per child. work has been carried on for several The teaching of oral hygiene in the years, school patrons of means and schools has, consequently, proven to local governing bodies have praised the be an effective subject in true educa- work and gladly appropriated the tion in the schools of the State. small amounts necessary to continue it.

Improved Mouth Health Reflects Monetary Saving To School Budget By LeRoy Martin, Executive Secretary, State School Commission

is natural for the public to believe financial welfare of the schools is cer- ITthat the State School Commission tainly one of the problems that must is primarily interested in the finan- be faced by every citizen, and no doubt cial welfare of the schools. The task the Commission is serving a useful pur- was given this Commission of taking pose in devoting its attention to this $16,000,000 and keeping the schools phase of the school system. As citizens open for an eight-months term. The of the State and as school patrons, the October, 19S5 The Health Bulletin 15

members of the Commission are, bow- A study of tbe school attendance ever, greatly interested in tbe welfare figures shows that a large number of of tbe teacbers and the children. It is our repeaters in school is due to ir- generally realized that we have salary regular attendance. The poor health conditions existing in the public schools of the child must be a substantial con-

which must be improved ; but in giving tributing factor in the poor attendance. consideration to this and other matters involving school finances, some thought should be given to the tremendous cost which must in any event be involved in tbe operation of a State school system and consideration given to a reduction of this cost without reducing efficiency, thus providing for the school dollar to buy more. One of the great lacks in our school system is the vast number of children who are forced to repeat their grades. Only a small part of this can be charged to inefficient teaching. In the main, we have good teachers. A study of the reports which have been made as a result of school surveys, which show that approximately eighty-five per cent of our school children are suffering from some physical defect, apparently finds the reason. A further look at the details of the report made LeRoy Mabtin shows that of those suffering from physical defects a larger percentage is Only a small part of the blame for the caused by undernourishment than is retarded child who is repeating his assigned to any other reason. It is grade is due to the indifference of the hard to see how this could be true in parent except as that blame is attached a great State such as ours where it is to the indifference of the parent in tak- possible to produce an abundance of ing steps to provide a more healthful everything needed for a child's physi- environment in the home and to remedy apparent defects cal development. It is pointed out that which are in the child. Everyone people make the mistake of thinking conversant with the operation of our that undernourishment means an empty schools must realize that there is room for great improve- stomach and that this is not always ment in the health conditions of the the case, since well-balanced meals children who are in our schools. mean more than an abundance of any The efforts of the State Board of one article. We are also told that next Health to correct and improve health to undernourishment bad teeth and conditions among the school children bad tonsils are next in the class of is to be highly commended. The Mouth physical defects. It is generally agreed Health Education Campaign in the that these three defects go together schools, conducted through the Division and that undernourishment, probably, of Oral Hygiene, and to which the is a greater contributing factor than State has made contributions through tbe other two. the State Board of Equalization when 1985 16 The Health Bulletin October, it was in existence, appears to be doing duced. It certainly seems that this good work. I believe it is shown con- activity might be enlarged and an ex- clusively that these campaigns have tension of health work in the public all along the line should be contributed to improve attendance ; and schools as a result, grade repeaters are re- undertaken.

Mouth Health and Body Health

By P. P. McCain, M.D., President, North Carolina Medical Society

diet is not only true that decayed and healthy gums as taking a proper ITabscessed teeth and diseased gums containing not only the necessary food cause various diseases in other values, but also a sufficient quantity of parts of the body, but it is also equally true that disease of the teeth and gums results from poor general health, from a neglect of health habits and from improper diet. Mouth health and body health, or mouth disease and body disease, usually go hand in hand. For many years it has been known that germs grow and multiply in the pockets of decayed teeth and that oftentimes both the germs and the poison from the germs and the decayed food pass into the blood stream through the porous roots of such teeth and are carried to all parts of the body. Also at times abscesses form at the roots of dead teeth which have been filled. Rheumatism, neuritis, lumbago, sciatica, disease of the eye and of the heart, et cetera, are at times caused by germs and poison which get into the body in this way. It is by no means true, however, that all such diseases are caused by bad Db. P. P. McCain teeth and diseased gums. In some quarters teeth have been too ruthlessly ex- the proper vitamins and minerals. On tracted. When some of the above men- account of the extra demands upon tioned diseases are present all of the them it is especially important for possible sources of the trouble should growing children and pregnant women be searched for and the teeth should to take the best of care of their teetb not be removed unless it is at least rea- possible, to take the proper diet, and sonably certain that they are respons- to observe proper health habits. ible for the trouble. For more detailed information on Keeping the teeth and gums clean is body health and mouth health con- very important, but really not as es- sult your physician and dentist, or sential in maintaining sound teeth and write to the State Board of Health. October, 1935 The Health Bulletin 17

The Value of Mouth Health Education In Rounding Out a Public Health Program

By R. M. Buie, M.D., County Health Officer, Guilford County

HUMANITY has never gone for- also may cause serious damage to his ward in the conquest of disease general health if they abscess. It is save in the light of truth. Dental important that these sources of infec- caries, commonly called decay of the tion be removed if the child is to have teeth, has been called the most preva- good health and do his best work in lent disease of mankind. Prevention school. of dental caries is, therefore, a most important problem. No health department is complete without a well-defined mouth health educational program as one of its chief objectives. For such a program to suc- ceed the health department must have the full co-operation and support of the governing bodies, the teachers, parent-teacher associations, and school patrons.

A child cannot be expected to do good school work unless his physical condition is good. No child should be handicapped in his work by any physical defect which it is possible to prevent or correct. There is no part of our health work more important than mouth health. No mouth is healthy that is not clean. We try to teach the children the value of the regular use of the toothbrush. Dr. R. M. Buie Many parents do not realize the importance of the child's teeth. Yet by We hope to teach all the children the time the child has started to school the value of mouth health. If we can he has, or soon will have, his six-year do that each year in the schools it will molars, which are the most important not be long before everyone will realize teeth in his mouth. It is a sad fact, the importance of the care of the but they are also the most neglected. mouth. We readily see that it is imperative to For the past five years this county, prevent their loss. Because the child's cooperating with the State Board of temporary or baby teeth will be lost Health, has put on a mouth health many parents think it is not necessary program in the rural schools. Each to give them the attention they should. year we have forty weeks of dental The child's baby teeth are as suscep- service in the schools. In this work tible to disease as the permanent teeth. we have had the very best support of They not only cause the child much the teachers, Board of Education, pain if they are allowed to decay, but parents, and county commissioners. 18 The Health Bulletin October, 1935

The program meets the approval of more of this work. It is impossible to both the physicians and the dentists. estimate in dollars and cents the The only fault of the program is that amount of good that a well-organized we do not have enough funds to do mouth health program does.

Mouth Health Teaching Popularized Public Health In Pitt County

By J. H. Coward, County Auditor THE effectiveness of a county agreeing to pay a part of the expenses, health department is determined to send a school dentist to the county in a large measure by the number for a given number of weeks, this vary- of people served in a practical way. ing with the amount appropriated. They must see the personal benefits to be derived. Not a great per cent of adults are inclined to seek this type of service for themselves. With most of them it is dire necessity or some health problem affecting their children which takes them to their county health department. It is the preference of far too many of them, it seems, that health department activities be confined to children. Even so, this is one of the best mediums through which to disseminate County Health Pro- grams. Benefited children become, in due season, adult boosters. Conse- quently, mouth health programs, in my opinion, should be one of the principal activities of a county health department. We take much pride in the fact that the Pitt County Health Department was one of the first established in the J. H. Coward State. It has been liberally supported and efficiently operated. We are so This year we have increased our ap- well pleased with its work that the propriation to double the amount pro- appropriation for this year is more vided for dental services in 1929. than double that of last year. How- The school dentist takes mouth ever, not until 1929, when we insti- health messages to all children attend- tuted mouth health programs, as di- ing school, white or colored. With rected by the State Board of Health, members of the County Board of Com- did we find a medium through which missioners I have visited schools where the masses could see direct results of mouth health programs were in prog- supporting the County Health Depart- ress, and have seen the school dentist ment. In this year, we contracted with teach health so that children could the State Board of Health, the county understand. We have seen him relieve —

October, 1935 The Health Bulletin 19

suffering of children from poor fami- moving diseased teeth, relieving infec- lies, some of whom very likely had tions, saving the permanent teeth of never before heard of a dentist. We those children whose parents are un- have instill seen him in the minds of able to pay for dental services ; teach- children of parents who were able to ing the value of proper foods grown at pay for dental services, but had them- home ; the value of milk, and the value selves not been taught the importance of cleanliness inside and out. Re- of mouth health, the immediate and peaters in school are being reduced, constant need for periodic visits to the thereby saving the taxpayers many family dentist, as well as the import- dollars. ance of personal care of the teeth. We Mouth health teaching is popular were particularly impressed as we saw with the masses in Pitt County. It is the dentist explain every correction demanded by their children. Unusual and show to the patient and those as it may seem, I have seen several looking on why certain corrections children receiving treatment, each de- were necessary. He was teaching by manding in no uncertain terms that no illustration and these illustrations re- one else get his turn, and not one of main with the children as constant re- them complained of pain. They will minders of mouth health. Further, it be health-minded men and women to- was conclusive evidence to those of- morrow, and boosters for public health ficials present (members of the ap- and the County Health Department. propriating body) that reports which There is no better way to build a suc- the school dentist rendered to them cessful county health department than told only in part of the good results to make it popular with the masses accomplished. there is no better way to make it popu- I believe the service is definitely im- lar with the masses than through proving the health conditions by re- mouth health teaching.

The Dental Approach To The Child

By Ernest A. Branch. D.D.S., Director Division of Oral Hygiene

THE main objective of the school have caused a wide gap between the dentists who represent the Divis- child and the dentist until, in some ion of Oral Hygiene of the North instances, the child has looked upon Carolina State Board of Health in the the dentist with great dread and public schools of the State is the creat- sometimes with great fear. ing in the mind of the child a clear Such was the case a few years ago. knowledge of the need for a clean, How different it is now ! When the healthy mouth. This approach to the school dentist goes into a schoolroom child accomplishes a great deal more today he knows child psychology ; he than simply saying to him "You must knows how to approach the child ; he have this tooth extracted, or this tooth understands the child ; and he knows filled." These are far from pleasant how to teach. I wish all the parents suggestions. The child has heard ex- could visit one of our schools in this periences related by his elders of their State where the school dentist is work- visits to dentists and these experiences, ing. I wish the dentists of the State told in anything but an attractive wav. would take time off and avail them- ;

20 The Health Bulletin October, 1935 selves of this opportunity and privi- In this State we found in our survey lege. The school dentist approaches of last year that 9.3% of the children the group of children and talks to enrolled in the schools of North Caro- them, on their own level, in a most lina needed orthodontic treatment friendly and intimate manner. He that is that 9.3% of the school chil- clothes his health truths in language which is easily understood and in a manner entirely acceptahle to the child. He loves the children; they know it, and they love him in return.

