The Health Bulletin [Vol. 51, 1936]

NORTH CAROLINA HISTORY OF HEALTH DIGITAL COLLECTION  

The Health Bulletin

Volume 51 (1936)

DOCUMENT NO. NCHH-04-051   

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PuHis\edb4 TfiE,/^°Km CfiRgUftA STATE- B7\mtfn

This Bulletin will be servt free to arwj cituerx of the State upory request!

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

Vol. 51 JANUARY, 1936 No. 1

GEORGE HUGHES KIRBY, M. D.

DISTINGUISHED PSYCHIATRIST, NATIVE NORTH CAROLINIAN, DIED AT PORTSMOUTH, NEW HAMPSHIRE, AUGUST 11, 1935 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. Lbb Large, M.D _ Rocky Mount H. G. Baity, ScD _ Chapel Hill W. T. Rajney, M.D _ Fayetteville Hubert B. Haywood, M.D _ Raleigh James P. Stowe, PhG — 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. 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

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 request to the State Board of Health, Raleigh, N. C.

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

Prenatal Letters (series of nine B 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 16

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 Midwivee

CONTENTS

page

Mental Health _ 3 Successful Living _ 4

I. Insanity 5 II. Practical Dealing with Mental Defectiveness 7 III. Nervous Breakdowns Due to Disordered Emotions _ 9 IV. The Development of Personality in Children 12 Unavoidable — 16 Early Diagnosis and Treatment of Syphilis 16 Vol. 51 JANUARY, 1936 No. 1

I Mental Health By The Editoe

this our first issue of the New Year we are doing two unusual things. First, INwe are dedicating the issue to the memory of the late Dr. George H. Kirby, who perhaps scaled the scientific heights to a point never before reached by a physician born, reared and educated in North Carolina. Second, we are devoting the whole issue to a republication of an article written by Dr. Andrew H. Woods, who is now doing a great work in Iowa. Dr. Woods' article was first published in the Iowa State Department of Health Bulletin for June, 1935. Dr. Bierring, Iowa State Health Commissioner, and Dr. Woods grant us permission to republish. Our readers will find the information interesting and helpful. Our friend Dr. James K. Hall of Richmond, himself a successful and widely known authority on mental diseases and beloved by his fellow North Carolinians,

in a personal letter soon after Dr. Kirby's death, said : "I feel like urging you to republish in your Bulletin every word of Dr. Woods' pamphlet. The problems cannot be talked about too frankly. I believe that if you would send that material out widely throughout the State that you would shake the folks up. Why not make the issue a Mental Hygiene issue as a tribute to Dr. Kirby?" Dr. Treadway of the U. S. P. H. Service told the Southern Medical Association at St. Louis a few weeks ago that "More people are hospitalized right at this moment in the United States on account of mental sickness than on account of any other single cause." And further that "We are dealing with mental sickness as a public health problem about as we did with physical disease eighty years ago."

We pass along the challenge to the only group who can accept it.

Dr. Hall wrote further about Dr. Kirby : "George Kirby was in my opinion one of the very best, if not the best, psychiatrist in this country. He was deeply

and broadly educated ; he was first and for a long time a profound student of the structure of the human body, and later became specifically interested in the function of the nervous system. I know of no other man who was better prepared in his latter years to practice psychiatry and to teach it. And with it all he remained the quiet, modest, self-effacing, Southern gentleman." High praise indeed from a competent authority, but every word deserved. Dr. Kirby was born in Goldsboro, N. O, February 9, 1875, and died in Ports- mouth. N. H., August 11, 1935. He was graduated from the University of North Carolina in 1S96. He completed his medical education in New York and on graduation became associated with the celebrated Dr. Adolph Meyer at a New York State Hospital. He spent many years as Professor of Psychiatry at Cornell Medical School and the College of Physicians and Surgeons of Columbia University. He was president of the American Psychiatric Association and editor of its journal. Perhaps his greatest contribution was the planning and carrying through to a successful conclusion the New York State Psychiatric Institute as a unit of the joint Columbia-Presbyterian Medical Centre. He was the recipient of many honorary degrees, one from the University of North Carolina, conferred in 1929. ;

The Health Bulletin January, 1936

Successful Living

Andrew H. Woods, M.D., Director Iowa State Psychopathic Hospital. In Ioica Public Health Bulletin GENERAL, HYGIENE AND MENTAL HYGIENE

HYGIENE is the general depart- To define successful living is a stiff problem for the writer of definitions. ment of science which derives When a man's mind has won riches for of prevent- and applies methods him, or when he has obtained perfect ing disease and of enabling men to at- health of body, is he living success- tain the maximum of health. Philoso- fully? Are the most intellectual the phers, religious leaders, and physicians ones who live most successfully? Cer- throughout the ages have sought reli- tainly many of us would not change able procedures also for preventing places with some of those who have mental disorders and attaining both been outstanding in these various health and efficiency in mental work, achievements. Merely because a man seeking thereby to bestow upon man- is happy and contented, shall we say kind the highest contentment and hap- he is successful? If so, we would have piness. A recent movement, which has to include many cheerful imbeciles and spread over the world under the name dements among the great successes. hygiene," was started a quar- "mental On the whole, we get our best sug- ter of a century ago and is now prob- gestion as to a definition of successful the end of a period in ably nearing living from biology. Every living thing useful contributions have which its from the solitary protoplasmic cells up diluted by premature and inflated been to man is pressed by internal forces claims and pseudo-scientific literary toward three general purposes : they productiveness. Physicians as a class continually do things to preserve their somewhat diffident as to its have been own lives, to grow, and develop each value but are now beginning to look according to its inherent pattern ; they its and fruitful de- forward to sound then persistently reproduce their own department of medical velopment as a kind and take care of the young until science. the offspring in turn have matured and, as a third end, they cooperate Objective of Mental Hygiene The with each other so that single cells Medical science has always been ir- group together and form higher organ- repressibly ambitious. Its chief effort isms, and these higher organisms, like has been to devise means to secure the ant, the bee. and flocks on the for mankind perfectly healthful, effici- prairie, work together as swarms and ent working of the stomach, heart, and herds ; while, at the top of the series, : all the other bodily organs. It now man refuses to live alone and persis turns its attention to the brain and tently associates himself with other seeks to discover means by which the men in doing work which proves ad- working of the mind can be made per- vantageous for the individual and for fectly healthful. the group. Thus society is formed, social and business organizations arise, It is easy to write down the objective nations are established. of hygiene of the digestive organs: to produce as nearly as possible perfect This, therefore, is what the newest digestion, that is, successful nutrition; branch of medical science aims to ac- but the service which man's brain ren- complish : to produce that healthiness ders to him is not so simply defined. of mind which will enable a man to The brain is the organ which enables preserve his own life and develop his man to win in the continual conflict best powers of mind and body ; to use with his environment. Its real product his sexual functions for their obvious is behavior. And so when we think purpose, joyously, justly, and without through all the various statements that by mor- could be made as to the purpose of becoming emotionally impeded with mental hygiene, we are finally forced bid repression ; and to cooperate his productively and happily, to this Utopian formulation : the objec- fellows tive of mental hygiene is successful while preserving a wholesome indepen- living. dence and individuality. : .

January, 19S6 The Health Bulletin

Outstanding service to his group can 2. A more hopeful attack upon the to some extent compensate for bad problems of mental defectiveness and health or sterility, but unless an in- undeveloped or perverse personality dividual has lived up to a certain (including criminality). minimum level in response to all three 3. Freeing men from the misunder- of these instinctive requirements, he standings as to religion, moral stand- becomes dissatisfied and emotionally ards, and social values, which hamper disordered. Nature sidetracks him them emotionally and thereby produce through nervousness or insanity to get the protean forms of "nervousness"

him out of the way of those who can ( psychoneurosis ) live to better purpose. 4. Education as to marriage and the building of homes as the indispensable basis for the development in children The practical efforts of science to of loyalty, industry, integrity, and all secure this healthy-mindedness for other ingredients of wholesome char- mankind are exhibited in acter. The attitudes which determine 1. Efforts to understand and then to character are built up in children in prevent and cure insanity. early home life.

I. INSANITY

The mental hygiene movement began in dark dungeons, and at the whim of when men realized that insane persons their keepers were chained to staples can suffer even more keenly than those set in the walls. It was years after who are sane. The manner in which the American Declaration of Indepen- this gradually clarified truth broke dence had announced the rights of in- into the consciousness of men and dividuals to self-direction that Philippe aroused the world to action is already Pinel in Paris started a new era in the known to most readers of magazine treatment of the insane. He alarmed literature, so that only a brief refer- the supposedly liberty-loving people of ence to its history is needed here. France by cutting the shackles of the Every person in America theoreti- insane in French dungeons and allow- cally has the right and responsibility to ing them freedom to mingle with each manage his own life, provided he shall other in the open air. not interfere with the corresponding Charles Reade stirred the English right in other people. That proviso ex- people in 1856 by his exposure of prison cepts criminals because they willfully conditions in, "It is never too late to encroach upon the rights of others; it mend" ; and again in 1S63 he turned also necessitates the limitation of the his dramatic pen against the inhuman freedom of insane persons, because treatment accorded insane patients in their minds fail to make the distinc- asylums as he represented their plight tions, and their feelings fail to provide in "Hard Cash." the motives, necessary for acceptable To a world half awake to these behavior. abuses of arbitrary power and respons- But the moment officers of the state ibility on the part of state and hospi- take over responsibility for determin- tal officials and their employees the ing what clothes a citizen shall wear, autobiography, "A Mind That Found It- what he shall eat, when he shall go self" came in 1908 with startling im- and come, and what he shall do, pact. A young college student suffer- trouble arises. If through carelessness, ing with a recurrent form of insanity stupidity, or meanness, on the part of graphically presented therein his remi- his keeper grave injustice is done to niscent account of the treatment he the person thus deprived of self-de- had received in one of the best of fense, the circumstances render it dif- American state hospitals. However ficult for the state to gain knowledge much the readers may have discounted of his predicament. So many of the the alleged facts, in view of the mental sufferer's charges and complaints have condition of the patient, the book been fabricated or delusional, that his brought to Americans, and later to testimony regarding a real injustice is readers all over the world, a disquiet- dismissed with the explanation, "He is ing realization of the mental suffering a criminal and can't be believed," or caused in sensitive, often cultured, "The man is crazy." patients by the crude, though usually Within the memory of some persons well meaning methods of hospital at- now living, insane patients were kept tendants.

i January, 1936 6 The Health Bulletin

This book, "A Mind That Found It- patients and in systematic investiga- self," became a ferment and rapidly- tion to discover the nature and cause aroused physicians and citizens of all of the disease-process itself so as to kinds to action. The development of devise means to remove it. Sometimes general hygiene since the establish- one or more of the endocrine glands ment of pathology and its special sub- are working badly. One woman who division, bacteriology, in the middle of in 1930 seemed hopelessly insane has the 19th century, had aroused new been kept in condition to care for her hope in the hearts of men that bodily home through five years by the regular diseases could be cured, and, what is addition to her food of an extract made better, could be prevented, if dealt with from a particular gland that is taken promptly. Rabies, small-pox, tubercu- from sheep. In many cases syphilis losis, diphtheria, and a long list of or anemia is cured, and mental restora- diseases once regarded as inevitable tion follows. and hopeless, had been brought under It has been repeatedly discovered control. Statistics showed that some that in certain cases particular avoid- of them had almost disappeared in dis- able experiences are the precipitating tricts populated by intelligent people. causes of insanity. Many predisposed The brain also is an organ and its patients are saved from later attacks activities produce consciousness, feeling, by the avoidance of one or another perception, and thought. Derangements form of excitement or strain, by the of the brain and the mind are, there- curing of menstrual disorders, by pre- fore, within the field of medical science. venting pregnancy, or by the regulation Many of the abnormalities of the brain of sexual relations. which produce insanity are as well un- A considerable number of mental dis derstood by physicians as are diseases orders are curable when certain mis- of the heart, liver, and other organs. apprehensions of the patients are re- For instance, a bright high school boy moved after being discovered by grad- of 16 years had always been considerate ual personal investigation through of others and was generally popular. memory association. He was brought to the Psychopathic When the citizens of the state realize Hospital truculent, excited and con- how much has been accomplished by vinced that he was pursued by bandits. these painstaking studies of the be- Examination showed that the left side havior, the thoughts, feelings and rea- of his brain was working badly. Ques- soning of mentally diseased patients, tions revealed that he had suffered a it will be made possible for our state blow on the head. Appropriate treat- officials to provide additional hospitals the nutrition ment was used to restore so as to relieve the present overcrowd- brain cells, and the of the damaged ing and to increase their medical and regained his wholesome boy quickly nursing staffs in proportion to the rela- personality. tive value and importance of the men- A considerable part of the insanity tal functions—which are. after all, the that occurs is due to damage suffered basis of man's highest efficiency and of by the brain cells from syphilis and his contentment as an individual and alcohol. Anemia, malnutrition, and as a member of society. kidneys to rid the blood failure of the Occasionally when all efforts to cure poisons, cripple of certain nitrogenous the mental disease have failed, so that mental action. the brain and confuse death occurred, and the family of the brain tumors Insanity also results from patient then requested that the nervous and disease of the arteries. organs be examined, the cause of the Two of the most prevalent forms of disorder has been discovered and new insanity recur so frequently in certain light has thus been thrown upon the families that one is forced to consider nature of the trouble. Those families them inheritable. who cooperate with physicians in this The daily work in our state hospitals way are benefactors to humanity and for the insane and in the Psychopathic become partners with the scientists of Hospital consists in caring for the wel- the world in the fight to overcome fare and present happiness of the insanity. :

January, 1936 The Health Bulletin

H. PRACTICAL DEALING WITH MENTAL DEFECTIVENESS

Mental defectiveness shows itself in various areas of the brain mal-de- A. Inadequate intellect. Idiots, im- veloped. Most of these children show

beciles, morons and "borderline defec- defects of intellect ; while in some the tives," are designations applied accord- intellects are excellent, but the feelings ing to the degree of the intellectual and motives (personality, character) inadequacy. are perverse. B. Constitutional inadequacy of char- Evidently the mind is dependent acter or personality ("psychopathic upon the working of the brain cells. personality") often is found in persons Brains that are damaged before or dur- with normal intelligence. When the ing birth, or shortly thereafter, show basis of the character fault is inborn varying degrees of intellectual defec- (constitutional) it cannot be corrected tiveness or character perversions, while by training and discipline. the brains that have already developed good mentality may at As a state we are faced by a contin- any time in later life be injured ually increasing number of feeble- by disease, drugs, or accident, with minded and psychopathic children who the result that intellect and personality are grow up to be a burden to society and temporarily or permanently crippled. a diluent to public opinion. Many of them become gangsters and criminals Hereditary mental defect and in- and impose a financial load upon the sanity. Many children like those of state considerably in excess of the total the Kallikak* and the Jukef families amount expended for education. If the are born with a continuous tendency money now being spent in this state generation after generation toward for policing, detection, court procedures, feeblemindedness, criminality, and de- and the imprisonment of derelicts of pendence upon others. When 20 per this class, had been spent in wise pre- cent or more of the offspring of a given ventive and educational measures, we feebleminded ancestor are idiots, im- could look forward with some hope to beciles, and criminals, it becomes evi- a day when feeblemindedness and dent that the chromosomes in the germ criminality would become minor prob- plasm of that family are tainted. The lems. building material of such brains is im- The oldest son in a certain large perfect. family has always been queer, awk- We cannot, however, assert that such ward in movements, selfish, over-sensi- conditions were inherited in particular tive, and inept in social relations, al- cases except when the parents or other though intellectually above the aver- ancestors and collaterals have in suffi- age of college graduates. The six other cient numbers shown mental defect to children of this family are bright, in- make it clear that the fault lay in the terested in others, gracious, and popu- germ plasm and not in the early en- lar. The oldest boy's head was dam- vironment of the children. aged in a prolonged birth; the other Prevention children, because of the mother's first experience, were born under especially 1. Sterilisation. When the public has expert obstetrical care. sound reason for believing that off- Children, who at conception are pro- spring produced by any individual duced from the best germ plasm, often would lay an unjust burden upon his have their brains damaged by disease fellows either in supporting the off- or accident while within the mother's spring or in protecting others from body, during birth, or in infancy before danger due to their misbehavior, the the brain-cells have matured. The state has the right to prevent that per- "simple infectious diseases" of child- son from procreation. If the blemish hood produce encephalitis in many is inheritable and if the potential par- cases, which permanently cripples the ent cannot with reasonable certainty brain. Prolonged labor and rough be prevented by other means from manipulations by midwives or unskilled propagating his kind, enforced steriliza- attendants damage the brains of far tion would be equitable. too many infants. These unfortunate In cases of non-inherited mental de- and often avoidable mishaps leave fectiveness or insanity, the unfortunate

" < dard H - ' H The Kallikak ! ££ ? - Family," MacMiUan. T The Jukes," Dugrdale, R. L., Putnam's Sons, 1877 ; reprinted, 1910. :

8 The Health Bulletin January, 1936 person as a parent'is usually incompe- they grow up into adult life as crimi- tent to supply the necessary conditions nals. for rearing children. Such offspring, A defect in state and philanthropic though born normal, have little chance institutions is illustrated by the case of growing into desirable citizens. of a girl sent to the Psychopathic Hos- When the public feels reasonably sure pital because of bad behavior and unin the case of any person that such un- cooperativeness. She was clever and fortunate results would follow propa- agreeable, but made no effort to be- gation, that segregation is not called come proficient in self-supporting work. for, and that contraceptive measures Her attitude was explained in her own would not be effective, sterilization statement, "Why should I worry? If would he appropriate. I don't like it in one place, I just start Coercive sterilization in a state will something and they send me to an- call for large expenditure of money to other." Here we have the typical secure adequate examination of each "charity school" spirit : restless, with- person recommended for operation. out ambition, usually critical and un- Without such precautions, injustice appreciative, taking for granted that will be done. It is also true that many the world owes them a living. citizens have conscientious convictions When we remove from any person, adverse to such operations. The whole especially during childhood, the whole- eugenic movement will be more steadily some spur provided by hunger and de- furthered if education precedes radical sire for shelter and attractive clothes, legislation. * * * we deprive him of the most primitive 2. Segregation and training. Idiots and necessary incentive to effort. Some and imbeciles as a rule must be cared public and private training schools for by the state, and a sufficient num- have succeeded in giving their children ber of asylums should be provided for the advantage that comes from living this purpose. For these cases steriliza- with these stimuli in normal operation. tion is not necessary. Morons and The principles to be followed are marginal mental defectives often are (a) Opportunity is provided to en- capable of useful work outside of insti- gage in work of various kinds suitable tutions. If their behavior is orderly to the various levels of ability. cooperative, they should be steril- and (b) Work is not required merely to ized and permitted to work outside, fill in the time or to keep the children to marry if they wish to do so. If and out of mischief. It is not held over coopera- they are not capable of such them as punishment. The product of tion and are a menace to society, they the work is such as will supply their institutions. must be cared for in state needs, or can be exchanged for the this state for a There is need in things they need. larger number of institutions for the (c) As far as possible, the children feebleminded and psychopathic. The pay for what they get, for instance, staffs of such institutions should be room, food, and clothes. A minimal selected on the basis of expertness in kind of quarters, food, and clothes is developing whatever latent faculties given to all, but provisions of better the inmates possess. The victims of kind are made available for all who encephalitis, for instance, whose in- earn enough to pay for them. tellects are normal but who because of (d) A scale of wages and payment disease have lost self-control, call for a is provided which is as different kind of training from that for products which is applicable for morons. The nearly as possible that of the com- state is now producing large numbers munity in which the institution exists. of juvenile delinquents many of whom This arouses the desire to earn and it are intellectually normal. These boys provides the self-respect incident to and girls if they had been placed in self-support. Unfortunately manufac- early childhood under capable foster turers and labor organizations oppose parents or in state institutions, whose the sale of supplies produced in state staff members are specially selected for institutions and thus throw an unfair qualities and experience which make burden upon taxpayers for the main- them effectual in building up motives, tenance of the inmates, and, at the could in many instances have been same time, make it impossible to de- reared as useful members of society. velop in dependent children the quali- Rigid prison discipline regularly ties that lead to independence and self- arouses hostility in such children and respect. January, 1936 The Health Bulletin

(e) The spirit of the whole working of damage to the infant brain. The group is the most important factor. It preventive measure in such cases, of can best be built up in a new institu- course, is the employment of skilled tion ; but in older ones it can be started medical attendants for the delivery of by separating a selected group from infants and for their care throughout the others, and then adding to it one childhood. by one boys and girls who catch the In spite of the wide-spread damage spirit. done to the brains of children by in- (f) Self-government by the members fectious diseases, we still frequently is to be encouraged, but always sub- hear of the "innocent diseases of child- ject to regulation from the superinten- hood." Mumps, chicken-pox, measles, dent. At the outstart. the self-govern- scarlet fever, and all of the common ing organization must contract to gain and uncommon infectious diseases, are certain clearly formulated objectives. capable of damaging the blood vessels (g) Such principles as the above and the cells of the brain and thereby can be applied only by a director and crippling its function for life. As a staff specially selected because of ex- result, deficiencies of intellect or char- perience and ability. The personnel acter appear as the children grow to of the staff is the critical factor. An adult life. The strict observance of institution of this kind would soon at- quarantine regulations and the utiliz- tract to its staff the graduates of col- ing of such special preventive measures leges, some of whom would seek oppor- as vaccination and immunization are tunity for apprenticeship in sociologic at present more dependable as preven- work ; others, a permanent basis for tives of these mental defects than are productive life work. sterilization and eugenic selection. 3. Adequate medical service. We have 4. Home atmosphere. In dealing noted that many of the intellectually with juvenile delinquents we often ob- deficient and psychopathic persons in serve the effects of bad inheritance and any state are thus defective not from of disease or damage to the infant's inherited fault of germ plasm but from brain as an underlying cause of the injury to the brain at birth or from trouble. Yet more often the reason for infectious diseases contracted by the perversion of character has been mother and child before birth, or by ineptness or positive maliciousness of the child shortly afterwards. Many the parents. The development of an women are unable or unwilling to em- infant's organs depends upon the physi- ploy skilled obstetricians and submit cal conditions within the mother's to the crude manipulations of neigh- body before its birth ; the child's per- bors or unskilled midwives. Precipi- sonality is still more sensitively depen- tate or prolonged labor and the rough dent upon the home atmosphere during use of instruments are constant causes its first five years.

HI. NERVOUS BREAKDOWNS DUE TO DISORDERED EMOTIONS

A well-known surgeon found that the Our grandmothers observed that the losses in money and scientific efficiency face of the girl disappointed in love in the staff of his clinic from jealousies, grows pale and her body emaciated. hurt feelings, and fear of being ignored, We know that her blood loses red cells outweighed his losses from bodily ill- and hemoglobin. Many worried business and accidents. A large New York ness men develop thickened arteries department store employed a wise and high blood pressure. Girls and boys woman as counsellor for its sales- with guilty feelings about their sexual women. From that time their leaves indulgences unconsciously transmute of absence for headaches, indigestion, their psychic discomforts into intesti- and various neurotic disorders steadily nal pain, headaches, and various diminished. phobias or obsessions. A young secre- If through an appropriate device we tary ten years ago asked treatment for observe the inner wall of a dog's "epileptic convulsions." After she had stomach when a friendly keeper offers confessed an amour that had occurred him meat, all the glands are seen to years before under somewhat disgust-

pour out healthful gastric juice ; but ing circumstances, and had been re- if a whip is shown, the dog's stomach lieved of an unfounded fear as to its wall dries up, or a perverted form of possible consequences, the convulsions secretion appears. ceased and have not recurred. 10 The Health Bulletin January, 193S

Physicians and the general public began. She was a trouble-maker. It look with proper admiration upon the was harder to persuade the man to ar- sleuth-like detection by scientists of range for her elimination than it would the microbic and bio-chemical causes of have been to get his consent for the diseases. Small-pox, malaria, yellow amputation of a leg ; but when she had fever, typhoid fever, diabetes, and a departed and he was again able to re- long list of scourges once supposed to turn to a peaceful and congenial home be unescapable, are now removed or after his daily work, successful living under control in all regions in which began again. people are intelligent enough to follow well established preventive and cura- 2. The Dread of Inferiority tive procedures. In all of this wonder- Man cannot bear to live alone. He working, medical un- science has one seeks companionship, and he becomes varying program : it discovers the cause restless and dissatisfied if he fails to of a disease, then finds to and a way secure some measure of recognition and remove it and its effects. in brief That admiration from his fellows. Unless he is the story of medical progress. feels that others find value in him, Removing the Causes of Nervous he loses zest, his nervous energy di- Breakdowns minishes, and emotional disorders arise which often side-track him in the It is, however, a peculiar fact that struggle for existence. patients and even many physicians are An ambitious society woman de- not interested in detecting or removing veloped paralysis of both legs. There the cause of an undramatic illness was no disease of the muscles or nerve- which does not call for the use of centers to explain her weakness. Con- elaborate instruments or operations. A versations with this patient revealed woman who suffered many years from her gradual realization that she was headaches told a friend that was by not popular ; her dinners and recep- it might be due to a brain tumor. She tions were poorly attended, and her went away disappointed when the name was not included in the invita- cause was found to be her dietary in- tion lists of several socially important discretions, remarking as if in criti- functions. For a while she tried to cism of the physician, "I'm sorry. I explain these slights as due to the hoped I had a brain tumor." A few envy of certain rivals ; then she gave instances of crippling diseases that up plans for entertainments at her have "uninteresting" causes will illus- home because of not feeling well. trate this attitude. Finally, dreading a particular dinner at which she knew she would play a 1. Intolerable Social Situations sorry part, she suddenly lost power to A skilled automobile mechanic had move her legs. Hysterical maladies been forced to give up a well-paid posi- usually have such a train of emotional tion because of insomnia, trembling, frustrations as their explanation. and indigestion. We physicians in cases Help for nervous breakdowns is of this sort are prone to examine the sought by students who fail to get into patient for a long list of cardiac and fraternities. One business man was intestinal diseases ; and, finding no encouraged through twenty years of trouble in these organs, tell the patient, struggle by the hope that he would be "You have no disease. Nothing but regarded as the shrewdest investor of nerves. Get back to work and you his city. The failure of one large will be all right." Unfortunately, pa- speculation brought on a deep melan- tients after receiving this advice often choly and he attempted suicide, not be- proceed to use bromides and other de- cause of the financial loss, but because pressing drugs which commonly only he could not bear to be considered a increase their nervousness. second rate business man. In this case the physician made use An athletic school boy was perma- of a tactful social worker and dis- nently crippled by an accident to his covered the actual cause of the disease. foot. No longer an athletic hero, he It was not clue to inflammation or stopped going with his playmates, kept toxins. There was no displaced verte- much to himself, and became sensitive bra. There was, however, a seriously and suspicious. Girls had formerly misplaced mother-in-law. This woman favored him ; he now thought they had come to live with the patient's ridiculed him. He dropped to lower family six months before his illness grades in classes and finally was — ;;

January, 1936 The Health Bulletin 11 brought for treatment as a mental pa- The word "expert" means experi- tient. If bis family and teachers had enced, and is derived from the Latin encouraged him to keep in touch with for "one who has gone clear through." his playmates, to follow other interests, Ambition (from the Latin for "walk- arid develop some other powers, his ing around" as a candidate) is benefi- emotional integrity would probably cent if it spurs us to develop our best have continued. inherent capacities ; but the only safe Pain is beneficent. The pain of a way to eminence is by first proving sprained ankle stops us from walking, capacity at a low level until we and thereby preventing permanent damage others are sure of our powers. Then to the joint, and stimulates us to effort self-confidence and earned reputation to cure the injury. Emotional pain at will follow, which are the two ingred- the realization of inferiority spurs us ients for emotional stability. When to effort to develop our latent superior we grab for degrees, fame, and posi- qualities. It, too, is beneficent. But tion, as ends in themselves, our days we continually try to find short-cuts to are full of fear, and equilibrium is un- shut off the pain that presses us to stable. Nervous strain, uncertainty, effort. The self-indulgent eater with and a galaxy of emotional symptoms, headache removes the danger signal by camp on the doorstep of the man whose taking aspirin—and continues the over- chief concern is to maintain a pose eating. The girl who observes her the ass lives in fear lest the lion's skin lover's failing interest suffers pain slip off. When our deep satisfaction which ought to spur her to effort to comes only from accomplishing results, dress and act attractively, to shine in we let the world worry about its esti- the circles which he frequents, and to mate of us. An expert blacksmith can win his admiration by gaining value be a greater man than a self-distrust- in his estimation. Instead, she tries to ing professor—and vastly stabler emo- lessen the clearness of realization of tionally. her shortcomings by criticizing the 4. Worry women who are winning his favor, and Man's brain gives him advantage to gain his pity by plaintiveness. over lower animals largely because it 3. Unwillingness to Be Ourselves automatically presents to him mental pictures of future situations. The dog Through the influence of friends, the sees a hot coal fall from the hearth to son of a bank president was made the floor and is not excited to action president after his father's death. For man sees it, and at once there appears a few years the bank went steadily before him a future picture of his downward until he was asked to re- house burning and destroyed, which sign. The shock to his pride left him stimulates him to act. robbed of self-confidence, confused, We can call up these mental pictures nervously ill, and stalled, for more at will. Look at Medusa's head and than a year. He then took stock of his you feel horror. Call it up repeatedly, own assets and concluded that he was and you can continue your suffering not an administrator, but he was sure through the night. Some men's brains he was an able bookkeeper. Having persistently present the gloomiest secured a position at his own best level, future possibilities for every event in health of mind and body returned, then life. Her child sneezes and immedi- self-confidence. ately the mother faces a picture of a Many men and women go to bed funeral with the little one in the coffin. every night insecure because of their A stock investment drops two points fear that they cannot keep up their the investor sees himself penniless and poses; and they awaken early in the his family in the poor-house. morning shivering because they expect Worry is diseased foresight. Some exposure that day. A school superin- morbid persons get a pathological joy tendent, ill-fitted for discipline and in- from whipping themselves with thongs capable of organizing her teaching into which tacks are twisted, while staff, lived in fear she would be found others torture themselves by gazing out, and gradually sank into neuras- upon the most unlikely pictures of thenia. She was persuaded to resign future misfortunes. and to become a primary teacher, There is no magic psychological whereupon her digestion became good, formula to cure worry, but serenity she gained weight, and found life can be attained gradually by those who, worth living. on seeing the vision of future misfor- ;

12 The Health Bulletin January, 19S6 tune, at once start active effort upon One of the pathetic spectacles often their environment to change its trends seen by physicians is the climacteric so as to bring about a desirable result woman who has come to realize that in place of the pictured disaster. Work- her time has passed, and the children ing to attain a satisfying result fixes whom she refused to bear because of that goal as a picture in consciousness the inconvenience now cannot be borne. with it before the mind's eye, enthus- Lonely old age is for her all that the iasm arises responsively, and the nerv- future can bring. This facing of a ous organs generate energy for the process of slow withering brings to effort. many a woman a deadening melan- choly that may become lurid with fear 5. Misconceptions About Sex and agonizing remorse for all sorts of insanely Nature is working to build a race. imagined misdeeds, which she To do that she has to produce indi- conjures out of the errors of her past viduals as the units, the bricks that life. are to form the larger structure. The production of children is painful to the mother, and lays heavy responsi- A wholesome and necessary reaction bility upon both parents. If no other is now in full swing against prudish- factors entered the process, the race ness and unfounded fear in regard to would have died out with Adam and sex, which has the virtue of frankness

Eve ; so nature contrived a way to keep even though at times it is not guided up a continual supply of babies by load- by good sense or good taste. It would ing the procreative acts with the high- be better to be burned a few times than est sensory and emotional pleasures to go through life in terror of fire, and known to man. As a result, men and looking upon it as a mystery or a ma- women are willing to sell all they have lignant enemy. Even scars and dis- to gain that pleasure as an end in figurement would be preferable to itself. But if in the process they per- superstitious fear and total avoidance sistently try to beat the game by of one of life's most beneficent forces. snatching the reward while omitting to Yet, on the other hand, one need not deliver the goods, nature comes back burn off an arm to prove he is not at them with a horde of big and little afraid of fire, or to show his apprecia- scourges. tion of it. * * *

IV. THE DEVELOPMENT OF PERSONALITY IN CHILDREN Observation of a large number of physical and mental pattern of every lop-sided personalities has impressed child is fixed in the germ plasm con- me with several steps in the first years tributed by the two family lines at the of children's lives which, if wrongly time of conception. One wonders at taken, produce maldevelopment or per- the casualness with which even edu- version of the basic feelings concerned cated young men and women select in character ; but which, if taken their mates. Often the decision rests aright, lead to mental effectiveness and upon a bit of color, clothes, a few tricks serenity. The attitudes toward life of manner, and passing sexual attrac- gained by children in the first four tiveness. If one had to cross the Sa- -or five years determine the future hara in an automobile, he would not careers. Here are briefly outlined sev- select his car merely because of its eral of these steps. If they are set paint and the sound of its horn. Now, forth somewhat dogmatically, it is only the few decades of the married life of for the sake of necessary brevity. the couple themselves is something of

A. The selection of ancestors. The a journey ; but the offspring must con- choice of marital partners fixes for all tinue the journey for a millennium. time the upper limit for the biological I mention this as the most important attainments of the resulting offspring. factor in determining the mental ex- Unfortunately a child has no vote in cellence of children. The hope for a the choice of its ancestors, which is all future healthy-minded nation depends the more reason why ancestors should on the foresight of present-day youth have a heart and think a moment be- as they determine who shall be the an- fore filling those positions. cestors of the coming race. Falling in love is a more serious mat- B. The home does for character what ter than selecting an automobile. The the mother's womb does for bodily January, 1936 The Health Bulletin 13 organs. Supposing that the pattern of Art and intellect have produced noth- body and mind fixed by the germ-plasm ing in any civilization that is of equal is good, the whole future realization of significance in terms of human welfare that pattern will depend upon the en- with well ordered family life. The vironment of the infant's first years. making of a home in which vigorous- Regarding the relative importance of minded children develop, and to which heredity as contrasted with environ- outside men and women come for cour- ment, I offer you this statement of age and inspiration is a career worthy what I believe to be the truth : heredity of the best intellect and the greatest supplies in the germ cell the pattern art. of the entire anatomical structure and Medical science, law, and sociology all of the physiologic and psychic ac- are working at unessentials when they tivities of the future mature being. En- absorb themselves in behavior correc- vironment, if most favorable from start tion, curing diseases, and punishing to finish, will permit and stimulate the culprits, while our young people show unfolding of that pattern in all its per- as little forethought in marrying, re- fection. Unfavorable environment can producing, and divorcing as in choos- hinder or pervert the development at ing and throwing away cigarettes, and any stage and to any extent. Environ- while our homes are becoming as unin- ment cannot add any excellence not spiring and casual as cafeterias. already provided for in the original C. Infants and growing children need germ-cell : for instance, one cannot in- much time alone. Up to the moment fluence an acorn to grow into a pine of its birth a child's nervous system has tree. been relatively unstimulated. It now A full-blooded colt in the care of a needs months of quiet and leisure to harsh, mean-tempered master will not feel around with its hands and thus develop the speed, gentleness, and discover its own bodily parts, to be- obedience for which nature prepared come accustomed to the differences be- structural arrangements in its body. If tween its legs or arms and the various the environment is controlled by a kind things against which they strike. The and understanding trainer, those good sounds and lights that impinge upon traits in the colt will spontaneously ear and eye are new experiences. It appear, exactly as the leaves form will grasp all of these outer realities themselves on a tree in the April sun- gradually and in proper sequence as it shine. lies clean and undisturbed in its bed, Perhaps someone is troubled because or later entertains itself in its pro- a child's character is more complex tected enclosure. than a colt's, so that, indeed, to formu- Most babies are not allowed this op- late and supply ideal conditions for its portunity to become familiar in an development would call almost for om- orderly way with themselves and the niscience. If one must think of omnis- outer world. They are dragged around, cience let him seek it in the designing rocked, held under electric lights, sung of the child's nervous system, which and chattered to, cooed at and fondled, is so remarkably constituted that, if and the adults explain this irrational family life supply only a few whole- conduct by claiming that it proves their some conditions and avoid efforts to affection for the child. They must force its growth, normal personality keep "doing something" for it. will unfold itself. The Indian squaw wrapped her baby Very simple-minded men secure near in a blanket and suspended it safely enough to ideal conditions of soil, mois- in a basket from the limb of a tree. ture, and sunshine for the development Fortunate papoose ! It communed with of seeds, even though they know noth- the leaves and birds and it listened to ing of biology and chemistry. So in our the music of the breezes ; and—must it homes, the most favorable environment be said that it was fortunate because for the growth of character does not its mother was not educated? depend so much upon formal learning D. Let the baby go to sleep. After as upon good feeling and good sense. an infant has recovered from the rough The world's great characters spring journey into the outer world and has up in bomes where the atmosphere is been bathed and covered with a rea- marked by sincerity, affection, cour- sonable assortment of clothes, if placed age, good sense, and industry. Any of in a quiet, airy room, it will relax, us can surround our children with breathe evenly for a moment, and then these. go to sleep. If, from the first sleep on- ;