What a wonderful situation ; what a wonderful opportunity! With this background of preparation, he explains to the child the need of good health. He teaches the child that to have good health he must have a knowledge of and put into practice certain health rules. The child must eat the right kind of food. He is taught what the right kinds of food are. The value of these foods is related to the child in the most attractive manner possible and in such a way that the child goes home almost demanding of his mother that he have these foods.

He is taught the value of brushing his teeth and the proper way in which to brush them. Db. Ernest A. Branch He is also taught that if his jaws are to grow normally and develop to dren's jaws were not sufficiently de- a sufficient size to accommodate thirty- veloped to accommodate their teeth. two teeth of the permanent set that irregular or are to replace the twenty teeth of the Therefore, the teeth were the child first set, his jaws must have exercise. crowded, which means that Exercise of the jaw means that they has an unsightly mouth. This, in itself, must have lots of work and for the is sufficient evidence that our jaws jaw to have work it must have hard need more exercise. foods to chew. Our present day living As a parting thought, the dentist does not require as much chewing of teaches the child that if he is to con- hard foods as formerly. This is why tinue to have a clean, healthy mouth, the dentist today will advocate the he must visit his dentist at least three chewing of gum. Contrary to the times a year, not necessarily for treat- notion of many people, chewing gum ment, but for a thorough examination does not harm the teeth. It does not and treatment if treatment is needed. kill the appetite of the child, but on With this as the objective of the the other hand, does furnish a splendid State school dentists, we see that they means of exercise for the jaw, and is have a great task before them, as well believed by many to stimulate the as a great opportunity. They are

appetite. measuring up to it in fine fashion.

I MR. JNO. G. BEARD, CHAPEL HILL, N . C.

PuHis\edb4 TttE, A°R37\ CfiR°LtrtA. 5TATL E^ARD s^AEMJn

This Bulletin will be seryt free to qimj crhzery of the 5tate upot\ request!

Entered as second-class matter at Postoffi.ce at Raleigh, N. C, under Act of July 18, 189+ Published monthly at the office of the Secretary of the Board, Raleigh, N. C.

Vol. 50 NOVEMBER, 1935 No. 11

CHRISTMAS SEALS FIGHT TUBERCULOSIS Buy Them and Use Them MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

- ---W,nst S S. D. CRAIG. M.D., President ^™ - _GolcU,boro^ J. N. Johnson. D.D.S., Vice-President ~--- y G. G. Dixon, M.D...._ - - $ -K Mount„£ H. Leb Large, M.D — °«*y ...Chapel Hill H. G. Baity, ScD _ - - Fayetteville Rainey, M.D _ W. T. Raleigh Hubert B. Haywood, M.D — — - ....Charlotte James P. Stowe, PhG ~ - - - Asneviue J. LaBruce Ward, M.D

Executive Staff

Carl V. Reynolds, M.D., Secretary and State Health Officer. G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Preventive Medicine. Warren H. Booker, C.E., Director Division of Sanitary Engineering. Ernest A. Branch, D.D.S., Director Division of Oral Hygiene. John H. Hamilton. M.D., Director Division of Laboratories. J. C. Knox, M.D., Epidemiologist. R. T. Stimson, M.D., Director Division of Vital Statistics. R. E. Fox, M.D., Director Division of County Health Work.

FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which will be sent free to any citizen requesting iL The Board also has available for distribution without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Scarlet Fever Cancer Health Education Smallpox Constipation Hookworm Disease Teeth Chickenpox Infantile Paralysis Tuberculosis Diabetes Influenza Tuberculosis Placards Diphtheria Malaria Typhoid Fever Don't Spit Placards Measles Typhoid Placards Eyes Pellagra Venereal Diseases Flies Residential Sewage Water Supplies Fly Placards Disposal Plants Whooping Cough Sanitary Privies

SPECIAL LITERATURE ON MATERNITY AND INFANCY The following special literature on the subjects listed below will be sent Health, free to any citizen of the State on request to the State Board of Raleigh, N. C.

: B months Prenatal Care (by Mrs. Max West) Baby's Daily Time Cards Under ; months ; 10, Prenatal Letters (series of nine 5 to 6 months ; 7, 8. and 9 19 months; monthly letters) 11, and 12 months; 1 year to Minimum Standards of Prenatal Care 19 months to 2 years Breast Feeding Diet List: 9 to 12 months; 12 to 15 months ; 2 to 3 Infant Care. The Prevention of months ; 15 to 24 Infantile Diarrhea years : 3 to 6 years Table of Heights and Weights Instructions for North Carolina Midwives

CONTENTS page

Notes and Comment - " The Western North Carolina Sanatorium for the Treatment of Tuberculosis 4 The Prevention of Tuberculosis from a Public Health Standpoint 5 Catawba County Preventorium for Under-Nourished and Under-Privileged Children 8 9 "Curing" at Home is No Easy Job A Few Facts About Milk, the Most Nearly Perfect Food 12 Book Review Labor Department Bulletin - 15 1934 16 Deaths from Tuberculosis of the Respiratory System—By County and Race : Vol. 50 NOVEMBER, 1935 No. 11

Notes and Comment

By The Editor ONCE again we present our special November issue, devoted for the most part to a consideration of the question of tuberculosis. When Dr. L. B. McBrayer, who is at present managing director of the North Carolina Tuberculosis Association, joined the staff of the State Board of Health, in 1914, in the capacity of superintendent of the State Sanatorium, at that time under the direction of the State Board of Health, and also in the capacity of director of the State Extension Service in the field of tuberculosis, he requested that one special issue of the Health Bulletin, either November or December, each year be devoted to the subject of tuberculosis. For the past several years we have devoted the November issue to this subject. One reason is, we like to call attention to the sale of Tuberculosis Seals, which, in recent years, have been so largely used on letters, cards, and Christmas packages so that we may give ample notice to the people that the time has again come to buy these seals. We hope that everybody this year will put aside in their budget for Christmas spending something for Christmas Seals. Full information about the sale and the purpose for the device and what it has meant in recent years may be had by writing to Doctor McBrayer at his office at Southern Pines, North Carolina. In this issue we present, as usual, on the outside back cover a list of the number of deaths, by county and by race, for the year 1934, caused by tuberculosis of the respiratory system. These figures, published annually, afford the people of the State a concrete view of the progress which has been made during the last twenty-one years in the effort to control and eliminate tuberculosis. We would suggest that our readers compare these figures this month with those published, say, five years ago. In this way the reader can readily see the standing of his or her county as to the progress being made. The reader will find in this issue a short but very interesting article by Doctor McCain, superintendent of the State Sanatorium, describing the new western North Carolina Sanatorium which was provided for by the last Legislature. Doctor Foster, health officer of Cumberland County, has a good article on the prevention of tuberculosis from a public health standpoint. We are quoting from the Sanatorium Sun an article entitled " 'Curing' at Home is No Easy Job." We receive many letters at the State Board of Health office from people asking for information which is covered in this article. One of the most interesting features in this number is the short descriptive article by Mrs. McKay, the county nurse of Catawba County, describing the work that they have accomplished there with underprivileged children in their preventorium for the past summer. An excellent photograph of this group of children is presented along with the article. The most interesting feature of Mrs. McKay's article, of course, is the plans which have been worked out and which they hope to carry through to keep this preventorium open the year round. We hope our readers will find the issue interesting. The Health Bulletin November, 1985

The Western North Carolina Sanatorium for the Treatment of Tuberculosis |

By P. P. McCain, M.D., Superintendent State Sanatorium and Director Extension Service

of the most constructive has reached the contagious stage and ONE get it under pieces of legislation passed by the until it is very difficult to tuberculosis does not last General Assembly was the control. Early is easy to cure enactment of the bill providing for make one feel sick. It All those another tuberculosis sanatorium to be and it is not contagious. to a case of located in the western part of the who have been exposed have a thorough State. tuberculosis should examination, for many of these con- The present sanatorium with its 4S0 tacts who feel perfectly well have the beds is already too large for rendering disease in the early stage, and, if they the most efficient treatment. Also it is are thoroughly examined, they can dis- too far distant from a large portion cover the disease in time to get entirely of the State's population to make it as well. available as it should be for diagnostic General Assembly appropriated service and for the visiting of the The sanatorium patients by their relatives. Most $250,000 for the western that an equal patients have to stay in a sanatorium with the expectation available from Fed- for several months and it is very help- amount would be beautiful site has been ful to them to get to see their relatives eral funds. A Asheville and Black at least occasionally. selected between special site commit- The present sanatorium is also so Mountain by the Governor, con- swamped with applications for admis- tee appointed by the sisting of Mr. Kemp D. Battle, of sion that men have to wait about six B. Webb, of months and women about three months Rocky Mount; Mr. E. Kinston. and Dr. W. W. Sawyer, of before they can be admitted. If pa- Elizabeth City. tients are not situated at home so that prepared providing they can get bed rest and nourishing Plans have been for food, many of them will get worse not only the most modern facilities while waiting for admission and some the medical care of patients, but also of them will get so sick that they can- up-to-date operating rooms, since sur- not be benefited by the time their turn gery now plays an important role in for admission comes. the treatment of patients who do not favorably to the usual medi- It is expected that the new sana- respond central heating and power torium will provide for approximately cal care. A refrigeration and laundry plant, 200 patients, and it is hoped when it is plant, dining room, kitchen and bakery put in operation that patients can be and a large enough to pro- admitted to both institutions without are being planned eventual capacity of about delay. vide for an patients. One of the most important functions 400 have been submitted for a of a tuberculosis institution is to offer Requests supplement the State consulting diagnostic services to physi- PWA grant to Senator L. L. Gravely, cians for their patients who are unable appropriation. chairman, and other members of to go to private specialists. Most the made several trips to patients with tuberculosis do not find our Board have and it is fully expected out that they have the disease until it Washington November, 1935 The Health Bulletin

that a total amount of approximately be available. The architect chosen by $500,000 will be available for the erec- our Board for these additions is Mr. tion and the equipment of the institu- E. G. Flannagan, of Henderson. tion. These additional facilities for the It is hoped that the contracts for control of tuberculosis in North Caro- the construction of the institution can lina will not only result in the relief be awarded this fall and that the of suffering and distress, but will also buildings can be completed and made be a splendid financial investment for ready for the reception of patients the State. In 1915, when the State first within a year from the time the con- began to make more liberal appropria- struction is begun. The architect for tions to tight the disease, the death rate the western sanatorium is Mr. W. H. per hundred thousand population from Deitrick. of Raleigh, and the engineers tuberculosis in North Carolina was are the firm of Wiley and Wilson, of 156.4. In 1933 the death rate was only Lynchburg, Va. 64.2. This means a saving of 3.058 The Legislature also provided funds lives annually. At the conservative for a surgical unit at our present insti- estimate of tution and also for an addition to the $5,000 per life this means Colored Division at Sanatorium. Sup- an annual saving of $15,290,000 per plemental PWA grants are being re- year. With these additional facilities quested for these additions also and it there should be a still further saving is hoped that a total of $173,000 will to the State both in life and property.

The Prevention of Tuberculosis From a Public Health Standpoint

By M. T. Foster, M.D., Health Officer, Fayetteville, N. C. war against THE tuberculosis has can only be brought about by public been amazingly successful. In 1900 health education. tuberculosis was the leading cause When writing a paper of this kind, of death, but in 1933 it occupied the there are certain accepted scientific fifth place as a cause of death. Statis- facts to be merely mentioned. We all tics from the Metropolitan Life Insur- agree that tuberculosis is an infectious ance Company show a decline of 71.2 disease, the organism being the tuber- per cent in the mortality during the cle bacillus. There are two principal thirty-three years which had elapsed. sources of human tuberculosis : the Because of this gratifying picture, primary source is man himself; the public health workers cannot afford to secondary source is cattle. The tuber- turn their attention away from tuberculin testing of dairy herds and the culosis. The disease is still a tre- pasteurization of milk has practically mendously important public health eliminated this secondary source. Prac- problem because it remains the chief tically all observers agree that sputum cause of death in early life. adult It from cases of human tuberculosis is is thoroughly believed that tuberculosis the main source of spread of the dis- can be reduced to the position of a ease. Infection takes place usually minor cause of death by the full co- during childhood, either by ingestion operation of the medical profession, the or inhalation of tubercle bacilli. A public health organizations, the social positive tuberculin test indicates an agencies and the general public. This infection has taken place by the The Health Bulletin November, 19S5

furniture, a table and storage tubercle bacillus, a negative test rules tors or being built in the cottage. The build- out the disease. ing can be built sufficiently light to be Since we agree that sputum from moved to another residence when nec- cases of human tuberculosis is the essary. The middle third of the side main source of spread of the disease, walls can be screened to allow an concentrate our efforts on we should abundance of fresh air. Sufficient room contacts in order such cases and their is allowed between the bed and side to prevent others from having the dis- wall for the necessary care of the ease. Case finding, before the patient patient. The length of the cottage is infects those around him, is not always that of a single bed. Visitors and an easy problem. The laity must be children may talk with the patient taught to go to their physician regu- through the screened side walls with- larly, and to seek medical advice early, out being exposed to the disease in in order to locate tuberculosis in a cur- any way. No one should be allowed to able stage before they have infected enter the cottage except a nurse or an others. Cooperation of the physicians adult member of the family. Awnings must be secured in order to have every should be provided to protect the pa- case found reported. A free clinic tient from the sun, and sliding win- should be conducted in each county dows to keep out rain and intense cold. several times each year for those who The location of the cottage should be cannot afford private medical care. such that the patient can easily at- When a death certificate indicates tract the attention of some member of death from tuberculosis, if this person the household at any time during the has not been under the supervision of day or night. the health department, a visit should After the patient is isolated, certain be made to the home and all contacts precautions should be observed. All for an advised to report to a physician sputum should be collected in fly tight examination. The examination of all containers and burned. Individual eat- contacts should include a physical ex- ing utensils should be provided and amination and tuberculin test. Those sterilized after each usage. Equipment reacting positive to the tuberculin test such as wash basins, towels, and other should be X-rayed. This examination should be used only by the should be repeated every two years un- necessities All linen should be sterilized til several examinations have been patient. Each pa- made. before going to the laundry. furnished tuberculosis All cases of active tuberculosis found tient should be cover his should be placed in a sanatorium if literature and taught to when coughing or possible. Some counties do not have mouth and nose medical treatment of a sanatorium, and, if the State Sana- sneezing. The patient is left entirely in the hands torium is not able to admit all cases, the physician. The health some of them must be isolated at home. of the family should visit the pa- Infection can easily be prevented in department nurse often as necessary, placing the home if the proper precautions are tient as on prevention of taken. Isolation of active tuberculosis special emphasis disease, and the neces- cases in the home is not advisable if spread of the examinations by a children under twelve years of age are sity for frequent tuberculosis contacts, present. When there are children in physician of all of making an early the home, a mobile tuberculosis cot- for the purpose disease. tage can be used to isolate the patient. diagnosis of the should have preventor- Such a cottage should be designed for All contacts care or extra care in the home in a single bed, no space allowed for visi- ium November, 1935 The Health Bulletin November, 1935 8 The Health Bulletin the form of rest periods, attention to The positive reactors should have a the diet, fresh air, etc. This special physical examination and X-ray. The care often improves the child's resist- physical examination and X-ray should ance sufficiently to overcome his infec- be repeated every two or three years, tion, possibly preventing a tuberculosis until several examinations have been breakdown in later life. The correc- made, in order to be sure there is an tion of physical defects and the giving early diagnosis, should the disease of hot lunches in school to the mal- develop. By these examinations, many nourished helps to improve the child's will be found needing sanatorium or resistance. preventorium care. The home of each The care of infectious cases and con- child with a positive tuberculin test tacts as outlined can be carried out by should be visited, tuberculosis literature given, and the source of infection a health department of most any size, looked for. Every member of the house- and would be far reaching in making hold should be advised to have an an- tuberculosis a minor cause of death. nual physical examination. However, larger units can go a great It is believed that the systematic offering tuberculin deal farther by the carrying out of such a program in test to all school children and teachers every county would eventually control under their jurisdiction, retesting all tuberculosis and make the disease a negative reactors every three years. minor cause of death.

Catawba County Preventorium for Under- Nourished and Under-Privileged Children

By Mrs. Elnoba M. McKay, Catawba County School Nurse FOR several years a preventorium Seal Committee—all of Hickory—and for under-nourished and under- the Newton Kiwanis Club. privileged children has been con- The camp this year opened on June ducted in Catawba County under the 10th and closed the summer work on general supervision of the school nurse. September 10th. The Catawba County This health project is sponsored an- Hospital building with equipment is nually by the different civic organiza- utilized. Its lights, water, and fuel are tions of Catawba County in co-opera- furnished by the local county govern- tion with the Catawba county government, and the Federal ERA this year ment. The school nurse, during her paid the salaries of the workers. The work throughout the school year, is working staff consisted of two nurses, charged with the responsibility of lo- two playground directors, one dietician, cating the children needing treatment, two cooks, and two janitors. and then, at the end of the year, of During the four months of progress selecting those most in need of this 73 children were admitted. Of this-

treatment and eligible to receive it. number 39 had tonsils removed. Each The civic clubs donating funds for child was given the tuberculin test, and this work this year are the Kiwanis, one. which was positive, was later ad- Rotary, Woman's Club, Business and mitted to the State Sanatorium for Professional Woman's Club, the Ameri- treatment. Only 16 out of the 73 needed can Legion, the Legion Auxiliary, the dental work. And the necessary work American Red Cross Local Chapter, was done. Eyeglasses were fitted for and the County Tuberculosis Christmas 6 of the children. Medical treatment November, 1985 The Health Bulletin 9

of varying kinds was given to 20, and dren have either mother dead or all of the children were carefully ex- father on the chain gang and the amined by a physician. The entire mother left unable to work. The pres- group gained 273 pounds, being an ent plans are to continue through for average gain per child of 3 and % one year, if the project is approved in pounds in weight. In addition to a Washington. regular balanced meal three times a A daily planned program which gives day, the group consumed 5640 quarts the children the proper amounts of of milk. well-planned food, rest, and recreation Specialists of the county, with facili- is followed. Each child is given one ties provided by a local hospital, did quart of whole milk each day. The the operative work. Local dentists con- program is planned so as to build up in each child a consciousness tributed their work free, and local of health in its broader meaning. An effort is specialists made corrections for the made to give each child a clear con- children needing eye work. Medical ception of the proper social attitude treatment was given by the county and to inculcate sound traits of citi- physician to the rest of them who zenship. It is an inspiration to ob- needed it. The material used in the serve the transformation which takes tuberculin test was furnished by the place in these little ones : their heads State Sanatorium. are lifted higher, their eyes brighten, In the camp now are 40 children. their shoulders straighten up, posture Of this number 21 are from active wel- is improved, color comes to the pale fare homes, and 19 are from families cheeks, and a smile takes the place of of the ERA group. The welfare chil- frowns.

"Curing" At Home Is No Easy Job

Although It Can Be Done, It Brings Many Difficulties, Some of Which Seem Insurmountable — Former North Carolina Sanatorium Patients Describe Their Experiences

From the Sanatorium Sun ONE of the most troublesome ques- Experiences Vary tions that vex the tuberculosis Various patients have found varying patient as he makes his plans to answers to this question in their own return home after a prolonged sojourn experiences. Some have found it com- as a Sanatorium resident is this one: paratively easy to continue at home the "Can I take the cure satisfactorily af- strict routine of rest and regularity ter I get back home, or am I going to which they were taught under the find conditions there such as to make watchful eyes of their doctors and further progress impossible and even nurses at the Sanatorium. Others have undo the progress I have made at the found the task difficult, but have over- Sanatorium? come their difficulties—although some- : ;

10 The Health Bulletin November, 1935 times only after a stubborn figbt Carolina Sanatorium patients and ex- against the advice and perhaps ridicule patients prior to his death in Albu- of uninformed and unsympathetic querque, New Mexico, a few years ago, friends and relatives—and made an ex- in an article in The Journal of the cellent job of getting well, in spite of Outdoor Life for November, 1931. "My all these troubles. Others have en- first trip lasted nearly five months ; my countered such overpowering difficul- second was extended to eight months ties involved in "taking the cure" at and my third was of nine months." home that they have found the task In his Journal of the Outdoor Life largely impossible, with the result in article, which was appropriately head- all too many cases that they return to lined "Why I Had to Come Back," the the Sanatorium or to their local doc- author, whose references to sanatorium tors for re-examinations only to find sojourns had to do with his months as out that, instead of progressing, they a patient at the North Carolina Sana- have grown worse. torium, went on to discuss the difficul- Even when home conditions are not ties of taking proper care of one's self particularly unfavorable for "taking the after going home, as follows cure," many ex-patients find themselves "Why I had to come back"—he was facing a difficult problem in the normal on his fourth trip to the North Caro- human weakness to avoid performing lina Sanatorium when he wrote the unpleasant tasks unless one has to. At article—"is no unusual story. Mine the Sanatorium there is very little is the story of thousands who have choice in the matter. Doctors and been obliged to make return trips to nurses see to it that it is easier to sanatoria. obtain proper rest than it is not to do "It was not the cranking of stubborn so, insofar as strict enforcement of Fords or playing football that caused institutional rules and rigid insistence my backsets. It was such little things upon hospital routine contribute to this that I thought could never possibly end. Therefore, the patient has the hurt me. These 'little things' sent me responsibility shifted from his shoul- back to bed time after time. ders to those of members of the staff. "At the Sanatorium everything was At home, however, he finds all this to arranged for the convenience of such be different. The responsibility is en- fellows as myself. The doctors and tirely his. Except for such moral sup- nurses were there to remind me con- port as he may obtain from the mem- stantly how necessary it was to follow bers of his family and others inter- the regular routine of rest and to ad- ested in seeing him get well, he alone vise me in case I should develop a must swing the whip of wise routine slight cold or have any spread of over his head, figuratively speaking, trouble. And, too, there were plenty and make himself do those things of sad cases near me to make me un- which he should do out of respect for derstand why I had to be careful. the condition of his lungs, and avoid Whenever I would find myself with a those things which tend to slow up, cold, or lose a few pounds in weight, or or reverse, progress along the long notice a slight rise in temperature, I and often discouraging highway to would report at once and receive medi- health. cal attention.