14 The Health Bulletin January, 1936 ward through its early years its mother If a boy has in him the capacity for will but leave it to spontaneous, natural responding to beauty, allow him to gaze sleep, the child will acquire one of the at beauty. Nothing further is needed. simplest yet most valuable of all the When we urge children to like things prerequisites for health and happiness. or people, we do them a double injury. The regular sleep rhythm will be estab- Urging arouses self-conscious effort to lished. Babies do not need to be "put generate feelings, and that kills feeling to sleep" by rocking, singing, hand- it also conditions natural responses holding, and being snuggled against with the disagreeable sense of obliga- their mothers. These self-indulgences tion and dependence. of a mother condition a baby so that in Often a yet worse result follows : the adult life it may have to use drugs or child may be bribed or forced into say- amateur psychology to coax itself into ing that it enjoys a thing when it does unwilling slumber. not. This produces insincerity, hypoc- E. Do not reward a child for crying. risy. The process is what the Bible Babies are helpless. They have no calls the sin against the Holy Ghost: means of caring for their own needs or the child has followed a false leader, meeting dangerous emergencies. But has been forced to desert the one safe nature is a shrewd contriver. Each guide toward excellence. baby has been equipped before birth Suppose that a particular child has with a self-starting signal of distress all the neuro-muscular arrangements which begins as a plaintive, persuasive for appreciating music and for produc- sound, and then grows into a noise so ing it. If the parents were to subject disagreeable that it calls to the baby's it to silence or to discordant noises, its aid not only the parents but all the longing for music might never be neighbors within ear-shot. aroused. If they allow it to hear har- its power of ap- This is all good ; but crying, like any mony at the level of other easy way to riches, will be sub- preciation, and if they encourage it to stituted for the more difficult but nor- practice on some instrument, the in- mal ways. When a child cries, it should born faculty will begin to unfold itself. be inspected and any necessary service From that moment onward its own de- quietly performed. If it continues to sires press it forward. It is by this cry, it ought to be ignored. When it same process that appreciation of the finds that pleasant rewards in addi- higher values of courteousness and tional food and untimely entertainment honor, and the exhibition of the cor- follow, it develops the habit of sum- responding behavior, develop. A fine moning food and entertainment at will. home atmosphere and true-heartedness The mother takes it up, and does this on the part of the parents and teachers or that as a bribe to end the noise. If supply the best stimulus for arousing the cry occurs during the night, the the best cravings in children. father is forced into service to carry it Biologically appetites and cravings until he is exhausted and it goes to are to be considered nature's call to use sleep. Later the cry is used to force a capacity that is now ready to mature. the father to buy it a bicycle, or the As we feel pressed by feeling to act mother to excuse it from school, or upon our environment so as to change from its share in the housework. When it into something more to our liking, the girl has married, she will cry when that effort calls out and develops the her husband's business plans do not appropriate inherent faculties. suit her. When met by the stern reali- G. The development of self-reliance. ties of fate, instead of meeting them Allow a child to decide and do every with intelligence and courage, such needed service for itself which its de- persons surrender as neurotics or make velopment up to that time makes it appeals to the pity of their groups. able to do. F. Alloic children to develop their When an infant needs solid food, na- own spontaneous feelings. Individuality ture has already prepared teeth, chew- set is attained when one feels in his own ing muscles, and a whole new of effort way, and then is guided by his own glands to meet that need. The to feelings. You may entice a child to chew the first solid food starts the new try spinach, but you can't argue or beat apparatus into action. When the time for tennis, or for him into liking it. comes for walking, Many parents coach a child as to piano-playing, as the child attacks its zests come into be- what it ought to like in art and litera- environment, new action, ture, or believe in religion and morals. ing, the faculties spring into January, 1936 The Health Bulletin 15

and the actual use of them thereafter the better satisfactions of good be- develops their strength and efficiency. havior can be realized. For this rea- Parents who save their children effort, son punishment has to be accompanied who spare them labor and study, are by positive effort to induce the offender depriving them of the one natural to try out the better activities, and means of calling into play new powers, thereby to discover their rewards. and of perfecting these powers. I. Fear is not a constructive develop- Every human being must meet mental process; it is a physiological trouble and endure pain and hardship. device for meeting dangerous emergen- Those children develop endurance, pa- cies and, for the time, it interrupts tience, and courage who have been al- development. lowed to deal with the difficult situa- There are certain forms of childish tions that arise in the day's work and sexual experiments such as masturba- to rough it in the woods and in athletic tion and investigations in anatomy, games. Even the faculty for decision which parents are determined to pre- itself remains undeveloped in many persons whose overbearing fathers or vent by fair means or foul, and regardless of expense to over-positive mothers have decided all the child's future welfare. Such performances of the domestic or the ethical and re- are religious problems for the family. sponses to normal tendencies and, so far as have It is good for children to read the we dependable knowledge, in most children stories of heroes and of the men and cause no damage ; they appear to be an women who have met life with fine orienting step toward mature sexual activities. Parental ef- moral and religious feelings ; but it is a forts at regulation serious error to force their theories might well be limited to and beliefs upon young people in the persuasion on the basis of good form of dogmas and creeds. Let them taste and what is acceptable to the group. have the benefit of knowing what the The best expedient is to great men of the world have done and get children interested in sports and productive believed, but leave them to develop activities, which are the safest preventives their own beliefs under the stress of of sexual stewing. Yet, most parents warn their dealing with the realities of life. It is children that by doing things, not merely thinking insanity and physical disease will follow any or reciting them, that children's powers sexual actions, and some parents unfold. Like the appendix vermiformis, even add punishments and invoke the penalties the brain atrophies and gets into of religion and superstitution as restraints. trouble when it is not making a dif- This treatment drives children into clandestine ference for good in things around it. indulgences, and attaches H. When punishment is applicable, to normal sexual feelings a it must be given in such a way that grotesque congeries of perverse emotions. Bashfulness, the child, after the episode, will feel prudishness, and unhappy surer than ever before of the parent's marriage relationships, are frequent affection, good sense, and fairness. Ex- results of this use of fear as a deterrent. perience is the best teacher, but at The severe neuroses, that physicians times the tuition is costly, for instance are called upon to treat, occur most often when a too daring child falls from in patients the roof. Wisely applied, punishment who were in childhood conditioned by fear of their normal spares wasteful and unnecessarily pro- sexual

1 instinct. longed experience. Nature herself punishes; she supplies pain when an The facts regarding reproduction are infant has eaten too much, and thereby to be treated as commonplace matters warns him and saves him from perma- of fact between parents and children, nent breakdown. without prudishness or embarrassment, Law too often punishes for ven- and especially without misrepresenta-

! geance. Courts and parents frequently tion. The correct, dignified names of punish merely to vindicate their own the sexual organs and processes are dignity. All such punishment produces the simplest and best. When frankness vindictiveness and defeats its purpose. and simplicity mark the parents' treat- If marked by fairness, good will, and ment of this subject, the children never obvious desire to help in the overcom- have reason to enshroud it in mystery ing of a fault, it acts upon the offender or to become paralyzed with dread as an effective conditioning factor to when sexual thoughts and appetites stop disadvantageous behavior until arise. —

January, 193& 16 The Health Bulletin

J. The avenues of communication Unavoidable between parents on the one hand and said the accident children on the other are to be kept AUTHORITIES open at any expense. These adult coun- was unavoidable." sellors are the most important compo- And nine times out of ten a nent in children's environment. To the authorities lied. child, the home and school are what The unavoidable accident on high- the soil is to a growing seed. A seed enclosed even in a golden capsule is ways or anywhere else is so rare as to hopeless. It must maintain intimate be almost non-existent. When a road ceases. contact with the soil, or growth is flung up under a car by an earth- parents Children who fear or distrust quake, when a tidal wave rolls across- teachers become imprisoned within or the highway from the sea, unavoidable themselves or seek outsiders as their accidents do happen. But when men fostering human environment. It is are killed or cars are damaged on or- better to allow a child to try out any dinary highways, the chances are over- form of behavior than to lie to him. that human being Kipling's "His Majesty the King" is whelmingly some the classical thwarted child, emotion- was to blame. ally separated from his parents ; and The all too frequent statement the rigid Miss Biddums stands for too "authorities said the accident was un- school teachers of today. Luck- many avoidable" is generally a statement of ily, the Commissioner's wife supplied official laziness or official stupidity or the needed element in his infancy, and official wish to protect from blame he grew in spite of his home. either the living or the dead. A young girl said to me, "I didn't long as accidents occur and the know. Mother tried several times to As causes not ascertained and announced, tell me about sex, but she was always so embarrassed that I felt awkward the rising toll of accidents are per- and more mystified than I would have mitted to teach no lesson of safety for been had she kept silent." Does not the future, and to furnish no example this episode explain the paradox that for other culpable drivers. the children of frankly Bohemian par- Accidents are happening and not for ents often develop the most open and lack of reasons. A first step toward well-balanced personalities? The magic safety should be the determination of was not in the parents' sexual unre- blame in every accident straint, but in their frankness and reason and good fellowship with the children. that occurs. News and Observer. Early Diagnosis and Treatment of Syphilis By John H. Hamilton, M.D.

Syphilis is most communicable during its early stages. Those patients with early untreated syphilis are principally responsible for its spread. If we are to protect the public, we must treat these carriers until they are rendered non- infectious. The welfare of the patient also indicates early treatment, for proper medication in the primary stage will produce best results at less cost. Why do we neglect early treatment when it promotes public safety, patients' well-being, and economy? Probably most delay in diagnosis is due to the tardi- ness of the patient in consulting a physician. Frequently the patient attempts self-medication until convinced of its certain failure. A short time ago. only well-equipped specialists had laboratory aid in the diagnosis of primary syphilis. Now, this procedure is available to every physician in North Carolina. The State Laboratory of Hygiene supplies a specimen container in which the micro- organisms will live for several days. Serum from the initial sore is collected in this container and sent to the laboratory where it is examined with a Dark- field microscope. With satisfactory specimens, definite findings can be made in a few minutes. With this aid to the diagnosis of primary syphilis, prompt treatment is encouraged and a step is made toward control. O «v

Published bH irVLNOESnCPRSimPi SWLB?AR.Ds>7\E\LJn

1 This Bulletin will be ser\t free to ar\u. citizen of the 5tateupor\ request! « —^— ——»«

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

Vol. 51 FEBRUARY. 1930 No. 2

MR. GILBERT C. HUNTINGTON CHARLOTTE, N. C.

Mr. Huntington came to Charlotte in 1899. He later became Interstate Secretary of the Y. M. C. A. for the Carolinas, and served in that capacity for nineteen years. Please read his letter on page 3 of this issue. )

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 Golds boro G. G. Dixon, M.D....„ H. Lbh Large, M.D Rocky Mount H. G. Baity, ScD _ _ _ Chapel Hill W. T. Rainey, M.D _ _ Fayette vi lie Hubert B. Haywood, M.D _ _ Jambs P. Stowe, PhG _... Charlotte J. LaBrucb Wakd, M.D Aflheville

Executive Staff

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

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 request to the State Board of Health, Raleigh, N. C.

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

Prenatal Letters (series of nine 6 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 16

Infant Care. The Prevention of months ; 16 to 24 months ; 2 to 8

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

CONTENTS PAGE A Helpful and Encouraging Letter 3 A Symposium on School Sanitation, or Rather Lack of It 4 Lack of School Sanitation _ 6 Students Demand Sanitation _ _ 8 "The Venerea! Disease Problem in North Carolina" 9 The Common Cold 11 "Cause of Death" 13 Dr. W. A. McPhaul New State Health Officer of Florida 14 A Special Study of Immunization in Charlotte 15 A Complaint from One Mother Who Lives in a College Town Too 16 Posture Week at Saint Mary's 16 :

Vol. 51 FEBRUARY, 1936 No. 2

I A Helpful and Encouraging Letter

have received many encouraging letters commenting on our reaching WEthe fiftieth anniversary of the establishment of The Health Bulletin, as described in our December issue. We appreciate every one of them as well as the kindly comment of a few of our newspaper friends. One of these letters is so stimulating and inspiring and so unusual that we have obtained the special permission of the writer, Mr. G. C. Huntington, a retired minister of Charlotte to publish it. We feel sure that all of our readers, especially the older ones, will appreciate his communication.

Mr. Huntington's Better

"Dear Doctor

"I have received the current issue of the Health Bulletin today and have

read it as I always do with much interest. I am 81 and my wife is 75 and we both have been interested in the article on 'The Problem of Old Age.' We have found many valuable suggestions for ourselves and our children in the Bulletin. We have four children, eight grandchildren and one great-grandchild. Only one death (a child two years old) in our family in 57 years of married life. We married in New York State. Spent 18 years in Colorado and came to Charlotte in 1899.

"My father died of tuberculosis in New York State at 48, but my mother lived until 75.

"I was Interstate Secretary of the Y. M. C. A. for 19 years and had a very pleasant acquaintance with Dr. Lewis during that period. Developed a "blocked" heart three years ago and had to retire from active service.

"Don't give way to that 'dead line' feeling. Your work in the Bulletin has been a potent factor in the health improvement in the State and I trust you will find much joy in continuing it along with other duties.

"We shall appreciate being favored with continuance of our copy for the present. We know not how soon the Lord will call us to our Heavenly Home.

"Yours sincerely,

"G. C. HUNTINGTON." —

The Health Bulletin February, 1936

A Symposium on School Sanitation, or Rather Lack of It

A Case It Seems of Everybody's Business Being Nobody's Business THE efforts made in North Caro- subject, wrote and put through the lina during the last twenty-five General Assembly a law that had years to provide for every school plenty of teeth. In those days the in the State a safe and practical type county superintendent of schools was of approved sanitary system has more a man of much power and authority and consequently of responsibility. He angles than Carter's field had oats. could be reached by the Board of The net result today is we have no Health. But just about the time every- policy on the subject and no one in- set to something dividual or organization of the many thing was really get concerned seems to have any authorita- done, the educational forces launched tive voice. School sanitation in this their big State-wide consolidation plans.

State at the present time seems to be On every hand the question arose : as the living example of the original vic- this little schoolhouse is to be aban- ious circle. Complaints of filthy and doned in a few months why insist on a waste of taxpayers money in pro- dangerous conditions coming to the viding sanitary facilities? So there State Board of Health every week can- again not be corrected by that body. If the Everybody happened. complaint is passed on to the State knows what Great fine-looking buildings (looking Department of Public Instruction, it probably just as quickly travels from from the outside) dotting the country- side there to the State School Commission. everywhere flanked by the two dirty-looking little shacks, one in the From there it may be just as promptly sent back to the Board, back to the northwest and the other in the south- Department of Education, on to the west corners of the grounds. In those County Superintendent of Schools or buildings in the cities, towns and vil- to the "files." The county officials lages where water and sewerage are promptly stand from under with the available in many instances the con- simple statement that the State is run- struction was faulty and the mainte- ning the schools, or perhaps it (the nance is careless or indifferent. complaint from a harassed and horri- We are not disposed to criticise any- fied grade mother) is sent back to the body for past mistakes. What we are local school committee, who in turn concerned about is present and fu- seem to have no trouble in convincing ture needs. And when we say "needs" everybody that they have nothing what- we do not mean maybe. soever to do with it. So there ! From Proper and safe school sanitation in an administrative standpoint—although this State is dependent on several im- results were the same, that is zero portant considerations. We herewith conditions were not always quite so enumerate a few of them. bad. Back in the dear dead days of 1. Some one individual either in the long ago, say about 1919, Wiley H. State, the county, or the school district

Pittman. then chief clerk to Dr. Joy- whose job it is to see that a safe and ner, State Superintendent of Public working system is present in each and Instruction, stung by criticism on the every schoolhouse and that the sys- February, 1936 The Health Bulletin tem is always kept clean and safe and We will now let the editor of the in working order. And further, whose Greensboro Daily News and the sani- head (political) will be cut off if he tary engineer of the State Board of does not deliver the goods. Health finish this chapter.

2. The construction, either and pre- — School Sanitation ferably water and sewerage—or out- "We find it difficult to think straight, door type must be properly and honest- or to see straight—red is the color and ly constructed to begin with. it is pretty much of a blur—in connec- 3. Facilities for constant mainte- tion with what is reported of condi- nance must be provided. And what tions at the Winterville consolidated are some of these "facilities?" Answer: school in Pitt County. There the sep- Money to provide a competent janitor, tic tank has become so confused with plenty of water, soap, scrubbing mops the water supply that it is difficult, if for the janitor, and individual towels not impossible, to distinguish t'other and soap for the children. from which. 4. And most important of all a prin- "Warren H. Booker, sanitary engi- cipal who is interested (and who will neer of the State Board of Health, has be promptly fired if he isn't) enough been down there looking things over. to see that the janitor performs his "In spite of another digging or so of duty every hour of every day. wells—wells are fairly simple in a Several things have happened lately section where one drives down a four- to precipitate this discussion at this or six-inch pipe—there are reported time. To begin with we have a bale 200 students of 725 suffering from in- of complaints from the eight nurses, testinal disorders believed to have re- employed solely by the State Board of sulted from the water. Health, who spend their time working "And if this in itself were not bad to promote the health of the State's enough, Engineer Booker is reported as children. Not only their own descrip- saying that the same condition exists in tion of conditions, but through the one Anson County community and that nurses hundreds of teachers have beg- he has reason to believe there are others. ged for help—grade teachers who have "How much authority Mr. Booker to live with the children, so to speak. has we cannot say. If he hasn't In 1934 an outbreak of a dangerous enough to close a school that cannot venereal disease disrupted a school in distinguish between sewage and drink- a western county and several little ing water, then he ought to resign. But girls were infected through no fault of if he has such authority and does not their own. Recently a large consoli- exercise it, then he should be fired. dated school in an eastern county has "We are not singling out folks to been closed for the same reason. At shoot at, and we yield to none in our last reports forty-six small girls affection and respect for the State De- were infected through contact with partment of Health ; but if Sanitary dirty seats in an outdoor pit privy. Engineer Booker knows as much as he A horrible situation and a prevent- says he does, he should either do some- able one. Finally sometime ago a thing about it or quit. septic tank infected the water supply "We can't imagine Dr. George Mar- in a large consolidated school in an- ion Cooper—we are trying for no odor- other eastern county. All of sufficient ous comparisons, but simply attesting importance to attract the attention of to the faith that is in us—standing for large sections of the public to the vital this sort of thing longer than it took need for civilized efforts along these him to find a committing magistrate." lines. —Greensboro Daily Neivs. 6 The Health Bulletin February, 1986