Different at Home Why He Had to Come Back "At home it was different. There, "Three times I left the Sanatorium, when I had a slight cold I prescribed and three times I came back," wrote my own medicine rather than go to the Spencer M. Smith, well known to North trouble and expense of getting a doc- : :

November, 1935 The Health Bulletin 11 tor's advice; or I said to myself that have to stand up against you yourself the cold would be gone the next day. and against your friends and relatives. The next morning I would find that it It will be unpopular. It may make you wasn't any better, but I just knew that, unpopular. For its sake you may re- with a little of my own doctoring, it ceive such opprobriums as 'over-care- would be gone in a day or two. And ful,' 'cranky,' 'lazy.' But stick to the so on. old backbone. It is your friend—your "One night there was a big street best friend." dance in town. Dancing was some- After describing a few personal ex- thing I knew I should not do, and if periences in trying to "take the cure" anyone had told me that afternoon that properly at home, Mrs. Hardman sum- dancing a few minutes during the eve- marized her observations and impres- ning would cause me to hemorrhage, I sions as follows would have laughed at the idea. Me "And so it goes. Fortunate are we dance? Why, the very idea! Not me. if we are blessed with a good, strong I knew better. But I knew that going backbone. If yours seems a little weak and watching the others dance and lis- at first, just use it and you will be tening to the music would not hurt me. surprised at the way it will stiffen up. So I attended the dance as a specta- Give it a break, resist a few tempta- tor." tions, and pretty soon you will have a But, the article goes on to say, this full-grown, well-developed old back- young man, who was so resolutely bone, a faithful servant you can de- determined not to do anything so un- pend on to serve you well, one that will wise, from the point of view of his help you to live a long and happy life health, as to dance, was induced to —when you go home." dance "just one time." Deciding that From still another former patient of "just one time" would not hurt him, the North Carolina Sanatorium, also he danced "just one time"—at first. writing in The Journal of the Outdoor Then he danced several times. And Life, her article appearing in the issue that night he hemorrhaged. And shortly of February, 1931, one obtains an ex- afterward he was back at the Sana- cellent picture of some of the difficul- torium. ties of "curing" at home, and particularly vivid is the picture of the troubles Says Backbone is Needed of the home "curer" struggling with "When you go home what you will the problem of visitors. This Tar Heel need principally is the old backbone," author, Miss Velva Brittain. discussed wrote another former patient at the such matters as irregular habits of eat- North Carolina Sanatorium, Mrs. ing and sleeping at home, the problem Mildred Hardman, in an article pub- of remaining contented among well lished in the September, 1931, issue of people, the longing for the moral sup- The Journal of the Outdoor Life. port of fellow-patients (and often un- "There are a number of qualities that appreciated help in sanatorium "cur- will come in mighty handy, such as will ing"), and other aspects of trying to power, self-control, and common sense, keep up at home the routine of the but backbone is just another name for Sanatorium. Then she had the follow- these, and a regular, one-hundred-per- ing to say regarding visitors cent, honest-to-goodness backbone is the "They seem to come in droves. May- thing that will see you through. It be there will be several days and no must be a good, stiff one, because there visitor. All of a sudden, from here and

will be a lot of strain on it. You will there, will come crowds of them. Sun- need to use it early and late. It will days are their big days, and getting —

November, 1935 12 The Health Bulletin one's rest-hour then is as hard as get- Nothing in the above should be re- ting every word in every cross-word garded as an effort to discourage those puzzle that one finds. In a small town who may be obliged to "take the cure" where everybody knows everybody else, at home. As many writers in The one can just expect endless visitors Journal of the Outdoor Life, the Sana- other publications fre- 'the butcher, the baker, the candle- torium Sun, and quently point out, it is possible to "take stick maker' and their whole families! the cure" at home and do so success- To keep tbem quiet or to keep them fully. But it is well for those who look away during two hours in the after- forward to going home as the begin- noon would necessitate hiring several ning of an easy and simple phase of rest policemen. Who can when a new recovering their health to face squarely family of visitors arrives every hour and with wide-open eyes the difficul- or every ten minutes? They don't un- ties that are often present and fre- derstand." quently appear well-nigh inescapable.

A Few Facts About Milk, The Most Nearly Perfect Food By John Andrews

(This presentation is a dialogue between Mr. Andrews, an engineer with the State Board of Health, and Mrs. Parsons. They have just met on the street during the lunch hour, and as the scene opens Mr. Andrews is speaking. It

is suitabe for a radio broadcast or for a play at school.—Editor. )

Andrews: Hello, Mrs. Parsons, I'm Parsons : Certainly, how could I help Blanks Brothers Dairy, certainly glad to see you. it? It said Grade A Pasteurized Milk. Parsons : I'm glad to see you. I want Andrews : To receive a Grade A rat- to ask you a question. ing, a cafe must, among other require- Andrews: Well, I'll do my best to ments, serve the highest grade of milk answer it. available, which is Grade A Raw or Pasteurized milk. It is re- Parsons: I just had lunch at the Grade A quired that milk be served in the orig- little cafe around the corner, and I inal container in order that the cus- noticed something I wanted to ask you tomer be given an assurance that he is about. Incidentally, a small blue and actually receiving the high quality pro- entitled. The fact white sign hanging near the cash regis- duct to which he is that you remembered the inscription ter said the place was rated as a Grade on the bottle cap is a good illustra- A cafe by the State Board of Health. tion of the value of serving milk in the But I wanted to ask you about the way original container.

they served milk. The waiter brought Parsons : That seems to be a very an empty glass and an unopened half reasonable requirement. Now I remem- pint bottle of milk, just loosened the ber that the teachers in school used bottle cap and then left them on the to say that milk was a good food and food is it? table. I had to pour the milk into my all that, but just how good a just glass myself. Why didn't they fill my Aren't there plenty of other foods glass in the kitchen and avoid the as good? there trouble of carrying the bottle? I sup- Andrews : No, Mrs. Parsons, pose there is a good reason, because are no other single foods which are people usually don't do unnecessary "just as good." Milk is the most nearly work. perfect food. I sometimes wonder whether we modern, twentieth century Andrews : There is an excellent reason for serving milk in its original con- people really appreciate the food value tainer. But, first did you read the in- of milk as much as did the people of scription on the bottle cap? olden days. The Bible describes the November, 1935 The Health Bulletin 13

Holy Land as a land "flowing with one of the most digestible of all foods. milk and honey;" dried milk consti- Of course, milk could not be used as tuted a large portion of the food ration the only food. It does not seem to of the soldiers of Genghis Khan, the be an entirely dependable source of Mongol monarch who conquered Asia the other vitamins, and it does not and part of Europe in the thirteenth contain enough iron. Normal children century ; cheese was important in the should drink about one quart of milk diet of the Vikings, who sometimes a day, together with a careful selection even crossed the Atlantic in their small of other foods, which should include ships. The cow was an ohject of re- orange juice, cod-liver oil, and green ligious worship by many primitive peo- vegetables. ples. The "Pilgrim Fathers" were not Parsons : I see now why milk is so wise, however. They brought no called the "most nearly perfect food" cattle with them on the Mayflower. The and I am going to start drinking a lot lack of suitable food, especially milk, more myself. It does seem to me, resulted in a very high death rate, though, that the production and handl- especially among the children. Every ing of milk should be carried on in the child under two years of age died dur- cleanest possible manner, for is it not ing the first winter, and nearly one- true that unclean milk can spread dis- half of all the persons who came on ease? the may flower died that winter. The Andrews : Yes. indeed ! In addition governor recognized the mistake and to being an excellent food for people, later ordered that one cow and two milk is a good food for bacteria and goats be brought over for each six certain disease-producing organisms. people. Unclean milk is unfit for human con-

Parsons : I guess milk is a good food, sumption, and for this reason it is all right, but it seems to me that milk necessary that the production of milk is composed so largely of water that be closely supervised by the health its food value would be much less authorities. than that of solid foods, such as Parsons: And. just how do the health peaches or carrots. departments exert this supervision?

Andrews : The fact that milk is a Andrews : By urging the various liquid is confusing; it actually con- cities, towns, and counties to adopt the tains more solid matter than a good Public Health Service Milk Ordinance. many so-called solid foods. Milk con- This ordinance sets forth minimum re- tains about 13% of solids by weight, quirements for sanitation and cleanli- which is a larger percentage than is ness in the production and handling of contained in peaches, carrots, onions, milk, and directs the local health of- beets, squash, pineapple, turnips, oys- ficer to enforce these regulations. ters, cabbage, radishes, cauliflower, Parsons : Roughly, what do these re- spinach, watermelon, pumpkins, toma- gulations consist of? toes, asparagus, celery, lettuce or cu- Andrews : They require that milk be cumbers. obtained from healthy cows, be handled Parsons: Is that a fact? Well, I only by healthy people in clean equip- certainly did not know that there was ment and in clean surroundings. The so much solid matter in milk. What is milk must be promptly and efficiently the composition of this solid matter? cooled, and properly bottled, and I know that the human diet must be labeled with the grade which is deter- well-balanced. mined by inspections of the dairy and Andrews: Milk is a well-balanced laboratory tests of the milk. That is food. The very fact that milk is the a general statement of the require- only food prepared by nature for the ments of the Public Health Service specific purpose of nourishing the Milk Ordinance. There are, of course, young of mammals is ample proof that many detailed requirements and cer- it is almost an ideal food. It has been tain minimum standards for equip- called "tbe most nearly perfect food." ment, construction and methods. It is rich in protein, the muscle build- Parsons: I wonder if some of those er; it is rich in lime, the tooth and requirements are not rather stringent. bone builder. Its large fat and milk Isn't it rather expensive for the dairy- sugar content give it a high fuel value. men to comply with all these regula- Milk is also a good source of Vitamins tions? A and G. But, probably the most im- Andrews : I will answer that ques- portant quality of milk as a food is the tion with two statements. First, the fact that it is easily digestible; it is Public Health Service Milk Ordinance 14 The Health Bulletin November, 1935 is based upon proven facts, and every out of a possible 100%. The eight single requirement can be justified dairies had a total of 136 violations of with a sound public health reason. It the milk ordinance. Today, there are has been our experience that it is not only seven such violations, and the raw too stringent and it does not cause the milk rating will be more than 95%. dairymen any unjustified expense. That is truly excellent progress in Second, let us assume that a particular dairy sanitation. requirement is hard on the dairyman, Parsons : Yes it is. That seems to but is vitally important in safeguard- be truly a great piece of work. How ing the quality of the milk. Certainly, did it affect the dairymen? What ef- a public health department would be fect did it have on the consumption neglecting its duty if it did not set of milk in Kinston? the health of the large consuming pub- Andrews : I was hoping you would lic at a higher value than the incon- ask that question. The consumption venience to the relatively small num- of raw milk has now increased 40% ber of milk producers. Actually, how- and the consumption of pasteurized ever, we have found the Public Health milk has increased 150%. It has been Service Milk Ordinance to be entirely our experience that it is definitely ad- satisfactory and practical. vantageous to the dairymen to clean up

Parsons : Well, now, after this ordi- and produce clean, safe milk, because nance is passed, doesn't it take a long after they have done so, their sales time for the dairies to be gotten in almost invariably show a large in- the proper condition? And how do the crease. dairymen feel toward this strict con- Parsons : Then it seems to me that trol of the sanitary conditions of milk when a town adopts and enforces the production? milk ordinance, the health of the com-

Andrews : Ordinarily, a period of munity is benefited in two ways : the twelve months is allowed between the quality and safety of the milk supply passing of the ordinance and the date is immeasurably increased, and the upon which only graded milk may be amount of milk consumed is greatly sold. Almost without exception, the increased. I should think that such dairymen feel that control of the sani- work would be of great value to the tary conditions of milk production is general health and welfare of the beneficial to them. I can illustrate people. this best by citing the experience of Andrews : We are convinced that it the city of Kinston, North Carolina. Ten is, so the State Board of Health and months ago the local health depart- the local health units are doing their ment began a vigorous clean-up cam- level best to increase the quality of our paign. At the start of the campaign milk supplies and to increase the con- the Public Health Service rating of sumption of milk, "the most nearly per- the raw milk supply was about 37%, fect food."

Book Review IN A BENGAL JUNGLE. By John drawings by Paul Porterfield are Symington, M.D. 245 pages. Chapel superb.

Hill : The University of North Carolina Dr. Symington has been health of- Press. Price $2.00. ficer of Moore County for several years. It is nothing unusual for a physi- He came to this State direct from a cian to crash into the big league of service of about twenty years as medi- writers and novelists. But when a cal officer on tea plantations at the foot physician who is a working health of- of the Himalaya Mountains in India. ficer in a North Carolina county writes There in an exhausting climate he a book as interesting as Dr. Syming- fought tropical diseases. He treated ton's it is big news in this office. The patients in huts and palaces. He made book has 245 pages and not a dull many of his calls on elephant back and paragraph in it. The University of was exposed to the dangers of attack North Cai-olina Press has never turned from wild animals as well as from such out a more beautiful job. The crayon diseases as cholera and plague. He : — !

November, 1935 The Health Bulletin 15

has skillfully set in down simple lan- Dr. Symington was born in the High- guage many of his experiences, and in lands of Scotland and before embark- doing so he has left an unforgettable ing on his Indian service he spent some impression of the routine daily life of years in the Belgian Congo as a medical some of India's millions. There is not missionary. He was the first white man in that one word of "shop talk" in the book. section of Africa. You will lay this book Each chapter is a separate story and down uncon- sciously wishing that the author all are interesting. This reviewer has had added a few more chapters which you seldom read any book with keener in- feel would have been easy for him to terest and greater pleasure than this have done out of the abundance of his one. experience.

Labor Department Bulletin MAJOR A. L. Fletcher, Commis- Tourniquet sioner of the North Carolina De- Graduated medicine glass partment of Labor, has recently Drugs written an excellent pamphlet setting 2 oz. aromatic spirits of forth the "Rules and ammonia Regulations Gov- 2 oz. 4 per cent boric acid erning Work Places and Working Con- 2 oz. alcoholic iodine solution, half ditions." strength (for external use) 2 3-oz. collapsible tubes of The publication is complete and full bicarbonate of soda mixed with vaseline of valuable information. (3 per If every em- cent for burns) ployer of labor in mill, store and fac- 2 oz. castor oil (for eye injuries) tory and otherwise would closely fol- Deessings low all the recommendations many lives 1 doz. assorted sizes sterile could be saved and much suffer- gauze band- ing ages resulting from preventable acci- 1 spool Z. O. adhesive plaster, dents 1 inch could be prevented. Such mat- by 5 yards. ters as heating, lighting, methods of 3 one-half ounce packages of absorbent cotton escape in case of fire, equipment and one-yard location 3 packages of sterile gauze of water closets and all such Splints of assorted sizes for fractures things are fully discussed. Wooden applicators wound with cotton The requirements for first-aid sup- Wooden tongue depressors." plies are simple and adequate, so much Nursery so that we pass along to our readers Rhyme—1935 the list of instruments, drugs and Mary had a little cold, but wouldn't dressings stay at to be placed in the first-aid home, And everywhere that Mary went, cases. They require all bottles that or cold was sure other to roam; containers containing drugs or It wandered into Molly's eyes and filled other substances to be clearly labeled them full of tears. and It that the specific purpose for which jumped from there to Bobby's nose, the and thence to Jimmie's ears. contents are to be used must be It painted Anna's throat plainly stated. bright red, and swelled poor Jennie's head; "The contents of the first-aid case Dora had a fever, and a cough put shall be as follows Jack to bed. The moral of this little tale is very Instruments quickly said She could have saved 1 pair scissors a lot of pain with just one day Thumb forceps in bed —Arkansas Democrat. November, 1985 16 The Health Bulletin

DEATHS FROM TUBERCULOSIS OF THE RESPIRATORY SYSTEM—BY COUNTY AND RACE: 1934 TOTAL DEATHS (TUBERCULOSIS, ALL FORMS), 2,143 CKAPEL HILL, N. C. 3^ 3fe®Ib fM Published bM TfiE, fl°R371 CAR°UrtA STATE. E>

This E>u]ktir\will be ser\t free to ar\\j crttzerx of the State upor\ request !

Entered as second-class matter at Postoif.ce at Raleigh, N. C, under Act of July 18, 18$i Published monthly at the office of the Secretary of the Board, Raleigh, N. C.

Vol. 50 DECEMBER, 1935 No. 12

PRACTICAL HEALTH TEACHING

Richmond County Health Department Booth at Ellerbe Springs County Fair

One of the most creditable booths at the Richmond County Fair in October was that prepared by the County Health Department under supervision of Dr. B. B. Dalton, county health officer, and the county nurse, Miss McCaskey. Elsewhere in this issue there is a brief descriptive article about this excellent exhibit based on information kindly furnished us by Mr. Isaac S. London, editor of the Rockingham Post-Dispatch, and Dr. Dalton. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

S. D. CRAIG, M.D., President _ Winston-Salem J. N. Johnson. D.D.S., Vice-President _ __. _ _Goldsboro G. G. Dixon, M.D _ _ _ ~ - Ayden H. Leb Large, M.D...._ _ _ - _ Rocky Mount H. G. Baity, ScD „ „ _ _ - Chapel Hill W. T. Rainey, M.D _ _ _ _ -Fayetteville Hubert B. Haywood, M.D — - Raleigh James P. Stowe, PhG...._ _ _.... - _ Charlotte J. LaBruce Ward, M.D _ ~ Asheville

Executive Staff

Carl V. Reynolds, M.D., Secretary and State Health Officer. G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Preventive Medicine. Warren H. Booker, C.E., Director Division of Sanitary Engineering. Ernest A. Branch, D.D.S., Director Division of Oral Hygiene. John H. Hamilton, M.D., Director Division of Laboratories. J. C. Knox, M.D., Epidemiologist. R. T. Stimson, M.D., Director Division of Vital Statistics. R. E. Fox, M.D., Director Division of County Health Work.

FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which will be sent free to any citizen requesting it. The Board also has available for distribution without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Scarlet Fever Cancer Health Education Smallpox Constipation Hookworm Disease Teeth Chickenpox Infantile Paralysis Tuberculosis Diabetes Influenza Tuberculosis Placards Diphtheria Malaria Typhoid Fever Don't Spit Placards Measles Typhoid Placards Eyes Pellagra Venereal Diseases Flies Residential Sewage Water Supplies Fly Placards Disposal Plants Whooping Cough Sanitary Privies

Prenatal Care (by Mrs. Max West) Baby's Daily Time Cards : Under 5 months ;

Prenatal 'Letters (series of nine 5 to 6 months ; 7, 8, and 9 months ; 10,

monthly letters) 11, and 12 months ; 1 year to 19 months ; Minimum Standards of Prenatal Care 19 months to 2 years Breast Feeding Diet List: 9 to 12 months; 12 to 15

Infant Care. The Prevention of months ; 15 to 24 months ; 2 to 3

Infantile Diarrhea years ; 3 to 6 years Table of Heights and Weights Instructions for North Carolina Midwives

CONTENTS pagh Notes and Comment 3 The Problem of Old Age 5 District Health Work 10 Health Exhibit at Richmond County Fair 11 Heart Disease in Persons of Middle Age 12 Plain Envelopes Again _ 14 Durham's Infant Death Rate 14 Name and Address Important _ 14 More Dangerous Disease -. 15 Ode to Posture 15 PUBLI5ABD BY TAB riORTA CAROLINA 5TATB BOAf^D -^HEALTH

Vol. 50 DECEMBER, 1935 No. 12

Notes and Comment

By The Editor WITH this issue the Health Bul- health in order that the ravages of letin completes fifty full years preventable disease might be eventual- of existence. This number is ly eradicated. twelve in the series of fifty volumes. Immediately following Doctor Wood's The Bulletin was founded by Dr. death in 1892, Dr. Richard H. Lewis Tbomas Fanning Wood, the first State succeeded him as State Health Officer. Health Officer. It went on a permanent During the ensuing sixteen years that basis fifty years ago. Doctor "Wood, Doctor Lewis served, his office was on as every one will remember, was the a part-time basis, and the total ap- first Health Officer. He worked on a propriation for all of the work of the part-time basis, and the first appro- Board during his term, which ended in priation made by the Legislature to the 1909, never exceeded two thousand dol- State Board of Health, when it was or- lars a year, with the exception of the ganized, was one hundred dollars a last two or three years, in which a year. Doctor Wood was a practicing small appropriation of a few hundred physician in Wilmington at that time. dollars was added to start the State He was the editor of a successful medi- Laboratory of Hygiene. cal journal, which was supported by The present editor of the Health private enterprise. Bulletin is one year older than the Doctor Wood became interested in State Board of Health. For the past public health work through his work twenty-one years he has been a staff as a journalist and a practicing physi- officer of the State Board of Health, cian. He became convinced that much and since March 1, 1923, he has been of the suffering and illness prevalent the responsible editor of the Health in that day was due to causes which Bulletin. Like Doctor Wood, he be- could be easily prevented. As the years came interested in the public health went by in the early 70's, Doctor Wood work while going about his duties as a gathered around him a few of like- practicing physician. In treating peo- minded physicians in eastern North ple for typhoid fever, and therefore Carolina, including the then young seeing many untimely deaths from that physician Dr. Richard H. Lewis. They terrible disease, and in coming in succeeded in organizing the State daily contact with the profound ignor- Board of Health in 1877. The Bulle- ance on the part of mothers in the tin was established as a medium care of infants, with the resulting high through which simple information could mortality among the babies for lack of be passed along to the people of the proper care, the editor became con- State which would cause them to think vinced during the early years of his and to act in the promotion of public practice that the public health work :