Lack of School Sanitation

By Wakren H. Booker, Director Division of Sanitary Engineering, State Board of Health (In Greensboro Daily News) U •OUR editorial article in the only one man or one organization for y;Daily News of November 29th the entire State, and where it was not has been read with interest. necessary to sell the various princi- Certainly the condition of our school pals, superintendents, boards of educa- sanitation in North Carolina is at a tion, and boards of commissioners in 100 counties countless cities low ebb. School sanitation in North and and towns, and where it was possible to Carolina is, in my opinion, far worse cooperate with one central engineering than our prison sanitation. You will and construction organization to secure note from the marked article in the a uniformly high degree of prison camp July, 1933, Health Bulletin that ap- sanitation that puts our entire system proximately 20 per cent of our North of school sanitation to shame all over Carolina schools had no sewerage the State. facilities at all—not even privies, only about 25 per cent had what might be "In an effort to secure a more direct classed as 'fair to good' sewerage and more workable law regarding facilities, and over 50 per cent had school sanitation, the enclosed Senate distinctly 'bad or dangerous' sewerage Bill No. 565 was first submitted to the facilities. As for school water supplies State Department of Public Instruction about 33 per cent had no school water for concurrence, or approval, but this supplies on the school grounds at all, could not be secured until 'the knowl- about 30 per cent had what might be edge and consent of the State Depart- termed 'fair to good,' or safe water ment of Public Instruction' clause was supplies, and over 36 per cent had 'bad inserted. The writer then had the or dangerous' school water supplies. bill introduced in the Senate. It was "Our laws on school sanitation are approved by the committee on public indirect and cumberous. Improvements health and referred to the committee to school sanitation usually have to be on education. Efforts to secure favor- taken up first through the school prin- able action through the chairman of cipal, then the county superintendent, that committee, now secretary of the the county board of education, and State School Commission, failed and finally through the board of county school sanitation is largely where it commissioners. Once an appropriation was. is made there is no provision that in- "During the period of CWA, ERA, sures against locating wells in base- WPA, and PWA this office has used ments, or adjacent to sewer lines, sep- every effort to improve and raise the tic tanks, or other sources of pollution. standards of school sanitation through- Often when we furnish plans and out the State, but with a limited meas- specifications for school water works ure of success. A number of school and sewerage facilities, we actually privies have been built, but such things find that the final construction job are a very temporary makeshift at pub- bears little resemblance to the original lic schools. A few school water supplies plans furnished. with water carried sewerage have been "Contrast this with our State High- installed, but much of this work has way and Prison Commission where it been done without plans, or without was necessary to deal directly with submitting plans to this Board for ap- February, 1936 The Health Bulletin proval, and even where we have pre- see red, just as they made the Daily pared plans they have not always been News, we do not know what will. followed. "This letter is in no sense an alibi, "The question immediately bursts facts the it is a simple statement of as forth as to what can be done about writer has seen them. Enormous them. And sickeniugly the answer construction cost, im- economies in and comes back, little or nothing under the sanitation at provements in school — lack of authority, the prevailing politi- least to the extent of raising school cal system and the multiplicity of sanitation to the level of prison sani- school agencies and controls in North tation—could be made, if school con- Carolina. could be centralized under struction "As the statutes now read 'The central authority like our one common County Board of Education shall pro- present system of highways and our vide, upon recommendation of the present system of prison camps. It is State Board of Health . . . sanitary also my opinion that much improve- privies at each public school . . . ment could be made in our school sani- and a failure of the part of the County tation were the State Board of Health Board of Education and county super- made more directly responsible in mat- intendent to make provision for sani- ters of design, construction, operations, tary privies, or a failure on the part of and maintenance of such matters as the county commissioners to provide school water supplies and sewerage. the funds shall be considered a mis- "It is the writer's opinion that while demeanor, and either the county board, prison sanitation is important, our the county superintendent or the im- school sanitation is infinitely more county commissioners may be fined or portant. It is my understanding that imprisoned in the discretion of the many of our North Carolina schools court.' While the principal of the teach hygiene and sanitation in the specific school is not mentioned, he class room. I would like immensely patently must be dealt with too. Three to see our State's practice in the school other agencies are mentioned, how- plant square with the teachings in the ever, which should be sufficient division classroom." for all the buck passing anybody wishes. And can anybody imagine a Sounding the Tocsin Raleigh representative coming into a "Elsewhere in the editorial section local community and getting a convic- of the Daily News there is published tion against any or all of these agencies today a communication from "Warren in the county court which is likewise H. Booker, director of the division of a part of their political system? sanitary engineering of the State Board "Provision of a good water supply is of Health, who discusses the sanitation, similarly circumscribed. 'It shall be or lack of it, in many North Carolina the duty of the County Board of Educa- schools. tion,' reads one section of the statute, "The Daily News hopes that its en- 'to make such provisions as will give tire family of readers will peruse care- the teachers and pupils a good supply fully and thoughtfully Mr. Booker's of wholesome water for the school contribution. It reflects, coming from term.' But, says another section, 'It is the man whose business is school in- the duty of the school committeemen spection, conditions which are not to see that the schools have a good merely a menace to health but a shame water supply.' It is then set forth and a disgrace to the State. If the how they shall report to the county revelations do not make the citizenry superintendent, and he to the County s The Health Bulletin February, 1936

Board of Education, et cetera, in the secretary of the State School Commis- same meaningless and ineffective circle. sion, which, as all who can see know, Similarly the committeemen are in- is the school boss in North Carolina, trusted with maintenance of all sani- but which, in the statutory hodge- tation about the school grounds, de- podge, which permits polluted drinking spite previous enumeration of the water and a disgraceful lack of sani- duties and responsibilities of the other tation generally, is nowhere, despite and higher school authorities. its ultimate responsibility and authority, mentioned. "Effort was made at the last session of the General Assembly, as Mr. Booker "It is a shameful state of affairs; points out, to secure a fixation of re- those who wish to learn more can do so sponsibility and empower the State by securing the health bulletin in Board of Health to deal with schools which Mr. Booker reports his findings which fail to meet sanitary require- and conclusions in detail and which, ments. After a bill had been drafted, incidentally, had been prepared long be- however, it was not accorded the ap- fore the 1935 Legislature failed to take proval of the State Department of Pub- remedial steps. Two courses appear lic Instruction until a clause had been open : One is to give the State Board inserted to the effect that health au- of Health full authority to safeguard thorities could not act without the North Carolina childhood and public 'knowledge and consent' of that depart- health and the other is to centralize ment. the present hopelessly divided school "With that provisor included, the maintenance responsibility so that proposed measure was offered in the somebody can and will be slapped in Senate, approved by the committee on jail for permitting any such intoler- public health and referred to the com- able conditions. mittee on education where it was al- "Neither objective is likely to be at- lowed to die and the school sanitation tained until the North Carolina citi- situation left as it had been. It may zenry goes on the warpath ; and to that be significant that the chairman of end the Daily News sounds the tocsin." this committee has since been appointed —Greensboro Daily News.

Students Demand Sanitation

Not Interested in Legal Complications

By Warren H. Booker. Director Division of Sanitary Engineering, State Board of Health OUR present day students stand possible 100%. When indictment was four square for sanitation of brought against it, as required by law, their eating places. At Chapel the magistrate's court promptly con- Hill the cafes and public eating places victed him, whereupon the proprietor appealed to the municipal court which were recently rated as to sanitation. held the State Hotel and Cafe Law en- The low rating cafes either voluntarily acted in 1921 to be unconstitutional. closed, or immediately began remodel- With the constitutionality of a law ing, cleaning up, getting health certifi- designed to safeguard the lives and cates for their employees, and request- health of the public questioned, the ing re-ratings, except one place. This State could do nothing less than ap- establishment rated only 39% out of a peal to a higher court. This was :

February, 1936 The Health Bulletin

done, and the matter will be heard next If the students are aroused enough to March. boycott unhealthy establishments, we will have been successful. At the same In the meantime, while this matter time, we suggest that students show was pending in the courts, the Daily their appreciation of the high stand- Tar Heel, a student publication, learned ards of other eating places by patron- of the situation. This publication lost age as they see fit." no time in publishing the original sani- In a few days after the above rating tary ratings of the various Chapel Hill and editorial appeared, the proprietor eating places on its front page. called at the office of the State Board In addition, this courageous student of Health and requested that a re-in- paper published the following two- spection be made of his establishment, column, boxed editorial in black face and claimed that the first clay the type beside the ratings above facts and editorial were published he lost 100 of his customers, "The ratings issued yesterday by health authorities reveal what the and was afraid he would lose more campus has been waiting for. of them. "If the local courts' contentions will Needless to say, this Board will ar- prevent local health authorities from range to make a re-inspection as soon administering a program which would bring Chapel Hill eating places up to as possible. But it cannot run the risk scratch, then it is the duty of this of contempt of court or becoming in- newspaper and all students to cooper- volved in any legal technicality in so ate on the basis of the health report doing. and to demand decent health standards in the below-par establishments. The encouraging features are the "This can be done by NON-PATRON- students' interest in matters of cleanli- AGE. We advocate a BOYCOTT of ness, decency, and the general safe- all unhealthy eating places until those guarding of the public health. establishments can prove that they have fulfilled the recent health stipu- More power to the Daily Tar Heel lations to the satisfaction of the board and other publications that are really of health by ameliorative changes. and truly interested in advancing "We do not question the courts' de- sanitation and the standard of living cisions. Our interest lies in student welfare and not in legal complications. in North Carolina.

"The Venereal Disease Problem in North Carolina"

By J. C. Knox, M.D., Director, Division of Epidemiology, North Carolina State Board of Health

ACCORDING to a recent survey penditure of the taxpayers' money. there are approximately 375,000 Little intelligent thought has been cases of syphilis in North Caro- given to the programs for the control lina. Admittedly this is a conservative of these diseases, chief of which are estimate. It thei'efore is apparent that syphilis and gonorrhea. Certainly, in the venereal diseases are becoming North Carolina there has been a retro- people more and more a menace to the gression rather than advancement in of the State. positive control efforts. One has only The so-called venereal diseases con- to cite the repeal of the law requiring stitute a grave menace to the people physical examination before marriage of any community. They also are infor sufficient evidence of this attitude. directly responsible for a great ex- The mere fact that these diseases are —

10 The Health Bulletin February, 1936 not freely discussed, but are spoken of mate goal will do much to lessen the in whispers, automatically places them number of cases occurring in North in the dark corners away from the Carolina. light of truth. Thus it is rather diffi- "According to the Social Hygiene cult for those agencies interested in Bulletin, 'What the public needs to controlling these diseases to know just know particularly is that syphilis and the extent of the problem that they gonorrhea are not punishments for present. We regret to observe that this crime and sin ; that they are caused attitude is sometimes prevalent in the by disease germs which live and die in medical profession, from which we accordance with known biological laws, should expect the greatest amount of and spread from infected to suscepti- enlightenment and cooperation. ble persons in any community by Syphilis and gonorrhea report- are methods fully understood and combat- able to the North Carolina State Board able. It is important for public wel- of Health either by name of the pa- fare that people should recognize that tient or by number ; if by number, then these—the so-called venereal diseases a corresponding number in the physi- are kept alive by a series of separate cian's files should identify the patient. localized outbreaks, rather than by Public health officials are not interested continuous centers of infection in any primarily in the name of the person community. This being the fact, it

suffering . with the disease, but rather follows that in the case of syphilis, as in the extent of the disease in the in tuberculosis tactful sympathetic in- State and in prompt treatment made vestigation to discover and treat those available for every case. However, we involved in each outbreak is necessary can expect to accomplish little in the and of great value to families and to control of these diseases as long as the community as a whole'." reporting is so seriously handicapped Such a program of Public Health by the fear of publicity. Physicians education must be carried directly to and public health authorities in most the parents for it is the responsibility instances look upon the venereal dis- of each parent to see that his children eases as they would any other com- are acquainted with the facts regard- municable disease : a condition to be ing these diseases, i.e., the methods in treated just as any other disease. The which the diseases are contracted and attitude that either of these diseases the necessity for early, careful treat- is just punishment for "moral delin- ment ; the serious consequences that quency" is not the proper way they follow no treatment or inadequate or should be considered and just this at- insufficient treatment ; the complica- titude is seriously hindering the prog- tions and conditions which might arise ress that should be made in control. from the infections which become Until these disease conditions are dis- chronic. Civic clubs also should be cussed frankly and given early treat- interested in learning these facts. ment just as any other disease, we can- Legislative bodies should be thoroughly not hope to make any appreciable prog- familiar with the economical results ress in their control. of cases of the venereal diseases that Every case of syphilis or gonorrhea have received little or no medical at- should be reported by name and the tention. A high case rate of chronic individual suffering with the disease syphilis, particularly among the in- should receive treatment until he is no mates of the various State institutions longer a menace to the community in should be the cause of considerable which he lives. A program of Public concern to this body of citizens. Sur- Health education with this as its ulti- veys show that an enormous sum of February, 1936 The Health Bulletin 11 money is spent annually to take care must be established if we are to expect of these individuals who are inmates of the greatest amount of returns from a such institutions because they are suf- control program. Those who are de- fering entirely or partially with syphi- linquent in securing treatment must lis in some form. have an adequate follow-up to see that A program as outlined above should the course of treatment renders that be supplemented by a most active individual non-infectious, because each epidemiological study of each case and acute case of gonorrhea or syphilis is a its source of infection. Little progress potential menace to other individuals. can be made unless such measures are Sufferers with the venereal diseases instituted. Diphtheria, scarlet fever, too often regard the course of treat- smallpox or tuberculosis cannot be suc- ment, because it necessarily must con- cessfully combatted if such studies are tinue over a long period of time, as a not made, nor can syphilis or gonor- means for the physician to make rhea be controlled if this part of the money. This decidedly is not true. control program is not closely followed. There must be adequate social service By an intelligent and frank approach follow-up to convince the patient that to the problem of tuberculosis that such an attitude toward the treatment disease has been very remarkably re- and the physician is entirely wrong and duced in morbidity and mortality with- can only bring serious harm to himself in the past twenty-five years. If a pro- when his course of treatment is wil- gram for the control of venereal dis- fully interrupted or discontinued. ease is as intelligently planned as that The State Board of Health is plan- dealing with tuberculosis, and a simi- ning an educational program by lecture lar sum of money expended for such a and motion picture demonstration to program, we can expect results that various interested groups in the State. are in a measure comparable to the It is hoped that this program will splendid results of our fight for tuber- create a desire for frank, open discus- culosis control. sion of this grave problem, which in Proper treatment facilities for all turn will result in a more enlightened cases of syphilis or gonorrhea, regard- public attitude and vigorous coopera- less of the ability of the patient to pay, tion in control of the venereal diseases

The Common Cold

By R. T. Stimpson, M.D.. Director Bureau of Vital Statistics

is evident that much has been and the method of prevention of many ITlearned during the past concerning diseases that are uncontrollable today. the diseases afflicting mankind. It has not been so long ago that That many diseases have been if not many of the conditions for which we entirely, almost eliminated, and others know the cause, and for which we have proven scientific preventive or curative have been greatly reduced. But the remedies were believed to be caused by last word has not been said and past various conditions that we know to- accomplishments are only an indica- day were fantastic. The selection of tion of the possibilities of the future, remedies for their treatment was often when our present knowledge has been the results of fancy or superstition applied to our daily lives. Further- and had no scientific basis. more, it is logical to assume that as People believed that during the win- time goes on we will learn the cause ter the blood became thick and slug- 12 The Health Bulletin February, 1936

gish. The approach of springtime was versial one. The successful treatment a signal for thinning of the blood. of all three is the successful prevention Sassafras tea was taken in quantities. of their complications.

Bleeding was practiced. Charms were Catarrhal fever, meaning all three resorted to. conditions—colds, grippe and influ- Instead of cleansing a wound, an enza—is an acute infectious disease ax or other tool which had inflicted the exact causative agent of which is the wound was anointed with lard and not as yet known. It exists locally as guarded from rust in the chimney cor- the common cold and grippe, and ner. Dusty spider webs were used to periodically and over large stop bleeding. Buckeyes were thought areas as the severe to protect from rheumatism and were influenza. Both the cold carried in the pocket to charm away and grippe occur with the greatest the disease. If a person had a chill frequency during winter and spring. he was bled. If he had a fever he was The severe type of influenza shows no bled. Some were bled on general predilection for season when first it principles. appears, but always in the second and With the increase of knowledge these third waves which characterize an superstitions have been largely over- epidemic there is a definite increase come. But there remains an almost in number of infections during the universal infection the cause of which months of bad weather. The symptoms has not been solved to our satisfaction. are almost too well known to call for any It is a disease which people usually description : typical "cold in the think of but little importance—the head," headache, chilliness, pains all common cold. This is one of the big over the body, especially in the back problems in preventive medicine that and legs, impairment of taste and yet await solution. smell, a non-productive cough with considerable The common cold produces an im- soreness in the chest, fever, etc. The variability mense amount of illness and suffering, of these symptoms

largely determines : of inconvenience, and loss of time from the diagnosis if the attack is mild it is work. That no deaths are reported as a cold, if severe, grippe; if severe due to this condition should not cause and occurring during an epidemic it is influenza. one to lose sight of the seriousness of the common cold. It is not the disease Although the definite cause of the per se from which the patient with a cold is not known experience has led cold dies but from the complications. us to believe that certain practices aid The most frequent of these are infec- in its prevention. Chilling of any portion of a sinus, middle ear disease, in- tion of the body and excessive fatigue fected mastoid, bronchitis and pneu- both no doubt lower the resistance to monia. the infection and should therefore be Some authorities hold that to draw avoided, especially during the incle- a sharp distinction between common ment months of winter and spring. The colds, grippe and influenza is futile, crowding together of large numbers of and the term catarrhal fever is used to people in closed spaces doubtless facili- embrace the whole group. That the tates the spread of the disease. ordinary cold, grippe (or non-epidemic It might be expected that one would influenza) and epidemic influenza are develop a cold every time the causative different manifestations of one and the agent or germ came into contact with same thing may be debatable, but from the lining of one's nose or throat. It the standiK)int of practical handling of seems that some other factor is neces- the cases the point is not a contro- sary to give it a chance. February, 1936 The Health Bulletin 13

Even though the cold is thought of Sinus trouble, middle ear and mas- little importance it no doubt so lowers toid infection have already been men- the body resistance as to allow many tioned as complications of the common more serious conditions to obtain a cold. A cold may lead to conditions foothold. It is true that no deaths causing impairment of hearing or deaf- were charged to common colds in 1934, ness in children. but there is no way to determine the The prevention of the cold with its number of fatal conditions started as possible complications lies in avoiding a cold. Many deaths are charged to so far as possible those conditions influenza and a great many more to favorable to its development. And bronchitis and the pneumonias. In especially is this true in regard to 1933 there were approximately 1000 young children. Once the cold develops deaths giving influenza as the primary medical advice should be sought and causes, in 1934 there were 300 less or above all it should be considered an in round numbers 700. For the first infectious disease requiring the best of 9 months of 1935 there had been over care to prevent any serious complica- 850 deaths from influenza. tion or its spread to other individuals.