The Health Bulletin December, 1935 of the State should be put on a sound writes or assembles from the pen of scientific basis and that it should have other writers can interest everybody or facilities to reach the people with in- can be helpful to everybody. The edi- formation which they so gravely* needed. tor would like to have suggestions as During the years which the editor to what kind of information most of has been responsible for the Health the people need and the kind which Bulletin he has at all times had many would be most helpful to most people. other duties to perform. For most of Never m^Lnd the brickbats ; we get the time the work he has put on the plenty of those, and we are proud to Health Bulletin has been simply a say that we also get our proportionate labor of love in the form of extra work. part of the bouquets. He has done his best to carry forward We are grateful to the many friends the precepts and standards laid down during the past few years who have by Doctors Wood and Lewis. He has taken the time and trouble to write to tried in every issue to present at least us to commend us for some particular some helpful information which would article that they liked and which was aid people in preventing sickness. This helpful, or for some particular issue has not always been easy to do. At which they thought, on the whole, was times he has wearied in his role of good. All of that has been stimulat- adviser. At other times he has been ing and encouraging, and, strange to discouraged because the need for such say, we have appreciated some of the work seemed so great and the visible knocks. Our early years wfere in- results have looked so small. Often he fluenced by the Biblical doctrine that has had to write against a "dead line" an individual should beware when all all newspaper people know what that men spoke well of him. That is to say, means. The fact is, this article is be- if everybody praised and nobody ing written against a dead line, and blamed, we might be satisfied that we it is being written somewhat in the were doing nothing that would inter- mood that Eugene Ashcraft, editor of est anybody. However, we do like to the Monroe Enquirer, expressed the get more commendatory expressions other day in his personal column. Mr. than criticisms. That is perfectly Ashcraft said that he got out his paper human. twice a week, more than a hundred Many of our readers have asked us issues a year, and as each issue came to publish more illustrations. For the off the press and went to the post of- last few years we have been unable to fice to be mailed to his subscribers, he do this because the cuts cost consider- had the feeling that never again as able and we have not had the money long as he lived could he assemble ma- to provide it. Another thing is, we are terial for another issue which would restricted to sixteen very small pages interest anybody. That paragraph each month and naturally we can af- surely went home to this particular ford but little space in such a small editor. For the last one hundred and publication for pictures and illustra- fifty issues of the Health Bulletin, tions, even though they are extremely covering a period now of nearly thir- valuable. One of our friends from teen years, the editor has had that feel- Texas two or three years ago suggested ing every time he has gone to the that we have our articles shorter and printer with a new issue. have more of them. That was a prac- In this month, at the close of the tical suggestion, and we have tried to

year, it is a good time to take stock comply as far as possible. Another and to take counsel of our readers. The friend from Florida suggested that we have more information on the preven- editor would like to have constructive ; suggestions. Not everything that he tion of venereal disease. These are : : ;

December, 1935 The Health Bulletin

only samples of the kind of suggestions toward the sunrise, and he is still which we would like to have. interested in the many problems in pub- As the months and years pile up on lic health remaining to be solved for us, in the language of some poet, who the benefit of the coming generation. has well said, "The more we live more So, with this closing issue of the brief appear our life's succeeding year and volume fifty, from the abundance stages," we are tempted more and more of a full half century of experience, the to become weary in well doing and to Health Bulletin would suggest to all its readers and seek seclusion and rest. From all such particularly those of middle-age and past that moods we always react by thinking of they take heart and renew their cou- the immense amount of work yet to rage and join in making 1936 the hap- be done in the field of public health, piest and most successful and year from though growing old, it seems en- the standpoint of health that the State tirely too fast, the editor's face is still has ever experienced.

The Problem of Old Age

A Sermon by Rev. S. L Morgan, Creedmoor, N. C. hoary HE head is a crown of Scott in Marmion glory; it shall be found in the 1 "Thus pleasures fade way of righteousness." — Prov- away; Youth, erbs 16:31. talents, beauty, thus decay And leave us dark, forlorn, and The ancient Wise Man's thought is gray." probably this, that it is a glorious thing to reach the age of the hoary Gerald Massey: head because it is at the same time an "Set is the sun of my years evidence and a reward of righteous liv- And over a few poor ashes, ing. The hoary head is honorable, be- I sit in my darkness and tears." cause it is proof that one has lived a clean, godly life. It is true in a deeper Instinctively we dread old age, when sense than the Wise our Man dreamed. powers fail, and the next step "Righteous" living lengthens the span must be—death. of life. To obey God's laws, Two facts which in- in our present day life clude the laws of health, is to add a new increase dread to old age. One is one's prospects of reaching old age and the speed of industry in our machine the hoary head. age. The worker of 45 dreads to hear the sentence of doom, "You We will notice four facts are too about old slow." And age: so he shaves to hide the tell-tale gray hairs, for fear of losing I. The universal dread of old his job. age. The demand for youth, car- Swift said, "Every man desires ried to to live absurd lengths today, brings long but ; no man would be old." into business Poets and the professions the so picture it. fear of losing one's job on the first sign of old age. Longfellow Often men and women in their prime, when mature wisdom and "The sunshine fails, the shadows ripe experience fit them grow to be then- more dreary, best, are haunted by the fear of losing And I am near to fall, infirm and their jobs because they are weary." too old. I know of a good town church that — :;

December, 19S5 6 The Health Bulletin

Numerous like passed a resolution not to consider for furnished by the king. the author make a pastor any man past 45! instances given by case. The laws of health It is the fashion to make sport of very strong wild oats, woman's sensitiveness to her age. To are simply God's laws. Sow

will ; commit any sort of excess do so is either cruel or else it shows if we and old age ignorance of a fundamental fact—the even in work or worry— upon us, and life is other cause for dreading old age today. begins to creep so much. That is God's It is the fact that women are every shortened by large in all the ages of day face to face with the insecurity of law, written Obey the law of love as age creeps on a woman. They human history. law of God—and the result see men tiring of aging wives and health—the period of youthful vigor falling for pretty young flappers. It is a longer grace makes youth and beauty a life-and- and usefulness, even of youthful good cheer. To live death matter for a woman. What and beauty and a Christian woman values more than life may he that sort of life is clearly God has revealed the secret. lost, unless she keeps in the back- duty, when point of the text ground the fact that youth and beauty That seems to be the head is a crown of glory" are fading. It is a matter too serious "The hoary the reward of obedience to God's for jesting. it is There are solid reasons to fear old laws of health. laws today are in the reach age. But the second fact about old age These if not already known. The gives the cloud a silver lining. of everyone, gist of this great door on deferring II. Old age can be deferred. The eminent physician, Dr. Arnold Lorand, old age is this: Live in the open air and sunshine; in his book, "Old Age Deferred," shows drink in moderation, and only convincingly that the average person eat and wholesome, avoiding tobacco today can defer old age, preserving what is alcohol, and even coffee and tea youthful vigor, and even youthful good and in excess; work hard with body and looks, for ten to twenty years. With stopping • short of fatigue and our modern knowledge of the laws of mind, strain; avoid all excesses, physical, health, he declares, there is no need mental and emotional; sleep at least to grow old at 40 or 50, or to die at seven hours; take a daily bath as a 60 or 70. Of course, as he says, we pure health measure; relax at least might have to go back a few genera- one day a week and rest; give con- tions and build up in our ancestors a kindly feeling, refusing more vigorous constitution through ob- stant play to absolutely to let the mind dwell on any- serving the laws of health. For par- thing unloving or ugly; actually take ents who have disobeyed these laws to be friendly, generous, religious. are doomed to pass down to their chil- time This author, who is a European, de- dren their own weakened constitutions. plores the fact that the average busi- The opposite is equally true. the United States leads The author gives striking examples ness man in the world in reaching a premature old of this fact. An Amsterdam physician, abusing himself worse than the who lived to be 94, had six sons whose age, slave driver ever abused his ages averaged over 100 years. Thomas worst wrecking his health by the time Parr, of England, was so remarkable slaves, is 40 or 50, and missing all the best for his physical and mental vigor at he the frantic rush of business. 152 that he was invited by the king of life in book is an impressive appeal to of England to live awhile at the court. His to 20 years. Accustomed through his long life to put off old age 10 age has peculiar dangers. simple living and plain food, he was III. Old people can begin today to fortify killed in a few months by the rich foods Young December, 1935 The Health Bulletin

themselves against these dangers, and "He can talk about only things in so make old age happier when it comes. the long ago." There is no need to cut Some of these dangers are: oneself off from people about us and 1. The loss of good cheer. In a live in the past. One should persist- recent book, "Old at Forty, Young at ently find out every day something in- Sixty," the author points out that most teresting to talk about in the present. people, by the time they reach forty, One should read the daily paper enough have lost the cheer impulse through to be intelligent about at least a thing neglect. This impulse, if cultivated, or two—something so fresh that the will beautify all the relations of life, past will look drab beside it. One can making life happier for oneself and easily know something new to talk others. it But can be kept alive only about every day. One must do it, or by persistent struggle. Lincoln was else be painfully alone. named as a striking example of what To live in the past means mental may be done to combat the tendency to stagnation and decay. One who does become gloomy and disagreeable. not brace the mind to read and to Tragedy's mark of sorrow was ever on think earnestly will soon become senile, his face, but he stoutly refused to be incapable of interesting others. A law buried under his sorrow. In the pres- of all being is that we must "do or die." ence of any human being his face We can keep alert to a good old age by lighted up with a kindly smile. How- earnest mental exercise. Sir William ever burdened his own heart, he would Herschel at 80 was still exploring the recall a story to bring good cheer to heavens and enriching man's knowledge the heart of another. of the universe. John Wesley at 80 President Roosevelt is another emi- was still traveling four to five thous- nent example of how one may triumph and miles a year behind his horse, over obstacles and radiate good cheer. reading many great books, keeping his One who has studied him closely remind vigorous by exercise, preaching calls how at about 39 Mr. Roosevelt twice a day, and living in intimate lost the use of both legs through in- touch with the present. At 80 Glad- fantile paralysis. The future looked stone was still the "grand old man" of gloomy enough, but he resolutely set England, taking up some new study about finding new interests, and losing every three months and keeping sight of himself in doing worth-while abreast of the movements of the world things, and his life has been remark- he lived in. One should refuse to be able for its good cheer and optimism. left behind as the world moves on, be- To keep sunshine in the life is one of coming alone and pitiable. the main secrets of perennial youth. 3. A third danger is that one will It will actually add to the length of give way to ill temper and intolerance. one's days. One sees customs and conventions 2. The loss contact of with the pres- change, and everything old either dis- ent. Old people, if they don't look out, carded or discounted. To age every- will live in the past, talk only about thing likely seems to be headed toward the long ago, and be painfully alone in the devil. Young people seem so dif- the world. They can prevent it if they ferent that they appear degenerate. will. It is a part of the tragedy of Age is sure of its wisdom, and so be- old age that one so easily forgets what comes critical and cynical toward all goes on today, while he has a vivid that is modern. So we find many old memory of events in the distant past. people sour, intolerant, out of humor The present rushes by freighted with with people and things all around them. events great and small, but likely the It is to be even disagreeable, unwel- aged man allows people to say of him, come, shunned; miserable themselves, December, 1935 8 The Health Bulletin they make all others miserable that watched by well-meaning children, come near them. their speech censored, their every move Such a fate can be avoided. The thwarted, and heard them say sadly, "I am so lonely !" To find oneself con- only escape is to keep up with the pro- stantly watched and repressed and cession—to live in daily touch with thwarted is a torture worse than death people and ideas as they change—to and surely hastens death. keep the heart warm and sweet by On the other hand old people often friendship, and by getting into the joys make themselves impossible by trying and sorrows of others and actually to dominate their grown-up, even their finding how to help. married children. This attitude makes This is primarily a family problem. the old people unwelcome, even One or two sensitive, irritable, critical dreaded. If parents must live with old people will take the joy out of any their married children, they must reso- home. Several provisions against it lutely set out to be only guests, never must be made during the years. A meddling, never criticising, never even sweetly reasonable family government advising except in the most delicate, must hold the respect of the children. courteous manner. Many marriages The parents must constantly enter into are broken up by parents who insist on the life of their children, entering old "butting in" and criticising the be- age as their chums and advisers, in- havior or the affairs of their married stead of their critics. As far as pos- children. sible they must grow with their child- Here is, in fact, the gravest problem ren, never permitting the separate in- old people ever have to face, to "let go" terests of youth and age to widen into gracefully, without giving up all initia- a gulf. tive and self-direction. It is seldom always One tells of a mother who done without a stubborn battle marked chil- maintained such a relation to her by resentment, if not ugly feeling. It of their dren. After they had children is nature's recoil against the sense of own it continued as a delightful com- being pushed out and "put on the radeship. Children and grandchildren shelf." It is a battle to the death, and came every Sunday to consult her about those looking on should show infinite their problems. They said, "She was sympathy and patience. One old man, always 'comfortable' to be with when when criticised for his autocratic, vio- we were children, and now she con- lent manner, explained it by saying, is tinues to be 'understanding'." Here "It is the only way I have to show old one of the main secrets of a happy them I am not dead !" To give up age, to continue a sympathetic chummy seems a certain step toward death. relation with one's own children. One can hardly take it all at once, nor

4. Loss of initiative is a fourth dan- gracefully. I recall one of the great ger of old age. To quit work, to fold leaders of our State, whose friendship the hands, to feel that life is done, is I enjoyed in his last years. For long to bring death nearer. "Do or die" is years his influence was almost domi- God's law also for old people. Those neering. A new day came, and others children are unwittingly cruel who de- came to the front, and he saw himself prive their parents of active employ- set aside. For several years he was ment. Some light work, some means of openly resentful, sometimes ugly. Then self-expression, some employment giv- he slowly adjusted himself, and his last ing all possible play to their own initia- years reflected all the beauty of the tive is essential, if old age is to have sunset colors. any joy and the life be prolonged. I IV. We may make the sunset of life have seen old people constantly glorious. One need not dread such an — : —

December, 1935 The Health Bulletin 9

-old age as the one just referred to. he talked unceasingly about the slights Each of us can recall a few old people and injuries, real or imaginary, he had whose last years were as radiant as suffered in his long life. It was pain- the sunset, and a joy and inspiration ful to hear. At last I said, "Now tell to all that knew them. can all We at- me some of the lovely things people tain to such an old age, if we will pay have done for you." He smiled, and the price. It will mean a high resolve said, "There are plenty of that kind to live from now on according to God's too," and for another hour he poured laws for body, mind and soul, keeping out beautiful incidents of the kind- all in health and harmony; to think nesses he had received. It was a de- only lovely thoughts, seeing that noth- lightful contrast. ing unloving or ugly in our life today Here is one of the main secrets of shall rise up to haunt us in old age. life. We grow into what we think. Above all, we must learn how to walk Ugly thoughts will doom us to an old toward the sunset hand in hand with age of misery for ourselves and all that the Friend who will be closer than a touch us. Lovely thoughts will build a brother, if we come truly to know Him. heaven in our hearts and will draw Reading widely of late on the problem people to us in old age. A recent writer of old age, I was impressed with how has said that two main things are generally writers, both sacred and secu- needed to bring one to a radiant old lar, put the emphasis on the power of age: faith in the good God, and ten true religion to make old age glorious. years of hourly, cheerful thinking, no And truly old age has its compensa- day without a cheerful act of service, tions. The fiery passions of youth have the heart always kept sweet and kind. given place to the freedom and repose Living in this spirit each day one may of old age. One is no longer in bondage look without fear toward the sunset, to what others do and say. An elderly feeling with Browning woman wrote to Dorothy Dix : "I used "Grow old along with to live in dread of old age, but now me! The best is yet that it has come, I am having the time to be, The last of life, for which of my life. Once I spent my life worry- the first was made ing over ten thousand trifles—dates and Our times are in His parties, how to dress, how I looked, hand Who saith, 'A whole what people said and thought about I planned, Youth shows but half; me, how to keep my husband in love trust God see all with me—would some pretty young : nor be afraid'." flapper get him from me? All that is Or with Whittier in "Eternal gone. People Good- will let an old woman do ness" as she pleases. My husband now is too old for any one else to want him, and "I know not what the future hath I have him all to myself and secure. Of marvel or surprise, Old age is glorious." Assured alone that life and death If old age is glorious, the heart must His mercy underlies. he kept sweet. All that is unloving And so beside the must be rooted out, and place given silent sea only I wait the to what is beautiful and true and muflled oar, good. No harm from Him "Where love is there God is also." can come to me The On ocean or world has no object more pathetic on shore. than an old age that is sour and cyni- I know not where his islands lift cal. I once drove for two hours behind Their fronded palms in air, a slow horse with an old man. I let I only know him I cannot drift do all the talking. For an hour Beyond His love and care." December, 1985 10 The Health Bulletin

District Health Work

By C. N. Sisk, M. D., Waynesville, N. C. not be identical exigency of the times required the two counties may THE nature. The work in Tyrrell and that North Carolina be divided in other small counties demands into 100 counties, varying in area numerous of a health officer, from Chowan with 165 square miles to the special training inspector, etc., just as Robeson with 990 square miles. In- nurse, sanitary the population in Guilford and other dustrial development convenient to populous and wealthy counties does. natural resources has concentrated our the limited funds available for population in certain areas of the With financing public health administration, State, so that we find a variation in obvious many small counties can- county population from Tyrrell with it is not provide a complete health unit, 5,164, to Guilford with 133,101. furthermore the small population would Public health administration, which not justify the full time of a health is defined as the science of organizing officer, and in some instances of a sani- and operating governmental agencies, tary inspector, and clerk, working whose purpose is to improve the physi- wholly in one county. With the object cal well-being of the general popula- in view of furnishing health service to tion, is becoming to be considered a the entire population on an economical necessary part of the political ma- basis, the combination of two or more chinery of government. A well-rounded small counties into a health district program of public health work in an appears to be the solution. area requires the services of a medical Such a district comprising the coun- health officer, a nurse, a sanitary in- ties of Haywood, Jackson, and Swain spector, and office clerk, not to men- Western North Carolina, was or- tion such important things as a Mouth in on April Health Program, and laboratory serv- ganized and began operation have been re- ice. A budget of approximately $9.- 1, 1934. Appropriations 000.00 is required to provide this mini- newed for the continuation of this de- mum personnel. For a county with partment for the current fiscal year. less than 20,000 population, to raise In reviewing the work of this organi- this amount of money would require a zation, one is impressed with the econ- tax levy in excess of what the average omy of distributing administrative cost, taxpayer would consider justified for the expense of clerical work, and labo- a service too frequently considered to ratory service, over the larger area. be a luxury. We find 38 of our 100 Offices are maintained at the county counties with less than 20,000 popula- seat in each county, while the clerical tion, and several more so near the bor- work is done largely at the main office der line to warrant a statement that in Waynesville. A bacteriological one-half of our counties cannot be ex- laboratory is maintained at the pected to provide adequate health serv- Waynesville office, and renders labora- ice within themselves. tory service for the private physicians The importance of protecting the throughout the district, as well as for and health workers. health and improving the physical well the hospitals, Laboratory analysis of milk samples in being of the human race does not de- enforcement of the Standard Milk serve debate. If public health admin- Ordinance is made for the three coun- istration is worthwhile in Greensboro in the central laboratory, which and Guilford County, it is equally im- ties obviates the necessity of duplicating in portant in Tyrrell County and Colum- each of the counties expensive equip- bus, although the health problems in December, 1935 The Health Bulletin 11

ment, and personnel trained for this cedure. Although the Haywood-Jack- particular work. The advantage of son-Swain District Health Department combined personnel in the event of an has operated very smoothly, yet the epidemic of communicable disease, and possibility for complications to arise for conducting clinics is apparent. We as a result of combining counties into a have not experienced epidemic an de- district health department is recog- manding unusual service, however, we nized. Sometimes civic pride and preju- have realized the benefits of having dice may be encountered, difference in available larger a nursing service in political faith, difference in population conducting tonsil and adenoid and im- and tax values may cause dissention. munization clinics. with the withdrawal of one county The mutual interest generated be- from the district, thereby disorganizing tween counties by a joint health or- the budget. The detached location of ganization results in closer coopera- personnel may prove a haven for the time tion, not only of health workers, but chiseler, and also permit the mis- fit to create unfavorable this feeling is also reflected to the criticism. The selection of personnel for school organization, farm and home a health district should be very carefully done to agents, and civic clubs of each county. assure the employment of tactful in- The combination of counties into a dividuals well trained, energetic and health district gives greater oppor- imbued with a natural love for their tunity for staff education and improve- work. Taken as a whole the advan- ment through staff meetings, and by tages to be derived by combining small interchange of personnel, also for counties in health work greatly out- standardization of methods and pro- weigh the disadvantages.