"Cause of Death •>•> FROM time to time we hear criti- exact and immediate cause of death. cism of the United States Bureau When there is the slightest doubt in

of the Census and even our own the physician's mind he is urged to Vital Statistics Department for the advise an autopsy. In the list of causes "incompleteness" of the death statistics no room is left for speculation on the and for the sometimes apparently "mis- part of the physician. He is required leading" statistics. A few newspaper to state two things : 1 the exact and editorials have recently been received immediate cause, and 2 the chief con- severely criticising the United States tributing cause. A good example would Public Health Service for a recent be say a death which resulted from statement to the effect that "such ill- "cirrhosis of the liver." Every physi- ness (meaning deaths from alcoholism cian knows that this condition is often and venereal disease) will probably be brought on by excessive alcoholism, but reported under some other name." We there are more than thirty other are reproducing below an editorial re- causes listed besides alcoholism. It cently appearing in the Winston-Salem is perfectly human for the attending Journal, one of the very ably edited physician, when it is left up to him, to daily papers of this State. A brief ex- put down what he knows to be accurate planation of the situation may help to- and exact without leaving a stigma ward a better understanding of the against the innocent members of the difficulties in the way of the statistical family. In short, he puts down "the division of the Government in obtain- truth" but not always the "whole truth." ing accurate statistics. No one can go "behind the returns" on a For more than a half century from death certificate when filled out in ac- time to time an international congress cordance with the international code assembles for the purpose of agreeing by a responsible and reliable physi- on a definite list of "causes of death" cian. The United States Government to be filed on a death certificate. The itself cannot question or change such a effort has been to avoid vagaries in so certificate unless evidence of fraud is far as possible and to put down the present. :

14 The Health Bulletin February, 1936

The statement of the spokesman for problem of public health guided by an the Public Health Service evidently official survey which has admittedly had in mind these difficulties. No one mapped the wrong road. could more desire the exact facts and "The advance report of the census "all" of them on every death certificate department points the need for accu- than the public health divisions of rate information on these diseases since national, State and local government. it reveals that since repeal, deaths Hence we welcome a discussion by from syphilis—the most deadly vene- newspapers everywhere even though real disorder—have increased over 6 some stinging criticism must be en- per cent ; that deaths from alcoholism dured. The attending physicians hold have climbed almost 20 per cent ; and the eventual solution in their hands. from cirrhosis of the liver—an alco- The editorial from the Winston- holic disease—have increased 12 per Salem Journal follows cent, reaching the highest figure since the adoption of the Eighteenth Amend- "A SURPRISING ADMISSION" ment, though still well under the pre- "The United States Public Health vailing rate for the pre-prohibition Service, which is spending $3,450,000 period. of WPA money to classify the causes "The fact that an investigation made of death for the guidance of public last summer by the American Public health officers, makes the astonishing Health Association revealed that the admission that 'it is not anticipated actual deaths from alcoholism were that alcoholism and venereal diseases more than double the number which will be reported with any degree of appeared on the records multiplies the completeness—such illness will prob- vital need for an honest and reliable ably be reported under some other report of the present trend. It is true name.' that the admitted inaccuracies are the "If this means that a great public result of indifference and not of malic- agency, supported by public funds, has ious purpose. But that does not alter no intention of giving the public the the fact that the United States Public facts it is paying for, then this is a Health Service is receiving $3,450,000 shocking statement indeed. Is the of public money and, in return, is ren- record to be admittedly false, and will dering the public a distinct disservice no attempt be made to correct it? Have by submitting a report which will list plans actually been laid to charge alcoholism and venereal diseases by deaths from one cause into the records some other name. of another? If so, then legislators and "The liquor traffic could afford to public health officers will attack the pay generously for this favor."

Dr. W. A. McPhaul New State Health Officer of Florida

December the Governor of Florida and should make the State of Florida INappointed Dr. W. A. McPhaul State an excellent official. Health Officer of Florida. For the Twenty-five years ago this month past four years Dr. McPhaul had been Dr. McPhaul was serving Robeson health officer of Pensacola and Escam- County as a member of the Legislature bia County, Florida. He has a long then in session at Raleigh. He took and successful record in health work a leading part in promoting health :

February, 1936 The Health Bulletin 15

legislation in that body, which enacted resigning in about a year to become many progressive health measures. He city health officer of Charlotte, N. C. had come to Robeson County from Ala- He held the latter position for about bama with his parents when he was a ten years, resigning to take up the child. He was part-time health of- Pensacola work. ficer, or county physician, in Robeson It will thus be noted that Dr. Mc- County for several years. In 1916 he Phaul's experience in the field of pub- became whole-time health officer of lic health work has been full and com- that county, where he remained until plete. he resigned early in 1919 to join the His old colleagues here in North staff of the Alabama State Board of Carolina wish for him a long and suc- Health. Soon after going there he be- cessful career as head of the Florida came city health officer of Montgomery, health work.

A Special Study of Immunization in Charlotte Dr. G. L. Rea, city health officer "10 had been immunized already. of Charlotte, has sent us a brief "4 were being given whooping cough summary of a special survey serum and would be immunized follow- made in a well-to-do residential dis- ing its completion. trict of Charlotte which should have "5 others had pre-school brothers and considerable interest for health officials sisters who had been immunized and and practicing physicians all over the State. mothers were planning to have the baby given toxoid also. The study was carried out under the direction of Dr. Rea by Miss Clara "5 were interested and would talk Henderson, a public health nurse of his to their family physician. department. "2 had appointments with pediatri-

The report follows cians for next month when it was to be given. "Study of Immunization in Elizabeth District "2 sick children with doctors in at- "Purpose: tendance said when patients were well "To find how the well-to-do regard they would have it given. immunization against diphtheria under "1 afraid it would have a bad effect one year, and whether or not children on the heart, and three other children are protected at one year. had not been allowed to have it, but "Method: would speak to her doctor at the "Names of 47 babies living in Eliza- nurse's suggestion. beth District between the ages of six "1 mother waiting until the child months and one year were selected was one year old. from the birth registration index file. "1 interested but had recently heard A public health nurse called at each home. of a child who had had a severe infection from the treatment. There was "Findings: another pre-school child in this family "Fifteen had moved. who had been immunized, and she "32 mothers received the nurse cor- promised to talk to her doctor about dially and discussed protection against it as her husband was greatly excited diphtheria. over this report of danger from toxoid." :

16 The Health Bulletin February, 1936

A Complaint From One Mother the approval of the public generally. All of them have worthy motives, and Who Lives In a College the original idea in setting apart a Town Too week or a day for special observance of some enterprise was to obtain suf- "Gentlemen ficient publicity about the proposal to request of little "At the repeated my center the attention of a large number is in the second grade at girl, who of people on the subject in the hope Blank School, I visited the toilet room that something would be done about it. the least, I was shocked at and, to say A few days ago in a column con- unsanitary condition of this room. the ducted in the Raleigh Times by Miss "I a graduate registered nurse am Anne Whaling, under the title "The I the that lurk in and know dangers Belles of Saint Mary's," Miss Whaling so families such places, where many described in a brief paragraph the ob- represented. if the help can't are And servance of "Posture Week" at Saint antiseptic solutions, I would sug- use Mary's School in Raleigh. This pro- water gest that plenty of good soap and posal struck us as being unusual, in combined with a normal amount of that it was an unusual way to observe this place good. elbow grease would do the very important rules for correct And since the State controls the schools posture. It is natural that in a school I feel that the Board of Health should for girls the question should be em- demand that a program of proper phasized. The time to teach these cleaning methods be employed in the things, however, is when the children protect the health of the schools to are small. Efforts cannot begin too children. From my own little girl's early in life. health records, I have had little We started out to quote Miss Whal- trouble until she started to school. ing's paragraph in the Raleigh Times Since then she has had ailments which without the intention of writing an I can attribute to the unclean condi- editorial ourselves. And we hope other tion of the school. A parent of this school told me that she became so schools are likewise observing "Pos- nauseated with the foul odors in the ture Week." The paragraph from commode room she was compelled to "The Belles of Saint Mary's" follows: hold her nose and seek freedom in "This is 'Posture Week' at Saint fresh air. I am writing this with the Mary's. Since good posture is neces- feeling that some investigation and sary to good health a definite stress is improvement will be made. placed irpon it. Each girl has been "Very truly yours," given a tag by her team captain and it is her duty to wear the tag at all times. Five Sigma's and five Mu's have been Posture Week at Saint Mary's appointed as policemen and they watch

During the past year we have had all the posture of the students at all kinds of weeks—from "Eat More times. If one is caught sitting or Cheese Week" to "Fire Prevention standing incorrectly she is told to put

- Week. ' All of these things are good, a mark on her tag, and so many marks but the public is a little weary of such put her in posture class. If she forgets designations. One reason is that there to wear this tag at any time five marks have become so many "weekly" observ- are given. Each one tries her best to ances that there are hardly enough hold herself correctly at all times so weeks in the year to go around. as to improve her posture and also not Every one of these enterprises which to get marks so that her team may has come to our attention should meet win." |

Published b4 TflL. N°¥3I\ CARPLtrtA STATLDPARDs^AEMJn

This E>u]fetir\ will be ser\t free to arxij citizen of the State upo r\ 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. 51 MARCH, 1936 No. 3

Famous Authority Now Director of the Department of Public Health in the School of Medicine at the University of North Carolina MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

S. D. Craio, M.D., President _ _ Winston-Salem J. N. Johnson, D.D.S., Vice-President Goldsboro G. G. Dixon, M.D - _ Ayden H. Lee 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

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 request to the State Board of Health, Raleigh, N. C.

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 PAOK New Public Health Department at State University 3 Typhoid Fever and Poliomyelitis (Infantile Paralysis) 4 Hospital Care _ 5 Winston-Salem Has Enviable Health Record in 1935 6 More Facts About Milk 7 Deaths from Typhoid Fever—1935 (Map) 8 Deaths from Poliomyelitis—1935 (Map) 9 Charlotte Maternity Clinic Report for 1935 - _ 12 On Psychiatric Mediaevalism - 13 Dr. Farrell and Miss Beam Complete Work in County 14 Cabarrus School Children Like Their Dentist 15 North Carolina Bureau of Vital Statistics Provisional Report for 1935 16 Vol. 51 MARCH, 1936 No. 3

New Public Health Department at State University THE most important development in public health circles in many years for this section of the South is the establishment at Chapel Hill of a department of public health in connection with the School of Medicine, and the selection of Dr. Milton J. Rosenau as its director. This development has been made possible by the co-ordination of the staffs and the facilities of the North Carolina State Board of Health and the schools of medicine and engineering of the University of North Carolina.

The new department, while an integral part of the University School of Medicine with Dr. C. S. Mangum. Dean, will be under the personal direction of Dr. Rosenau. Dr. Rosenau is generally regarded as America's foremost authority on public health. His books on preventive medicine are used everywhere as standard textbooks in all schools of public health. Until his retirement recently from that faculty he had been head of the famous Harvard School of Public Health for many years.

For a long time the officials of the State Board of Health have worked hard to secure the establishment of such a school. The necessity for it has been apparent to all responsible health workers. The chief credit for success in launching the enterprise should go to Dr. Charles S. Mangum, Dean of the University Medical School, and to Dr. Carl V. Reynolds, State Health Officer. Both of these officials have worked hard and cooperated with each other in overcoming all difficulties in the way of the establishment of the new department.

In the opinion of Drs. Mangum and Reynolds the development was in part made possible by the success of the course put on in the school year of 1934 and 1935 at the University under the auspices of the School of Public Adminis- tration. The first course put on with the teaching aid of the Schools of Medicine and Engineering of the University and members of the staff of the State Board of Health comprised a course of instruction for physicians in public health administration and extended over a period of twelve weeks. The work was so excellently done that they received recognition from the United States Public Health Service which assigned several of its applicants for post-graduate work to take the second course.

We hope and believe that this enterprise under Dr. Rosenau's direction will expand into one of the most important departments of public health education in the entire country. The need for special training for physicians who want to enter public health work is great. Efficient public health departments, Na- tional, State and local in modern conditions of living are an absolute necessity. There are large numbers of young physicians who with proper post-graduate training could make excellent health officers.

The success of the new department at Chapel Hill will go a long way toward establishing an efficient system of public health work on a sound basis throughout the entire southeastern section of the country. The Health Bulletin March, 1936

Typhoid Fever and Poliomyelitis (Infantile Paralysis)

ELSEWHERE in this issue of the covers, are severe, and in many in- Health Bulletin we are pub- stances last for life. We have in mind lishing two maps. These maps as these lines are being written a most indicate the particular county in North prominent lawyer of this State who has Carolina where a death occurred dur- had a great deal of trouble with an ing the last year from typhoid fever, infected leg and foot for thirty years indicated on one map, and poliomyeli- after a severe case of typhoid fever. tis, or infantile paralysis, indicated on We know a woman living in Raleigh the other map. Each large black spot who still has trouble from a compli- on the maps indicates one death. On cation following a case of typhoid fever one of the maps the black mark will which occurred thirty-five years ago. indicate a death from poliomyelitis and Poliomyelitis is a disease in which on the other map the black mark will little is definitely known about it, in indicate one death from typhoid fever. so far as preventive measures are con- It will be noted by a study of the cerned. Numerous vaccines have been maps that typhoid fever cost the lives tried, all of which at present are in of 79 people last year. Poliomyelitis, the experimental stage. No one knows on the other hand, cost the lives of 67 the exact and definite specific cause, people. During the same period doc- although some progress is being made tors of the State reported 675 cases of along this line. As stated above, the poliomyelitis. They reported also 645 deaths occurring among cases resulting cases of typhoid fever. It will be seen from attacks of poliomyelitis are fewer therefore that the death rate, accord- than in the same number of people having to cases, was greater among the ing attacks of typhoid fever. The people having typhoid fever than it complications, with the exception of a was among those having poliomyelitis. small percentage of cases, are no worse We are publishing these comparisons than those of typhoid fever. It is true because we feel that deaths from ty- that a few attacks result in permanent phoid fever are just as final as deaths impairment for life in crippling suf- from poliomyelitis or any other con- ficiently to put the patient possibly on dition. crutches for life. It is this spectacular For a number of years physicians result of a few attacks on a few people and health officers have known defi- and the mystery that still surrounds nitely how to prevent typhoid fever. the attacks which have so horrified It is easy to prevent, but it re- people throughout the country that quires the cooperation of all the communities and even states become people of the State and the Nation. upset when cases are reported, to The causes of typhoid fever are defi- an extent entirely unjustified by the nitely known. Through sanitation and facts when studying the history of the the use of a special vaccine, if carried disease. The 675 cases reported in out on the part of all the people of the North Carolina last year with the 67 country, the disease would be entirely deaths resulting aroused a thousand eliminated. Another consideration is times more apprehension on the part of that in typhoid fever the complications the people than did the 645 people with resulting from a severe attack of this the 79 deaths resulting from typhoid disease, even though the patient re- fever. ; :

March, 1936 The Health Bulletin

We would not, under any circum- person who has had an attack of the stances, try to discount the seriousness disease, who recovers, but who after- of a case of poliomyelitis or of the outward, sometimes for life, harbor the break in a community of that disease germs and therefore may infect a it is sufficient to arouse the parents of susceptible and unprotected person children everywhere when cases occur upon contact. Vaccination probably in a community parents are also justi- ; affords the best protection against the in fied undertaking to keep their chil- carrier. dren out of such communities when the We are much gratified to know that disease is prevalent. We would, how- even though there were more cases of ever, undertake to impress again, for typhoid fever last year than the year the millionth time, upon the minds of before there the people the importance and the dan- were fewer deaths last gers of an outbreak of typhoid fever. year in the State than ever before, The control, to its present status, of although there should have been no typhoid fever is one of the most glor- deaths from the disease, and there

ious achievements of preventive medi- should be no cases to report. It is cine during the last thirty years. But possible that as summer approaches the disease has not been eliminated. If again this year there will be an in- precautions all along the line should crease in the number of cases of polio- be suspended for one year even, the myelitis as well as typhoid fever. We disease would probably be back in all hope, however, that neither of the dis- its devastating fury, and be much more eases will be prevalent serious to the public at large than an to the extent of outbreak of poliomyelitis. last year, and we surely hope that One of the potential dangers in there will be no outbreak at all this typhoid fever is the carrier. That is a year of poliomyelitis.

Hospital Care

DURING the past year or two in aminations, and all the different es- numerous sections of the State sentials to a stay in the hospital with- hospital care associations have out any additional charge to the pa- been formed. Many of these organiza- tient. The patient, of course, selects tions are conducted on a legitimate and and pays his own physician, and also helpful basis. All of them are organ- is privileged to select any hospital ized on a commercial basis and seem which recognizes the association. to provide the assurance of a limited Mrs. Mary R. Campbell, of Asheville, number of days in each year of hospi- who is local secretary of the Hospital tal care to people who join the asso- Care Association, Incorporated, of that ciations and who pay a small monthly city, is so enthusiastic about the con- fee. The idea is that this small fee, tribution her association has made to paid in by a large group of people, is community health in the city of Ashe- sufficient to provide hospital care for ville that she has written a poem ex-

any of the number who need it during pressing her sentiments. We quote the year—that is, for a limited number below of days, of course. Wise and Othebwise

By hospital care is meant a room There was a man, thoughtless and gay, never looked and a bed, nursing service, operating Who ahead a day, But spent his money, every dime, room fees, anasthesia, drugs, X-ray ex- On food and clothes and a good time. ;

March, 1936 6 The Health Bulletin

His wife would worry, for well she And then one day, down was he struck knew, O, that poor man, such awful luck. hospital room was then his lot, The time would come when he would A And he knew that money he had it not. rue his for that time Not saving money, "Had I but joined the Hospital Care, when my mind would now be light as air. We go to a hospital, "One out of ten." But I wasted my money, so how can I pay bill? I no way." But he would say, "We're of the nine, This hospital see But neighbor Jones joined Hospital Who won't be sick, so why repine? Care Why spend money, tho the cost be And is never troubled by this night- small, mare. When we may not be sick at all?" He can enjoy a nice vacation, Protected by the Association.

Winston-Salem Has Enviable Health Record in 1935

R. L. Carlton, city health record is one of which the city should Dr.officer of Winston-Salem, has be proud. kindly supplied us with copies of For several years the health depart- his report for 1935. There are at least ment in Winston-Salem has been carry- three things in his report for which ing on an excellent program in the that city as well as the entire State schools. School health supervision in should be grateful. First, the city en- the city means exactly what it says. joyed the lowest general death rate There is intensive work done throughout the school year by a competent ever recorded ; second, the lowest infant mortality rate, and third, the lowest staff of physicians and nurses engaged tuberculosis death rate by a good many in the work. We feel sure that the health points. The infant deaths, that is, following summary of school those under one year of age, num- work done in the city schools by the the bered 127 in 1935. In 1934 there were health department, quoted from 157 deaths in the same age group. The Winston-Salem Journal, will be of in- foregoing number of deaths give the terest to all of our readers. per thousand live city a rate of 75 28,214 Children Examined in Schools compared with births for the year, as Here Last Year a rate of 97 per thousand live births for the previous year. The city ex- "Health officials reported here yes- perienced no epidemics from any dis- terday that 28,214 routine and special ease, and there were three thousand examinations of children were made in fewer cases of communicable diseases 1935 in efforts to find, control and pre- than were present the previous year. vent communicable diseases. There were marked decreases in deaths "The examinations were made by from such preventable diseases as physicians and nurses of the Health tuberculosis, diphtheria, measles, scar- Department, who made 360 and 1.235 let fever, and the diarrheas of infancy. visits respectively to schools during On the debit side of the record was an the year in connection with the city's increase in the number of stillbirths, program.

deaths from pellagra, and maternal "Thirty-six children were given com- i

' deaths. On the whole, however, the plete examinations. Nearly 100 who —

March, 1936 The Health Bulletin

were to enter strenuous athletic compe- "One hundred and two students were tition were carefully looked over while excluded from school because of skin 2,238 children were given various forms conditions, most of which was reported of first aid. as scabies and pediculosis. "Physicians vaccinated 877 school "Eye trouble was responsible for 18 children and 432 pre-school children exclusions, throat conditions for 11; during the year. Examinations were exposure to communicable diseases, made of 542 children in the pre-school 124 ; ear conditions, 5 ; and miscellan- clinic. eous conditions, 26. "The Schick test reportedly was "Health authorities pronounced the given to 1,3S0 children to determine small number of exclusions to 'indicate diphtheria susceptibility. Toxoid was a good health year' for the more than given to 384 positive reactors. 15,000 children in the city schools. "The Matoux (tuberculosis) test was "The school health work was car- administered to 3S2 students, most of ried on as only a part of the duties of them seniors in the high schools, fol- seven nurses and one physician, who lowed by physical examinations and had many additional duties. x-rays of the positive reactors. " 'The staff of health workers for our "There were 699 students excluded little army of school children from school for various reasons during needs to the year, officials stated. The majority, be brought up to its former strength of 405, were sent home because of high considerably more workers than now temperature and general ill conditions available,' health authorities stated in of health. comment on the annual report."

More Facts About Milk

By John Andrews, Junior Engineer, State Board of Health

(This presentation is a dialogue between John Andrews, an engineer with the State Board of Health, and Mrs. Walter Parsons. They have just met on the street. It is suitable for a radio broadcast or for a play at school. Editor.)

Andrews: Good morning, Mrs. Par- to "get acquainted" with their families sons. I hope you had a very pleasant again.

New Tear's day and I hope that in 1936 Andrews : You are very philosophical your cup of happiness will be "filled to today, Mrs. Parsons. I see the stay at home program has had its effect on overflowing." you, too ! But I know that we all have

Parsons : The same to you ! I had a enjoyed the warmth and comfort of very pleasant New Year's day. I spent our homes and have avoided, as much as possible going out into the cold and the whole day at home by the fire writ- snow. But some people have not been ing letters and reading. This wintry able to stay inside by their fires during weather certainly keeps one close to the cold weather. I think we should the family hearthstone. I heard some express our appreciation to all the people who have braved the elements commentator remark recently that to bring us each day the necessities of people have stayed at home more this life. I mean the delivery people, the mail carrier, the past Christmas than in a long, long paper carrier, the milkman and all the rest. time, and I think it has been very Parsons : You ax*e right. We have beneficial to many families to have this grown so accustomed to many things which are really luxuries that we ex- opportunity to be together. I suppose pect them without thinking about the people many were glad of this chance (Continued on Page 10) 8 The Health Bulletin March, 19S6

o i -J X < 5: X

ic UJ March. 19S6 The Health Bulletin

I <0

< 10 The Health Bulletin March, 1936

MORE FACTS ABOUT MILK methods of controlling the process were (Continued from Page 7) not so accurate as they are today. Un- doubtedly quite a lot of the early pas- difficulties and discomforts that fre- teurized milk did have a cooked taste. quently beset the people who make People learned this and it became a them possible. I don't mean to change common belief that pastuerized milk abruptly the subject of our conversa- naturally had a different flavor, and tion, but when you mentioned the milk- that if milk was pasteurized it just man you reminded me of several more must have this distinctive flavor. This questions I want to ask you. I remem- belief still lingers in the minds of ber that some time ago we discussed many people, even though a cooked the great food value of milk, the abso- flavor is not now characteristic of lute necessity for sanitation and clean- pasteurized milk. liness in every step of milk production, is phase to and the responsibility of the public There another the prob- too. It is true that modern equip- health organizations to make sure that lem ment and methods have eliminated such milk offered for sale is safe for human flavors the milk in its state consumption. But at that time we said when raw is clean and wholesome. However, even very little about the pasteurization of with modern equipment and methods, milk. I know that the State Board of Health advocates the use of pasteur- objectionable flavors may develop when an unclean milk is treated. Per- ized milk. raw sonally, I regard this tendency for the Andrews : Yes indeed ! The State appearance of such flavors in unclean Board of Health recommends that pasteurized milk to be very helpful to people use milk which has been prop- the efforts of the health departments erly pasteurized. The resulting pro- to improve the quality of the milk used duct is as safe for human consumption in pasteurization, since no plant can as we know how to make it. And we successfully sell milk which the cus- don't regard pasteurization as a "cure- tomers find unpalatable. all" or as a means of producing a Numerous tests have shown that the clean, wholesome, safe milk from an proper pasteurizing of clean wholesome inferior raw milk. The State Board raw milk causes no perceptible change of Health urges the production of raw in its flavor. Further evidence of the milk which is as clean, wholesome and truth of this statement is the fact that safe as it is possible to obtain with we now have practically no complaints modern, sanitary methods, and the about such flavors. pasteurization of this milk, in a plant equipped and constructed in such a You said. Mrs. Parsons, that some of manner that the milk can be properly your friends cannot drink pasteurized pasteurized, cooled and bottled, and be milk because of its taste. I wonder have heard raise subjected to no re-contamination. how many people you pasteurized milk with- Properly pasteurized milk is the safest this objection to milk we know how to produce today. in the last year or two.

: Well, I don't know. Now Parsons : I always drink pasteurized Parsons milk, but what of the people who can't that I think of it, probably only one or drink it? two people have mentioned it. although I admit that now I can't recall Andrews : Do you mean people who must live in a town in which pasteurized who they were. milk is not available? I believe you're right, now that I it. I suppose I have just gone Parsons : No, I mean people who think of can't drink milk which has been pas- on believing that pasteurized milk teurized—people who find its flavor ob- tastes different, in spite of the evidence jectionable. I especially want to know of my "taster" which shows that it why some people say that pasteurized does not. milk has a cooked taste whereas others Andrews : The next time you hear don't notice any such flavor. I drink anyone say that pasteurized milk has a pasteurized milk and I don't notice a special flavor I wish you would pass cooked flavor. on the things we have just said, and ask him to a careful test, himself. Andrews : The answer to that ques- make last tion is a long story. Today, properly Parsons: I certainly will. The pasteurized milk of good quality does time we talked you spoke of the fact not taste different from the raw prod- that the Hebrews, Mongols. Vikings, for the uct. But years ago when the pasteuri- and others had a high regard that zation of milk was first begun, equip- food value of milk. Now I know dairy ment was not so efficient, and the the ancient people had no large March, 1936 The Health Bulletin 11

Industry such as we have now in the perature of 160 degrees Fahrenheit and United States. Most families kept a holding for 15 seconds. cow or two and probably sold a little Parsons : Is pasteurization as effec- milk to the neighbors. This condition tive as boiling? existed, I suppose for thousands of Andrews : From the public health years. Then a few years ago, the pres- point of view, pasteurization is equal ent dairy industry sprang up within a to boiling, since it destroys the germs few decades. I know, of course, that which cause disease in man. most industries have had a tremendous Parsons : I suppose, then, it is the growth in the past century owing to policy of public health departments to the inventions, and the like, but I want promote the consumption of pasteurized to know some of the factors applying milk, and to discourage the use of raw particularly to the dairy industry. milk. I wonder whether or not that

Andrews : The development of the is the proper attitude. Milk is such modern dairy industry was largely due a good food—I believe you call it "the to several inventions, and may be said most nearly perfect food" — that I to have begun about the middle of the should think you would encourage the nineteenth century. More important use of any milk, whether pasteurized than any invention, of course, was the or raw, and whether clean or unclean. development of chemistry and bacter- Andrews : You are partly right about iology, which enabled us to discover our policy, but you are partly wrong, the character of milk and its proper- also. We do encourage the consump- ties and which revealed the tremend- tion of pasteurized milk, but we do not ous importance of the bacteria, thus discourage the use of raw milk. We leading to knowledge of the reasons urge people to drink plenty of clean, for the souring of milk and the possi- wholesome milk, and point out the bilities of transmitting disease by un- fact that in order for milk to be made clean milk. Of the inventions, artificial as safe as we know how to make it, it refrigeration, the cream separator and must be properly pasteurized. We do the Babcock test are of major import- use all methods at our disposal to pro- ance. mote and increase the use of pasteur- The development of scientific breed- ized milk. However, we cannot recom- ing of cattle and of scientific feeding mend the use of any milk which is not have enabled the milk production per obtained from clean, healthy cows, and cow to be doubled. The economic value handled by clean, healthy people in of this development is obvious. clean equipment, and in clean surround- Without artificial refrigeration, it ings. would be impossible for a large portion Parsons : Just what do you mean by of the people of the United States to clean? Naturally I know what cleanli- obtain milk which is safe for human ness is, but what means do you use in consumption. Proper cooling inhibits judging which dairies produce clean the growth of bacteria, those which milk and which produce unclean milk? cause milk to sour, and those which Andrews : By inspecting these dairies cause disease in man. In many parts at frequent intervals, and seeing that of Europe and South America artificial they meet the requirements of the refrigeration is lacking and the house- United States Public Health Service wives boil the milk to keep it from Milk Ordinance. souring. It is interesting to notice that Parsons : Oh. of course, that's it ! I there is practically no milk-borne dis- remember now. That is a "model" ease in those countries in which the milk ordinance prepared by the U. S. milk is boiled. This fact shows the Public Health Service and recom- effectiveness of boiling, and indicates mended for adoption by the individual that we could obtain the same results towns and counties, is it not? in this country by pasteurizing all milk. Andrews : That's right. This ordi- Parsons: Just what is the difference nance has been very carefully prepared, between boiling and pasteurizing? taking advantage of the advice of many

Andrews : In boiling, the milk is authorities, and is, we believe, the best heated to a temperature of about 212 existing means of securing proper sani- degrees Fahrenheit. In pasteurization, tary conditions at our dairies and pas- the milk is usually heated to a tem- teurizing plants. The ordinance pro- perature of only 142 degrees Fahren- vides for the necessary inspection heit and held at that temperature for service and laboratory examinations, 30 minutes. Another method of pas- and it goes into all the necessary detail teurization involves heating to a tem- of setting forth the minimum require- : :

12 The Health Bulletin March, 1936

ments for sanitation in the handling towns on their routes they may expect and processing of milk. Many dairy- to secure clean, safe milk. men do much more than is necessary Parsons: Don't all North Carolina to meet the minimum requirements, restaurants and cafes serve Grade A and we naturally encourage this ten- Milk? dency. Andrews : All first class restaurants The U. S. Public Health Service Milk and cafes must serve the highest grade Ordinance has already been adopted of milk available. In most portions of by more than 100 municipalities in the State Grade A Pasteurized or Grade North Carolina and by more than 600 A Raw Milk is available. communities in the United States. Parsons : Is it not also true that

Parsons : How is the public informed cafes must serve milk in its original of the condition of the dairies? container, with the cap still in place,

Andrews : The dairies and plants are so that customers may see on the cap graded several times a year on the basis the grade of the product? of compliance with the ordinance. The Andrews: That is right. sale of inferior grades of milk is pro- Parsons : That seems a very reason- hibited, and the grades of all dairies able requirement. If I go into a res- are published in the local newspapers. taurant and buy milk, I am certainly At least once every two years a Fed- entitled to know what kind of milk I eral survey is made, and the milk sup- receive. ply of each town in given a percentage Andrews: The better restaurants rating. The names of all towns having recognize this fact and serve milk that a rating of over 90 per cent are pub- way. If anyone should neglect this lished by the U. S. Public Health Serv- simple rule, I suggest that you call it ice in its Public Health Reports. That to his attention. organization hopes that as the ordi- Parsons : I most certainly will. But nance is adopted and properly en- now I simply must be going, I'm late forced by more and more towns for an appointment already. Thanks throughout the nation, their tabulations so much for the information, and I'm of the milk ratings of cities will in going to think up some more questions time become a guide which tourists and to ask you the next time. Good bye. travellers may use to find out at which Andrews : Good bye, Mrs. Parsons.

Charlotte Maternity Clinic Report for 1935

are indebted to Dr. W. Z. Bradford of Charlotte for a report of the WE clinic work of the maternity conducted there by the Health Department. The report presents the summary of the work done during the year 1935. For the especial benefit of other cities where the local health departments and physicians may be carrying on such work or planning to do so, we are publishing the entire summary as submitted. It will be noted that both the maternity as well as neonatal death rate was gratifyingly low. The report follows:

Prenatal Service Syphilis New Patients 676 Wassermans taken 676 White Patients 124 Positive Wassermans (26%) 176 City White 70 Treatments given 745 County White 54 Luetic Patients del 143 Colored Patients 552 Living Children 123 City Colored 385 Stillbirths 11 County Colored 167 Miscarriages 9 Visits to Clinic 3217 White Patients 440 Delivery Service: City White 268 County White 172 Number of Deliveries 552 Colored Patients 2777 White Patients 112 City Colored 2205 County White 38 County Colored 572 City White 74 : : :

March, 1936 The Health Bulletin 13

Colored Patients 440 Premature separation of County Colored 120 Placenta 2 City Colored 320 Prolapsed Cord 1 Home Deliveries 468 Unknown 4 Hospital Deliveries 84 Neonatal Deaths 9 Patients Receiving Prenatal Care 497 Etiology Patients Not Receiving Prenatal Hydrocephalus 1 Care 55 Premature 4 Visits by Students 3421 Spina Bifida 1 Spontaneous Deliveries 530 Syphilis 1 Operative Deliveries 22 Unknown 2 Version and Extraction 1 Maternal Deaths 3 Mid-Pelvic Forceps 8 Low Forceps 5 Etiology Cesarean Section 7 Utero Placental Apoplexy.. 1 Porro-Cesarean Section 1 Pelvic Peritonitis and Pneumonia 1 Mortality Tuberculous Peritonitis, Miscarriages 14 death 3 months Post- Etiology partum 1 Syphilis 9 Toxemias 33 Chronic Nephritis 1 Nephritic 5 Unknown 4 Eclamptic 1 Stillbirths 20 (3.62%) Pre-Eclamptic 13 Etiology Hypertension 11 Syphilis 11 Chronic Nephritic 2 Toxemia 2 Diabetic 1

On Psychiatric Mediaevalism

By James K. Hall, M.D. In Southern Medicine and Surgery OUT in Saint Louis the other day, by politicians and by other laymen at the meeting of the Southern who know nothing about medicine. Medical Association, Dr. W. L. How can progress ever come out of Treadway, Assistant Surgeon General, ignorance? Most State hospitals are Division of Mental Hygiene, United managed by boards of directors com- States Public Health Service, Washing- posed of laymen — politicians and so- ton, read a paper before the Section on called business men. The responsibil- Neurology and Psychiatry. He dis- ity of selecting the medical superin-

cussed : The Significance and Content tendents of such hospitals is given to of Mental Health Administration. The such lay boards. And not infrequently paper should be read by every physician they elect as superintendent a physi- in the country and by all intelligent cian who knows no more about psy- laymen. I remember that Dr. Treadway chiatry than the family doctor knows, remarked that psychiatry, as a public and who knows nothing at all about health problem, is being dealt with hospital administration. Here in Vir- about as stupidly as public health ginia the five State hospitals and sev- folks dealt with physical diseases eral allied institutions function in a eighty years ago. And he added that general way under the auspices of the there is no hope of the situation's be- State Board of Public Welfare. But ing any better so long as the manage- that is an organization of laymen, un- ment of mental hospitals is controlled trained in psychiatry and inexperienced !

March, 1936 14 The Health Bulletin in hospital management. Per contra, Time was, of course, and not so long the State Board of Health is composed ago, when the medical colleges gave no largely of physicians, and the Presi- instruction in the diagnosis and the dent of the Board is a physician. Yet treatment of mental sickness. But that no intelligent person can believe that time is passed. All medical schools the problems with which the Boards of now give some instruction in psychia- Directors of the State Hospitals deal try, and the younger physicians know are smaller or less complex than those something about the importance of with which the State Board of Health mental hygiene. I am wondering how deals. Why are those conditions re- much longer the younger doctors are lating to mental sickness handled by going to be willing for laymen to have laymen, and those caused by disease charge of every State's biggest and of the body cared for by physicians? most difficult medical problem—mental Who knows? sickness.

Dr. Farrell and Miss Beam Complete Work in County

County Health Board Expresses Appreciation for Services Rendered School Children by State Dentist and Nurse; Urges Follow-Up Work on Part of Parents. MONDAY was a regular meeting That is, the teeth of each of the 1.205 cleaned, then fillings, re- day for the county board of children were other operations were done health, at which time gratifying movals or necessary to get the mouth in good progress in the county health became as the figures mean that each known, but also some serious points of shape. And have almost four opera- weakness. child had to tions, which seems to spell a bad story J. F. Allen is chairman; Mrs. H. J.

neglect ! But now we have at Dockery, secretary, and Dr. B. J. Mc- of oral 1,205 children in the county Googan, of Morven; Dr. J. F. William- least whose teeth should not be any hin- son, Dr. C. I. Allen, Mayor L. D. Rivers their health for a long while. are the remaining members. All were drance to did $5,- present except the last two named. At private rates, Dr. Farrell of dental work. It's $4,- Dr. J. H. Bennett is county health of- 594 worth charity rates ficer. The board meets three times a 991.50 at year. The schools were enthusiastic over Improvements deserving the public Dr. Farrell's work. All the principals notice at this time include the splendid want it again next year. work by Miss Cora Beam, State done Board Appreciates nurse, and Dr. W. I. Farrell, State special ap- dentist, among the school children of The board expressed the county. preciation of Dr. Farrell's excellent Dentist's Work work for the school children of the

Dr. Farrell completed his work here county. observation just this week for the time being. He An interesting incidental examined and treated the teeth of 1,- is that about GOO of those whose teeth repeaters in 205 children, for whom 4,3S9 separate had to be treated were operations were done besides cleaning. their school work—that is, half of those : —

March. 1936 The Health Bulletin 15

backward dentally were found to be The local hoard went on record with backward mentally, which at least sug- a recommendation that the families of gests a definite relation between physi- these children with physical defects cal and mental health. should follow up the nurse's reports with the needed corrections, removing Nurse Reports the tonsils or adenoids, or getting Miss Cora Beam completed her work glasses, etc., as may be necessary. of physical defects in the examination Where parents are unable to do this, other than teeth just before Christmas. local organizations, primarily the She had been working here since Sep- Parent-Teachers associations, will be tember. In that time she examined urged to do what they can to help. 5,177 children and found 3,222 with The board again considered a wholesome form of physical defect—that's time health department for about 62 per cent. Miss Beam called Anson and attention to the fact that only a small expressed approval of such an import- number of the children were vaccinated ant move for our county welfare. against smallpox, as the law requires. Anson News.

Cabarrus School Children Like Their Dentist

By Richard C. Montague

journeyed out to Hartsell school It is quite interesting, this method 1 yesterday. Not that I particularly used to teach the children oral hygiene. wanted to see the school itself, but Dr. Smith, although performing some I had heard many interesting things actual work on the teeth, stresses most- about the work one Dr. Marcus R. ly the educational angle. He does this Smith, school dentist for Cabarrus by demonstration. County from the Some of the children have never been Division of Oral to a dentist. It is necessary to ac- Hygiene of the quaint them with one—and make it State Board of pleasant. Stories from the outside so

Health, was doing often have made it sound rather hor- and being of a rible and painful. curious nature Dr. Smith has his models—both of wanted to look in good and bad mouths—for the demon- on the dental strations and his examples keep the clinic program children in rapt attention. Stories are while in progress. used to illustrate the benefit of nourish- This is the ing vegetables on the teeth and the fourth year that harm caused by sweets. Mb. Montague the clinic has been The dentist gains the confidence of held and the third these children. He takes them right year Dr. Smith has been conducting the into his friendship—they become bud- work. It is the first year, however, dies. It is always that I have been here, therefore the "Let's see what your teeth show to- first occasion offered for me to view day, Pee-Wee,"—or "Red," "Tubs" or the work. "Shorty."