Health Exhibit at Richmond County Fair are indebted to Mr. Isaac WE S. wrong methods of sanitation — even London, editor of the Rocking- fine homes can have disease-breeding surroundings, ham Post-Dispatch, for some in- while more modest ones may meet all teresting information about the requirements of mod- the health ern sanitation. These comparisons of exhibit put on at the Ellerbe Springs homes and their surroundings were County Fair, held in October. The ex- eye-openers and so plain everybody hibit was prepared by Dr. B. B. Dal- could get the lesson at a glance. On the walls maps of ton, County Health Officer, and his the county—one showing the large amount of sanitary assistants. Mr. London has kindly con- improvements made over the county sented for us to use the cut which he since the first of this year. Another had made for use in the Rockingham map was a graphic picture of the tuberculosis situation in Post-Dispatch. We are presenting this the county. Active cases were shown by pins of different on the front cover. The exhibit was colors, representing the white and arranged in such a manner that any colored races. The pins were rather person thick could understand the serious around the more populous sections of the lessons it presented. We quote from county, but it is significant that in the large sandhill township the Rockingham Post-Dispatch as fol- of Beaver Dam there was not a single lows : one—meaning that that township had had no active case of "A new display at any of our fairs tuberculosis in the last three years. and one of the most enlightening was Syphilis was rated as the county's Public Enemy 1." that of the County Board of Health. No. On a large sand-table were shown com- In addition to the above description, plete the homes as examples of right and following further outline is inter- —

12 The Health Bulletin December, 1935 esting. As will be seen on the front cover checking the epidemic, according to picture in the front right corner, is a Doctor Dalton. He thinks that whether cemetery with placards showing what or not that is true, he can offer no each child died of and how it could other reason for the abrupt termina- have been so easily prevented. Other tion of cases of the disease in the sections had comparative farm houses county. and yards contrasting the neatly kept Doctor Dalton has as assistants an premises with sanitary privies as office clerk, one nurse, and a sanitary against the ramshackled ancient "back- inspector. From February 1 to August houses." It was a fine piece of edu- 1 they had as an additional assistant cational work. Mrs. Elizabeth H. Tudor, an efficient In Richmond during the months of nurse who was employed through June, July, and August the Health funds provided by the U. S. Public Department gave free typhoid preven- Health Service. The services of Mrs. tive treatments to 8,670 different per- Tudor had to be terminated in August sons, a total of 26,010 separate treat- as a result of the failure of Congress ments. This does not include the large to enact the Deficiency Bill. Since that number given by the physicians of the time Mrs. Tudor has taken the pre- county all through the period. Up to scribed six weeks course as additional July 18 there had been twenty-three study at Peabody College. It is hoped cases of typhoid fever with two deaths that the Federal funds will again be- reported in the county. Not a case has come available and that she may be been reported in the county since that restored to her place in the Richmond date. Vaccinations are given credit for county organization.

Heart Disease in Persons of Middle Age

By R. T. Stimson, M.D., Director, Bureau Vital Statistics THE man or woman who lives the seem to be the compelling forces. In full three score years and ten, has place of a strenuous mood and ten- but a short existence. To child- sioned nerves, we should substitute gentleness, hood, life appears long; but when it peace, and understanding; and the higher one rises in the world is passed, it seems only a brief space of activity, the more careful one must of time. Even the material things that be, to bring rest and play into life. we see around us, are to last much Regardless of what forces are act- longer than we. ing to increase or decrease the span of is short, its duties and labors If life life, it is clearly shown by our records, cannot last long. There is much to be that the hazards to life and health, done, and the briefer our stay, the have undergone much change since more need of earnest action. Life is 1900. For the most part, there has in a sense—a crisis, and whatever is been improvement, but in a few re- done, must be done now. If a man spects, the change has been for the is drowning, or a vessel at sea is in worse. In so far as declines have oc- distress, the remedy to be applied must curred in the death rates from indi- be applied now, or it will be in vain. vidual causes, these have been gradual, The purpose of our modern business and therefore, have not been very ap-

man, to "make hay while the sun parent from one year to the next ; but shines'' is shared by men of different as we look back over the years, to the occupations. Hurry, drive, and action, beginning of the twentieth century, it ; ;

December, 1935 The Health Bulletin 13

is very evident that great gains in a very real rise in heart disease mor- many conditions, have been achieved. tality. In 1924, heart disease accounted Preventive medicine has been highly for 1780 deaths in North Carolina. In successful in the control of infectious 1938. 4500 deaths were charged to this diseases. Tuberculosis is an outstand- condition ; accounting for a rate of 137 ing example of this, in the record of per 100,000 population (against a rate the past three decades. In 1900, and of 75. for 1914). Twenty years ago, in fact—as late as 1915. this disease out of every 100.000 population, under was the leader among man's enemies, 55 years of age, 30 died of heart dis- in this State. ease every year. This has increased

Today it has fallen to fifth place in until today, the rate is 44 per 100,000 the causes of death. In the last thirty population, under 55 years of age. odd years, the mortality rate in the What is the reason—that out of a United States, has declined by more given population of young and middle than 70 per cent. Deaths from diph- aged people—3 deaths occur now for theria, are on the way to elimination, every 2 that occurred twenty years if we use more widely, the means of ago? This should cause people of protection that are at our command. active years, to halt occasionally and Deaths from infantile diarrhea, scar- take stock of their physical condition. let fever, and other acute diseases of If this is done at intervals, and if some early infancy, have also been greatly abnormality of heart-action is found reduced, although not as much as de- in time, the activity of the individual sired or as is possible. Typhoid fever, can be so restricted as to give a weak- no longer holds as high standing as a ened and overworked heart, the best principal cause of death, as it did a possible chance to recover. few years back. The decline from Some one has said that we are liv- these diseases is continuing steadily, ing in a day of "tired people", not so and will continue—provided the fight much from over-work, but rather from to eradicate them is continued. reckless dissipation of nervous energy, In his struggle against bacterial dis- associated with wrong methods and ease, man has been eminently success- habits of living. The vacation time af- ful, but in another field, efforts have fords a splendid opportunity for rest been less fruitful. The diseases which rest of body and mind, which will be have been successfully dealt with, helpful and aid materially to keep the affect—in the main—infants, children, system in good condition and running and young adults. With respect to order. conditions of older ages progress has The case of cancer is another one of been difficult, and in some conditions, the serious set-backs which we have to actual set-backs have been suffered. acknowledge. We are confronted with

More attention is being given to the a new situation ; the reduced mortality diseases of middle and late life at the younger ages of life, preserves a especially to heart disease and cancer. greater number of people to attain the Heart disease, today, ranks first in older ages, where the risk of cancer is the causes of death. In the last thirty greater. To improve this condition, the years, the death rate from this cause, emphasis must rest on early diagnosis in the United States, has doubled. It and the immediate and skilled treat- is true that a part of this increase ment of cancer. merely reflects the increasing propor- Looking back to the beginning of tion of older persons in the population, the century, we note with satisfaction, among whom, deaths from heart dis- how much the average length of life

ease chiefly occur : but a material part has been extended in this country, and of the increase is due to a definite and how much greater a proportion of per- —

December, 1935 14 The Health Bulletin

or literature, when sons are surviving to maturity and old to personal letters in envelopes or pack- age. The average length of life, or it is requested, simply bearing the P. O. box as it is often called, the expectation of ages of the State Board of Health life at birth, has increased by more number than eleven years. The newborn baby at Raleigh. of today, may look forward on an aver- Infant Death Rate age, to sixty years of life. In 1900, his Durham's years. Life is prospect was only 49 our August issue we published the more boys and girls safer today, and IN1934 provisional infant death rate maturity and old age. will survive to by counties. The figures were given still remains to be discovered, Much by place of occurrence of death and not with our present knowledge, but even by residence of decedent. For nearly more can be accomplished. much all the counties the procedure is fair should be focused on these Attention and accurate. In Durham County, middle and late life. conditions of however, on account of a large outside give more attention When individuals patronage coming to the hospitals there, remaining well, and seek medical to the county reported last year 234 non- regularly, instead of waiting advice resident births and 40 non-resident in- are well along the road with until they fant deaths under one year of age. So, chronic ailment; such as some serious, by place of residence the Durham in- or cancer, the length of heart disease fant death rate for 1934 was about 86 individual and of the people life of the per thousand live births, instead of will be further lengthened. as a whole, about 100 charged against it. It is hardly necessary for us to say Plain Envelopes Again that Durham has long maintained a health department. our August issue we had a para- most efficient INgraph explaining that it has not and Address Important been the policy of the State Board Name of Health in the past to supply litera- Again we call attention to the fact write to the ture or information mailed in plain en- that a great many people Health, requesting lit- velopes in response to an occasional re- State Board of of it desired by return quest for such service. erature, much any name or ad- The paragraph brought a letter mail, without giving dress whatever. Some of them sign from one of the editor's most valued their name, but give no address, and friends protesting the policy. Our the postal cancellation mark is fre- friend is a distinguished psychiatrist quently blurred or not on the card at and he made the point that many It is impossible to reply to such people, especially young people, are all. material. Now and then we receive a sensitive about such matters. Come postal card addressed to the State to think about it, he is right: our Board of Health, the reverse side en- literature and our "personal hygiene tirely blank. In such case the writer service" here is for the purpose of evidently set out to write us for cer- helping the citizens of our State in addressed the card, any and every legitimate way we can. tain information, ask for the infor- We have always held in strict confi- and then forgot to dence the personal communications mation desired. want to request every one and given each inquirer a confidential Again we Board of Health to be answer. We herewith announce that who writes the that his name and address in future we shall be glad to comply sure to see communication be- with such requests in so far as pos- is properly on the his hands. sible. We shall mail out such replies fore it leaves ;

December, 1935 The Health Bulletin 15

More Dangerous Disease crease during cold weather and will not subside until spring. The deaths PARENTS who are thrown into a from diphtheria are little short of in- paroxysm of fear by the mere men- excusable. One injection of toxoid tion of "infantile paralysis" would is sufficient to immunize from 96 to 98 do well to pay heed to statistics re- per cent of its recipients. cently released by the State Board of Thus it would appear that scores of Health. The most dangerous enemy, it North Carolina children are annually is revealed, is not always the foe whose sacrificed needlessly and without great approach is heralded with a fanfare of dismay. With the services of city, trumpets, as the following figures county and state health departments forcefully indicate: at their disposal, it is almost unbeliev- "A total of 741 cases of diphtheria able that careless and neglectful par- have thus far this year been reported, ents should fail to safeguard their with GO deaths up to September 1st. progeny against one of the most dread- There have been 9,682 cases of whoop- ful of children's diseases. North Caro- ing cough, causing 266 deaths. Cases lina has received more than her share of infantile paralysis have totaled 632 of publicity with regards to infantile paralysis. Perhaps it during this period, accompanied by 48 would be well to turn a portion of the spot light in an- deaths. Be it remembered that infan- other direction, revealing in its rays a tile paralysis is a warm weather dis- ravager of childhood even more sinister ease and likely to disappear almost and yet one which could be put to entirely during cold weather, while instant flight with ease. — Charlotte diphtheria and whooping cough in- Neivs.

Ode to Posture

By Lillian C. Dbew, American Posture League

Good posture is an asset If you would cut a figure Which very few possess In business, sport or school, Sad to relate the favored ones Just mind the Posture Precepts, Seem to be growing less. Obey the Posture Rule.

We see the folks around us Don't thrust your head out turtlewise, All slumped down in a heap, Don't hunch your shoulders so; And the way that people navigate Don't sag and drag yourself around— Is enough to make you weep. No style to that you know.

Some elevate their shoulders, Get uplift in your bearing, Some hollow in their backs, And strength and spring and vim; Some stiffen up their muscles, No matter what your worries, And some just plain relax. To slouch won't alter them.

The one who walks with grace and Just square your shoulders to the poise, world, Is a spectacle so rare, You're not the sort to quit; That even down on gay Broadway "It isn't the load that breaks us down, The people turn and stare. It's the way we carry it."