Dr. Smith has spent two weeks in The children like it. They are not the Hartsell school and now moves on afraid to have him treat their mouths. around the circuit. His entire clinic It is impossible, however, to treat all will take 24 more weeks. the children needing work done, so Dr. —

16 The Health Bulletin March. 1936

Smith has cards made out by the teach- He explained to me, however, that ers and sent- to the homes of those he did not work on the children's mouths if word was sent by the parents children in need of dental attention. that they did not wish such treatment Then he treats those who are in given. Few do this, he continued, for most need of attention. most of them realize its benefits. I Dr. Smith has a complete portable left the school, with Dr. D. G. Cald- well, county health officer, whose de- dentist's outfit and takes it with him partment cooperates with the State in from school to school. There is a small carrying out this program, with a vast- sterilizer for the instruments, a fold- ly improved knowledge of dentistry and ing dentist's chair and a pedal drill, the care of the mouth. among other things needed in his work. There was a group of children, most of them having no previous contact Once up in the chair the youngsters with a dentist, who now felt confidence do not find themselves facing a in him. They knew the importance of changed man—a grim and businesslike oral hygiene and understood the part they could carry out and the necessity dentist. He is still their buddy. First, of going to the dentist. Dr. Smith hands them a mirror and Yes, these children will never be after examining their mouths again afraid of the dentist. They will keep points out the trouble to them—they their teeth in good condition and visit follow with interest, eyes searching in him often to ascertain the condition of the mirror. their teeth. And there will not be nearly so much Then the doctor begins his work ; he dental work necessary for these chil- extracts, fills, and cleans—whatever is future. have profited needed. Some teeth are treated with dren in the They the educational and corrective silver nitrate which acts as a tem- from clinic. Concord Tribune. porary agent in halting decay. dental NORTH CAROLINA BUREAU OF VITAL STATISTICS PROVISIONAL REPORT FOR 1935 1935 19Si 1 935 193U No. Rate No. Rate Total number deaths.,33,705 35,112 Epidemic cerebrospinal Death rate 10.1 10.6 meningitis 26 0.8 21 0.6 Total number births.,79,746 79,556 Rabies 5 0.1 1 0.03 Birth rate _ 23.9 24.1 Tetanus 27 0.8 24 0.7 Infant deaths (under Tuberculosis, pul- one year) _ 5,358 6,196 monary 1,759 52.7 1,937 58.6 •Infant mortality rate 67.2 77.9 Tuberculosis, other Maternal deaths . 523 605 forms 176 5.3 206 6.2 •Maternal mortality Syphilis, locomotor rate 6.6 7.6 ataxia, paresis 325 9.7 413 12.4 93 2.8 80 2.4 1935 19Si Malaria 1,728 51.8 1,784 54.0 No. Rate No. Rate Cancer, all forms Diabetes mellitus 349 10.4 386 11.7 Typhoid and para- Pellagra 387 11.6 436 13.2 2.8 typhoid fever 80 2.4 91 Pneumonia, all forms 3,089 92.6 3,176 96.1 Endemic typhus fever 2 0.06 2 0.06 Diarrhea and enteritis 2 0.06 Undulant fever (under 2 years) .... 743 22.3 1,001 30.3 Smallpox - Appenditicis 312 9.3 340 10.3 Measles 70 2.1 333 10.1 Puerperal septicemia 139 158 1 ) Scarlet fever 22 0.6 39 1.2 other 6.6 7.6 •Puerperal, ( | Whooping cough 299 9.0 427 12.9 forms 384 ) 447 > Diphtheria 158 4.7 207 6.3 Suicide 255 7.6 242 7.3 Influenza — 967 29.0 804 24.3 Homicide 368 11.0 469 14.2 Acute poliomyelitis and polioencephalitis .... 67 2.0 22 0.7 Preventable Accidents

accidents Air transportation ac- Automobile 10 0.S primary 978 29.3 875 26.5 cidents 4 0.1 drowning.. 140 4.2 108 3.3 Automobile and rail- Accidental and ac- road collisions 42 1.2 53 1.6 Conflagration 230 6.9 252 7.6 Other railroad acci- cidental burns traumatism dents 99 3.0 105 3.2 Accidental by firearms 88 2.6 117 3.6 1935 figures provisional. •Infant and maternal rates (per 1000 live births). pffife®Ib> fki

This Bu]ktir\willbe ser\t free to or\\j citizen of the State upor\ request !

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

Vol. 51 APRIL, 1936 No. 4

OLD COMPANY MILL NEAR CARY

The old water mill shown above was once owned by the father of Walter Hines Page. It is now the property of the Boy Scouts.

Dr. Edward J. Wood always contended that when the people consumed corn bread and wheat flour fresh from those old water mills, fruit, vegetables and meats of their own production, pellagra was unknown in North Carolina. ,

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

S. D. Craio, M.D., President _ _ Winston-Salem J. N. Johnson, D.D.S., Vice-President - - Goldsboro G. G. Dixon, M.D Ayden H. Lee 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

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 free to any citizen of the State on request to the State Board of Health, Raleigh, N. C.

Prenatal Care (by Mrs. Max West) Baby's Daily Time Cards : Under 5 months ; Prenatal Letters (series of nine 5 to G 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. 16 Breast Feeding Diet List: 9 to 12 months ; 12 to

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

CONTENTS PAOB

Notes and Comment j> Sanatorium Sun Ten Years Old °

; ." Pneumonia :";"";v , The State Board of Health Undertakes Work in the Field of Industrial Hygiene 11 Anti-Mosquito Campaigns *- Pellagra J* Extracts from County Health Officers' Reports Jo lb Death of Many Children Due to Carelessness with Drugs :

Vol. 51 APRIL, 1936 No. 4

Notes and Comment By The Editor

have repeatedly criticised in me that the chief motive is that there WEthese columns various schools is more profit in selling the candy, it is easier to handle, there is no loss by about over the State for the vic- decay, and no wastage in that respect, ious habit of selling candy and indi- but think how much the children suf- gestible cakes and such mess to the fer in so many ways by eating this cheap candy instead scbool children. It seems, however, of the proper nourishing food that they should have have paid any attention to that few in the middle of the day." us, and that we hav? done no good, if The foregoing is simply a sample we are to judge by the repeated reports of from our nurses now in the field com- the complaints our experienced school plaining about the underweight and nurses have made to us for many years lack of nourishment they find among in their weekly reports coming from tbe school children where such stuff is the various counties. These nurses, sold. It seems that some of the schools when they commenced their work six- themselves sell it in connection with teen years ago, found very few, if any, the so-called cafeteria service, or in school cafeterias in the State. They place of such service. themselves helped to carry on the agi- A recent report from one of our tation for what we then termed "hot nurses, who is, at present, working in school lunches" for the children. a large and wealthy county, has the Thousands of the children over the following complaint State today have the benefit of well- prepared school lunches, served in "This week I have worked in school. I think that they have a very cafeteria style, composing the kind of nice school and a fine system through- food children ought to have, such as out the school with the exception of a soups, vegetables, fruit, and milk—the store in the building in which they sell principal food serve'd in such cafeterias. so much candy. I can see now why they have so many children under- There are, however, a large number of weight and malnourished. I did my children yet left exposed to the pro- best to get them to sell fruit instead. miscuous sale of cheap candy, messy The principal uses the argument that cakes, and other indigestible and dam- the children are going to buy candy anyhow and the school had just as aging substances. As anyone with any well sell it and make the profit because sense knows, a young child, with a if the school did not sell it, the chil- nickel for lunch, if allowed the choice dren would go to a store nearby and of purchasing either five cents worth buy it anyhow. Then they would be subject to the danger of being run of candy, or five cents worth of sweet over by cars as they crossed the road milk or hot soup, will, every time, to the store. I think the children choose the candy. The granting of such could be punished for leaving the a choice is an injustice to the children. school grounds for any such purpose, and that would stop that. It seems to It is unfair to them and to their par- The Health Bulletin April, 1986 ents for the school system to be guilty This stuff is dangerous to use in ex- of subjecting them to any such tempta- cess over a long period. The fact is, tion. we have reports of at least one death The State Board of Health would in which prolapse of the bowel in an suggest that wherever such practice as elderly person first occurred, leading above described exists that it be dis- on to a hopeless condition which was continued at once. ended by death. And in the second place, the exploitation of such drugs has no place in a parent-teacher pro- WE hate the role of a kill-joy or gram or in a school curriculum. We stick to soap critic because nobody in the world, would advise folks to they do not. even a baseball umpire, is hated so coupons—no matter what may will upset perma- consistently as a critic; but it is neces- to clothes, they not of the sary for some things to be said once in nently the digestive system family or to magazine a while—in a constructive way, of members of the — form of course—which might eventually bring subscriptions or some other about the elimination of certain habits gentle graft. It is hopeless to try to the that are undesirable. educate people to the dangers and surrounding the patent Today, while we are buzzing around foolishness medicine industry, when the school sys- as a gadfly, we want to urge the tem leads off and teaches the children people in charge of the school system in their most formative years that all and the parent-teacher associations to such stuff is respectable and legitimate be scrupuously careful in accepting business. any kind of offer through which they In reporting the incident the nurse may be able to make a little money. takes a crack at many schools which One of our nurses was horrified last been teaching sanitation "from a spring at a largely attended parent- have teacher meeting in a county seat town. book" for years in many of the schools, They put on that afternoon a kind of white and colored, where there is none special health program. The nurse practiced whatever. In this connec- had been invited to talk, and did. The tion we repeat again what we have children put on a little health play, already published a time or two in which was good, and a brief report the Health Bulletin — the occasion was made by the nurse and others of when the late Charles L. Coon, one of the work that had been done for the the great school men of North Carolina, health of the children in the schools. who was superintendent of the Wilson The meeting was then climaxed by the city and county schools for so long. appearance on the platform of the wife walked into a grade room one morning of one of the most prominent citizens and found the teacher and the children in town, giving a report of how much all busily engaged studying hygiene and money they had received, made by sell- sanitation in "the book." Mr. Coon ing one of the most detestable purga- glanced around the room and saw that tive drugs now on the market, flying the broom had not been used in some wide and handsome under a fancy time. He noted the dirt piled in the name. We will not advertise the stuff corners of the room, the scraps of paper by calling the name, except to say that and the general disorder and dirty con- it is horse medicine which generally dition. Without a word, he took the sells for about a dime a pound, but book from the teacher, walked around put up in a pretty package under a the room, gathered up all the copies of disguised name it sells for $1.50 a "physiology and hygiene," took them in pound. his arms, and at the door he said. "We April, 1936 The Health Bulletin

will now study practical physiology they want in the way of improved and hygiene and sanitation for the facilities for their children. next hour. Go get the broom and go get After all, it is a matter of attitude a bucket of water and a mop, and get a and ideals. Sometime ago an old law- duster, and let us see if this room can- yer who had been mayor of his town not be cleaned up and a little practical and had practically run its affairs for sanitation taught." a long time was arguing against the To illustrate further, one nurse re- installation of a public water supply. ported working in a school up in a He stated that he had been brought up in basin, mountain county last winter, a large a and had got along very well. He might have stated that his school with no sanitary or toilet facili- ancestors, had he gone back far enough, ties of any kind available to teachers used a wooden plow, and when the or pupils on the school ground, and yet corn was made, carried it to the over- they were all rearing and holding mass shot water mill, strung across the meetings to petition the Washington horse's back, with a rock in one end people to lend them five thousand dol- of the bag to balance the corn in the lars to build a gymnasium. other end, not having sense enough to The times or something is badly out divide the corn into two parts, and so of joint when such things happen. It to carry twice as much at a load as may be a reflection on the State Board when using the rock ballast. of Health and its Health Education De- All of these things are problems to partment, and probably is, although the be settled by the right kind of educa- Board has been doing its best for a

tion ; hence our lecture at this time. long number of years to keep constant- The moral of the foregoing is that ly before the people of the State the we hope this year more will be done needs for practical sanitation and for for the protection of the school child's the health care of the children in the health and the advancement of per- schools. It feels that it has done its sonal hygiene and sanitation than has best with the means at its command, ever been accomplished in one year but at the same time it feels somewhat before in this State. discouraged to know that sanitation is yet an unknown quantity to so many people in the State. To be fair, we present the other side C INCE the above items were written of the picture, which is encouraging. we have received some additional

That is, during the past twenty years information which constitutes more or there has been a marvelous improve- less interesting comments on our fore- ment in the sanitary facilities in many going editorials. TVe will present the schools of the State, and the rank and best first. The superintendent of Hyde file of the teaching profession now County has written us, sending along realize the necessity for health work a copy of a letter he had written to the in the schools and joyfully welcome the head of a local school prohibiting the representatives of the Board of Health sale of candy in the school building or wherever and whenever they appear. on the school grounds by the school sys- Our criticism is not directed at the tem itself or by any representative. He teachers, who bear the brunt of the went on to insist that the midday work, but toward the school authori- lunch should be a nourishing, well- ties and now and then a principal who prepared lunch which would be good has no interest in these things and. for the children, and not be harmful. most of all, against the people of such Such action as Mr. Gallop, the superin- communities who generallv have what tendent in Hyde County has taken 6 The Health Bulletin April, 1936

should be highly commended, and his ing, say, from an acute attack of ap- example should be followed by all the pendicitis if that person wasted valu- school officials throughout the length able time experimenting with such and breadth of North Carolina. worthless remedies as are made up and The other information which we sold under the sacred name of the drug herewith pass along is not so encourag- trade business. It would seem again, after reading such ing. In fact, it is badly discouraging, an advertisement, that the first thought which would but it has no direct relation to the come to an intelligent person would be schools one way or another, except in the need for a house-cleaning in the so far as the schools may be charged business world itself. Now and then we with failure to educate the children hear an orator get up in front of the about the dangers inherent in the radio microphone or on a rostrum to promiscuous sale and consumption of bleat away about the necessity for hav- the most disreputable of so-called ing a business man as governor or patent medicines. Dr. Floyd Johnson, sheriff, or whatever it happens to be. of Columbus County, recently sent us As long as business, so-called, tolerates a copy of a local newspaper, published and encourages such methods, and as at Whiteville, in which appeared a long as editors prostitute their privi- large display advertisement from a lege in running such advertisements, medicine concern having headquarters we pray to be delivered from a busi- in South Carolina. The name of this ness administration of any kind. concern we will omit, but it has the same name of a great institution at present on the lips of most of the peo- A T the time Doctor Johnson sent us ple in North Carolina, as well as in the foregoing clipping, a friend South Carolina, very frequently. In from a small village far in the large type, at the beginning, this ad- up Smoky Mountains wrote us as follows: vertisement says : "If you are suffering from any of these diseases or condi- "I am enclosing a label taken from a tions, we have the best known medi- bottle of medicine being sold by a man cine treatment that will relieve, get going through the country gathering you well and cure quickly in 80 per up the ill-to-be spared money of these cent cases and many 100 per cent." gullible people, and, where there is no They then list in the advertisement in money, taking chickens, etc. The label this reputable weekly paper fifty-seven speaks for itself." We might as well diseases which they promise cures in quote from the article right here: from "80 to 100 per cent." These dis- "Herb Tonic, recommended for high eases range from appendicitis to vari- and low blood pressure, rheumatism, cose veins. The list of these 80 to 100 kidney, bladder, liver, and stomach per cent cures includes paralysis, no troubles, including pellagra, nerves, in- matter from what cause, syphilis, pneu- digestion and constipation." monia, arthritis, diabetes, and so on. Quoting further from our correspon- It does seem that people who are in- dent's letter: "Of those right around telligent enough to read a newspaper me, one has bought it for rheumatism, would know that such an advertise- two for 'nerves,' one for pellagra, and ment was false from beginning to end. one for stomach trouble, another for The worthless drugs sold under such a liver trouble (his diagnosis). All tell promise not only do immense damage with such confidence when remon- !' to the patient's health, but cause an strated with, 'But he guaranteed it irreparable waste of time. Imagine We are hoping you can do something what might happen to a person suffer- about this, I am confident, very harm- April, 1936 The Health Bulletin ful imposition. Two of this group paid in reserve sufficient horse and buggy him five dollars each for a 'whole treat- transportation to reach their patients ment.' Those reported are people just when necessary. Another thing, the at hand who have voluntarily reported, old Ford Model T was built so high off with pride. I fear it has been the same the ground that it would just about all around this community, and no one negotiate any road that a horse and knows how many more." buggy could get over.

Our friend probably expressed the None of our great systems of hard feeling of a majority of the people who surfaced highways had even been con- buy such worthless stuff and expect it templated previous to 1918. For the to help them of various and sundry ail- past few years the winters have not ments, in the expression "he guaran- been severe, the roads have been open teed it." Very few people stop and practically all the winter, and at the consider that a guarantee is worth no same time practically all automobiles more and no less than the reliability sold have been built lower and lower to of the individual or company making the ground. So this winter, when the the guarantee. After years in the busi- roads became impassable, there being ness of the study and practice of medi- few horses and buggies to fall back on, cine and mingling with our fellow many people all over the State have humans in their joys and their distress, suffered for the want of medical at- in sickness and in health, we have tention. It is hoped that never again about reached the conclusion that a will the same conditions prevail. It has rather large percentage of human be- not only been hard on the sick patients, ings immensely enjoy being humbugged. but it has been equally hard on the If they do not, why do they keep on physicians. They have undergone a patronizing the charlatans? great deal of exposure and have suffered many hardships like those thousands of us in private practice went through twenty and thirty years ago TV7ITH the sunshine and showers and practically every winter. Reports from blossoms April affording definite of many sections indicate that the physi- evidence that the winter is behind us, cians and the people have met the and a winter which will long re- be difficulties with fortitude and courage, membered for its extreme weather and and we therefore hope that there have the damage to our public road system. been a minimum number of deaths re- desire call attention fea- we to to one sulting from inability to procure a ture which has not been emphasized physician's service when sorely needed. elsewhere. It is the great suffering that has been endured by a large number of people living off the hard sur- A CHECK-UP on hookworm disease faced highways, who have had such is being made in seventy counties great difficulty in procuring the serv- in the State to determine what the in- ices of physicians, when ill, during the fection is today. The survey is being months of January and February. Up made under the direction of the State to 1918, the last severe winter in this Board of Health and in only those State physicians ; doing any consider- counties which showed a 20 per cent able amount of country practice kept infection in 1914. The Health Bulletin .4/»-/7, 1936

Sanatorium Sun Ten Years Old

The March issue of the Sanatorium 1935 there were 1935 deaths from Sun is an anniversary number. With tuberculosis in North Carolina, which the issue of March, that very interest- constituted a rate of 58 per hundred ing and helpful publication was ten thousand population. To be more years old. It seems only just the other specific, in 1935 the State had probably day that our friend Miss Sudie Pyatt a half million more inhabitants than it launched that undertaking. It was to did in 1925, but it had 825 fewer be supported by a small subscription deaths from tuberculosis. price and advertising. Every number It would seem, therefore, to be ap- since the first issue has carried helpful parent to any observing person that the information to the people interested in fight against tuberculosis is a winning tuberculosis—and that should be every one. It shoidd only be a matter of person in the State. time when the disease may be elimi- Not long ago the Extension Depart- nated entirely from our State. At ment of the Sanatorium was able to present there are a number of well- take the journal over and publish it conducted county sanatoria, and the in connection with the regular Sana- State itself is now beginning the con- torium work. Several years ago Miss struction of its new AYestern State Pyatt resigned and Mr. John M. Gib- Sanatorium near Asheville. That build- son became the editor. Since becoming ing should stand until the time comes a regular and official part of the ex- when not a bed will be occupied by tension work under the able direction tuberculosis patients. of Mr. Gibson, the Sun has extended its We herewith extend our congratula- influence. tions to Dr. McCain, Dr. McBrayer, and Mr. Gibson and all the others who It is interesting to make a compari- have been associated so long with the son in the tuberculosis situation ten work against tuberculosis in this years ago and today. In 1925, the year State. We hope that as long as there before the Sun was established, there are any tuberculosis patients left that were 2750 deaths from tuberculosis the Sanatorium Sun may continue to reported to the State Board of Health. carry its message of hope and cheer as That constituted a death rate of 89 well as its valuable information to all per hundred thousand population. In such patients.

Pneumonia

By It. E. Fox, M.D., Director, D ivision of County Health Work LAST year in North Carolina this The provisional report as compiled by disease claimed more lives than the Bureau of Vital Statistics of the any other condition responsible North Carolina State Board of Health for death, other than infant deaths for 1935 lists pneumonia, in all of its under one year. Is it any wonder that forms, as being responsible for 3,0S9 Sir William Osier called pneumonia deaths in this State. This was 92.6 "the captain of the men of death"? per 100,000 population, as compared :

April, 1936 The Health Bulletin with the next highest cause, pulmonary attacks the strong and robust in early tuberculosis, where there were 52.7 adult life, but under these circum- deaths per 100,000 population, and can- stances the chances of recovery are cer as the third, being responsible for good. 51.8 deaths per 100,000 population. The pneumococcus has been grouped The term pneumonia includes a into four main types. Three of group of varied diseases due to dif- these groups show reactions wr hich ferent causes, but all producing an in- are fixed and specific. The fourth flammation in the lung tissue. Pneu- group includes some twenty-eight sub- monia may be primary or secondary groups. Studies made on cases of it may be lobar (croupous) in type, or pneumonia reveal that 33% are of it may be lobular (bronchopneumonia). group 1, 31% of group 2, 12% of group While the pneumococcus is the most 3, and 24% fall in group 4 with its common cause of pneumonitis, other subdivisions. Of those cases of pneu- pathogenic organisms may be respons- monia resulting fatally, type one has ible, such as streptococci. Pfeiffer's been responsible in 25%, type 2 in 22%, bacilli. Friendlander's bacilli, plague type three in 45%, and the large group, baccili, typhoid bacilli, and others. A type four, in 16%. pneumonic condition is also a frequent The pneumococcus leaves the body terminal state, especially in the young mainly in the discharges from the and in the old. mouth and nose, and enters the system Some 95% of the lobar type of pneu- through the same channels. It is as- monia have been shown to be due to sumed, therefore, that this represents the pneumococcus. This is an acute the mode of transmission. It must, febrile infection with massive consoli- however, be admitted that there are dation of lung tissue which, in typical many factors and features concerning cases, ends by crisis. The pneumococ- pneumonia that are obscure and puzzl- cus is found not only in the lungs and ing. Evidently the pneumococcus is the respiratory tract, but often invades spread by contact with cases or car- the blood. riers. The pneumococcus does not As we have noted from the statistics thrive in the outer world and man, already quoted, pneumonia is the most therefore, must be its source and re- prevalent and fatal of all acute dis- servoir. Pneumonia clearly belongs to eases. It occurs in all climates. It the great group of contact infections shows a distinct seasonal prevalence, spread by secretions from the respira- being most frequent in the winter and tory tract. For a person to acquire the early spring months. Pneumonia is disease, it is necessary to have a com- more fatal among negroes than among bination of circumstances : first, the whites, and is more frequent in males pneumococcus ; second, susceptibility to than in females. It attacks all ages. that particular pneumococcus ; and It is common in children under six third, accessory factors. years ; between the sixth and fifteenth Pneumonia is epidemic when influ- year, the predisposition is less marked, enza and measles are epidemic. How- but for each subsequent decade it in- ever, pneumonic plague always occurs creases. Sir William Osier has said, in real epidemic form. The pneumonia, "Pneumonia may well be called the however, is secondary to the influenza friend of the aged. Taken off by it in and measles. Otherwise, pneumonia an acute, short, not often painful ill- shows no tendency to frank epidemic ness, the old escape those 'cold grada- outbreaks. It may be considered as tions of decay' that make the last stage recurring in epidemic form during the of all so distressing." Pneumonia often cold weather in almost every place hav- 10 The Health Bulletin April, 1936

ing a cold winter season. Ordinarily, record of individuals who have had ten the disease shows little tendency to or more attacks. Rush gives an in- develop in those immediately in con- stance in which there were twenty- tact with cases. The excessive preva- eight attacks. lence of pneumonia so commonly found All kinds of animals, even the most in camps, barracks, asylums, and susceptible, may be rendered actively among working people, is believed to immune to pneumococcus infection by be due primarily to crowding of a par- the previous injection of nonlethal ticularly susceptible group in the doses of living pneumococci, or even by of specific virulent presence pneumo- the injection of the dead cocci. A high cocci. degree of immunity may also be ac- Pneuinococci are frequently found in quired by the injection of purified ex- the mouths and throats of healthy per- tracts. The serum of such actively sons, but a person must be susceptible immunized animals, in many cases, to the particular organism present in possesses protective and even curative order to contract the disease, and the power. Theoretically, we might ex- accessory factors must be present. By pect it to be a hopeless task to produce these accessory factors, we mean by artificial methods a useful immunity weakening diseases which diminish to a disease which leaves little or no resistance to the pneumococcus. natural immunity. On the other hand,

Pneumonia is frequent in alcoholics, a high degree of protection can easily and is commonly brought on by ex- be induced in susceptible animals to posure to cold, trauma, or to local ir- virulent cultures of pneumococci when ritation. It is a frequent complication injected into the abdominal cavity, the of influenza, measles, whooping cough, blood stream, or under the skin. The typhoid fever, and other infections. results of preventive inoculation upon Pneumonia often closes the scene in man by the use of a purified extract is chronic heart disease, pulmonary tuber- being tried by Felton.

culosis, Bright's disease, diabetes, and The prevention of pneumonia is stili other debilitating affections. baffling for lack of a better under- Immaturity and old age, as well as standing of the fundamental factors in other enfeebling conditions, may act as the epidemiology of the disease. We a predisposing cause by lowering im- cannot boast of success with an infec- munity. However, it should be remem- tion which is one of the chief causes of bered that pneumonia, like other com- death. The disease should be handled municable infections, frequently attacks along the general lines found success- the strong and robust. Fatigue, ex- ful with other contact infections. posure, and overexertion have long It is well that sputum be taken from been recognized as contributing causes the patient to ascertain the type of of pneumonia. pneumococcus causing the disease, for One attack of pneumonia does not some practitioners feel that cases pro- confer a high or lasting immunity. In duced by groups one and two may be fact, there seems to be increased sus- benefited by the administration of con- ceptibility to subsequent attacks. Man, centrated serum specific for these two however, must possess a certain degree types. of resistance to the pneumococcus, else It should become common knowledge the disease would be more prevalent that anything which tends to reduce than it is, and recovery would probably vitality predisposes to pneumonia, be less frequent. Recurrence is more such as dissipation, loss of sleep, over- common in pneumonia than in any work, worry, poor or insufficient food, other acute disease. Instances are on lack of exercise, alcohol, colds, or ex- April, 1936 The Health Bulletin 11

cesses of all kinds ; the atonic effect of should be isolated in bed during the living in overheated rooms, and the in- acute stage and at least as long as jurious effect of excessively dried and there is fever. Exposure, overexer- warmed air, and sleeping in warmed tion, and fatigue under these circum- rooms. Cold baths, regulation of tem- stances may be hazardous. perature and ventilation, sleeping with We should bear in mind that every open windows or in the open air, as case of pneumonia should be regarded well as oral hygiene, are assumed to as a focus for the spread of the in- be useful prophylactic measures for fection. We should think of pneumonia pneumonia, as well as tuberculosis, very much as we think of whooping colds and a large group of diseases. cough and tuberculosis—as an infec- More attention should be given to tion which is spread from man to man the minor acute respiratory infections, through the secretions of the mouth such as ordinary colds, so-called in- and nose. fluenza, bronchitis, and sore throats. The prevention of pneumonia rests These catarrhal inflammations are of- upon the discovery of an effective im- ten associated with pneumococci and munizing agent. Advances along this predispose to pneumonia. Persons suf- line which promise practical results fering with these minor infections are now in progress.

The State Board of Health Undertakes Work in the Field of Industrial Hygiene

By M. F. Trice, Sanitary Engineer NORTH Carolina has recently rec- compensation laws of North Carolina. ognized by law that there are Twenty-five diseases and conditions are very definite health hazards as- written in the law as being occupa- sociated with various occupations in tional diseases within the meaning of many industries. Until quite recently the Act. For its administration a sum this fact had been formally acknowl- of .$10,000 was appropriated and the edged by only one state health depart- chairman of the State Industrial Com- ment, that of the State of Connecticut. mission designated as the administra- The United State Public Health Serv- tor. ice, however, has long been cognizant This official, who at the time was of the existence of such dangers; its Mr. Harry McMullan, recognized the of Industrial Hygiene and Sani- office public health aspect of the situation tation has carried on much research created by the passage of this legisla- and made many investigations in this tion and sought the assistance and field. In fact, much of the present day guidance of both State and Federal knowledge of the subject has been con- health officials. As a result, many contributed by this governmental agency. ferences were held during the late sum- The 1935 General Assembly of North mer and early fall of the past year. Carolina passed what is known as the These meetings were attended by Dr. "Occupational Disease Act." This legis- C. V. Reynolds, State Health Officer. lation makes disablement, or death, by Dr. R. R. Sayres, Director of the Of- an occupational disease interpretable fice of Industrial Hygiene and Sanita- as an accident by injury and thus com- tion, U. S. Public Health Service, and pensable for the first time under the various members of the State Indus- 12 The Health Bulletin April, 1936 trial Commission. These conferences physician. Dr. H. F. Easom, was ob- resulted in an agreement that made tained from the staff of the State Sana- possible the inauguration of work in torium (tuberculosis) at Sanatorium, industrial hygiene a function of the N. C, while the engineer, Mr. M. F. State Board of Health. Thus a Divis- Trice, came from the Division of Sani- ion of Industrial Hygiene was tenta- tary Engineering of the State Board of tively set up. Health. Since their transfer, these The inception of the work will date from September, 1935, since in that men have devoted all of their time to month a physician and an engineer the inauguration of industrial hygiene were assigned duties in this field. The activities in the State.

Anli-Mosquito Campaigns

By M. F. Wooten, Jk., Assistant Engineer, North Carolina State Board of Health ANTI-MOSQUITO campaigns will, woi'k unless he can notice a correspond- of course, vary in nature according decrease in the number of ordinary ing to the commimity in which pestiferous mosquitoes. It must be the work is to be done. For this rea- remembered, too, that in the average son no general rule can be given, but it inland town the people themselves is well to indicate a few of the facts raise most of the mosquitoes about which should be kept in mind and a which they complain. It is a com- few of the possible "lines of attack." paratively simple matter to eradicate In general, municipal anti-mosquito Anopheles mosquitoes, which breed work must include the control of all mostly in ditches, pools, and other different types of mosquitoes which are natural breeding places ; but the elimi- encountered in the town or city, nation of all mosquitoes is a man-sized whether disease-bearing or merely job. pestiferous ; otherwise the campaign One of the most important factors in will fail to receive the necessary popu successful anti-mosquito work is an lar support. In rural campaigns the adequate, well-organized inspection important activities may be confined service which can make vigorous and to the protection of the people from the systematic inspections of all premises. attacks of the mosquitoes rather than This should be coordinated with the the control of the mosquitoes them- inspection of streams, marshes, and selves. This is usually done by screen- swampy areas in the outlying dis- ing, mosquito-proofing, better housing, tricts in such a manner that every spot and so on. in which there is a possibility that Ordinarily, larger problems are en- breeding may occur will be visited once countered in municipal campaigns, and a week or at least once every ten days. even though the campaign is primarily The organization of the inspection a health measure directed against the work will vary with the size of the malaria-bearing mosquitoes, it must in- town or city and the amount of work clude suppression of all mosquitoes in to be done. Supervision is usually order to be considered a success by the given by the health officer. If the people in the municipality. The aver- health officer is employed on a part- age person regards mosquitoes as time basis, the direct supervision may mosquitoes, and he will not be very apt be given by some other city employee to believe in the efficacy of anti-malaria such as the city engineer, water works :

April, 1936 The Health Bulletin 13 superintendent, city marshal, or street crew, the appointment of inspectors, the superintendent. If the town is small, duties of the inspectors, the habits of perhaps one inspector can do the entire the Gambusia, the stocking of ponds, job. If the town is large, it should be and other similar subjects. In short, divided into inspection areas, with an the people of the community should inspector in charge of each. be informed what is being done and When the inspector makes the first how it is being accomplished, inspection of his area, he should take The following ordinance has been in his time and explain his mission to the force in towns in North Carolina and occupants of each house which he has been a part of several successful visits. He should point out to the oc- anti-mosquito campaigns. cupants any actual or potential breeding places and insist politely that they ORDINANCE FOR THE PREVEN- be eliminated. If he sees any condi- TION OF MOSQUITO BREEDING tion that he considers should be IN THE handled by the anti-mosquito forces, such as a large pool in a street ditch that needs draining, he should make a note of it and report it to the proper Section 1. It shall be unlawful to authority. have, keep, maintain, cause or permit,

If, on his second trip of inspection, within the (incorporated) limits of the inspector finds mosquito breeding through fault of the occupant of the any collection of standing or flowing premises, he must have an anti-mosquito water in which mosquitoes breed or ordinance to rely upon in forcing the are likely to breed, unless such collec- removal of these breeding places. The tion of water is treated so as to ef- ordinance at the end of this article was fectually prevent such breeding, prepared jointly by the U. S. Public Section 2. Any collection of water Health Service and the International considered by Section 1 of this ordi- Health Board and is recommended for nance shall be held to be those con- adoption in any town or city. tained in ditches, pools, ponds, exca- Publicity must not be forgotten, for vations, holes, depressions, open cess- it is probably one of the greatest helps pools, privy vaults, fountains, cisterns, the director of an anti-mosquito cam- tanks, shallow wells, barrels, troughs paign can have. After all, one of the (except horse troughs in frequent use), most important objects of the whole urns, cans, boxes, bottles, tubs, buckets, campaign is education. When the peo- defective house roof gutters, tanks of pie have learned how to free themselves flush closets or other similar confront mosquitoes, they will go a long tainers.

way toward doing it without any urg- Section 3. The method of treatment ing by the inspector. The publicity of any collections of water that are should not be stopped after the funds specified in Section 2, directed toward for the campaign have been obtained the prevention of breeding of mosqui- and the campaign is well under way. A toes, shall be approved by the ac- steady flow of publicity should be kept credited health officer, and may be any up from the time the work starts until one or more of the following after it is ended for the season. There (a) Screening with wire netting of should be issued periodic statements of at least 16 meshes to the inch each way the progress being made, giving such in- or with any other material which will formation as the percentage of drainage effectually prevent the ingress or egress completed, the formation of an oiling of mosquitoes. 14 The Health Bulletin April, 1936

(I)) Complete emptying every seven Section 6. For the purpose of enforc- (7) days of unscreened containers, to- ing the provisions of this ordinance, the gether with their thorough drying or health officer, or his duly accredited cleaning. agent, acting under his authority, may (c) Using an approvad larvicide ap- at all reasonable times enter in and plied under the direction of the health upon any premises within his jurisdic-

officer. tion ; and any person or persons (d) Covering completely the surface charged with any of the duties imposed of the water with kerosene, petroleum by this ordinance failing, within the or paraffin oil once every seven (7) time designated by this ordinance, or days. within the time stated in the notice of (e) Cleaning and keeping sufficiently the health officer, as the case may be, free of vegetable growth and other ob- to perform such duties, or to carry out structions, and stocking with mosquito- the necessary measures to the satisfac- destroying fish. tion of the health officer, shall be (f) Filling or draining to the satis- deemed guilty of a separate violation faction of the health officer. of this ordinance. (g) Proper disposal, by removal or Section 7. Any person who shall vio- destruction, of tin cans, tin boxes, late any provision of this ordinance broken or empty bottles and similar shall on each conviction be subjected articles likely to hold water. to a fine of not less than One Dollar Section 4. The natural presence of ($1.00) or more than Twenty-five Dol- mosquito larvae in standing or running lars ($25.00), or imprisoned for not water shall be evidence that mosqui- more than ten (10) days, or both, at toes are breeding there, and failure to the discretion of the court. prevent such breeding within three (3) Section 8. All ordinances or parts of days after notice by the health officer ordinances in conflict with this ordi- shall be deemed a violation of this nance are hereby repealed, and this ordinance. ordinance shall be in full force and ef- Section 5. Should the person or perfect 15 days after its approval. sons responsible for conditions giving Section 9. Should any section, para- rise to the breeding of mosquitoes fail graph, sentence, clause or phrase of or refuse to take necessary measures to this ordinance be declared unconstitu- prevent the same, within three (3) tional or invalid for any reason, the re- days after due notice has been given mainder of said ordinance shall not be to them, the health officer is hereby affected thereby. so, all necessary authorized to do and Adopted this day of cost incurred by him for this purpose shall be a charge against the property- this day of owner or other person offending, as the Approved case may be.

Pellagra

There were fewer deaths from pel- trend for an increase in cases and lagra in 1935 than were reported in deaths from this disease this year. For January 30 1934 ; but, judging from reports re- example, in the month of ceived from physicians and others deaths were reported, as compared to about over the State independent of the 29 deaths in the same month last year. direct report of cases to the epidemio- We want to call attention to the mat- logical department, there seems to be a ter at this time because the months of :

April, 1936 The Health Bulletin 15

April. May. and June nearly always least very few cases and still fewer seem to be the time in which more deaths from this disease. There is cases and more deaths occur from pel- much yet to learn about pellagra, but lagra. The disease is probably present enough is already known to prevent

in latent form all through the fall and most cases. If every family in the winter, but the varying changes in the State could only be induced to partake spring months seem to precipitate the of a eommonsense, varied diet, which attack. We repeat again that in a State such includes pellagra-preventing foods, the

-•is North Carolina there should be at disease would no longer be a problem.

Extracts From County Health Officers' Reports NOW and then some of the county "At several points in the county cen- health officers favor us with a ters were established and monthly ex- narrative report of their work. aminations made of all babies of indi- All such reports have many items of gent parents. Midwives were urged general interest. We have space here to have their promised cases of ex- for a brief review of two or three such pectant mothers come to the centers reports which were very interesting for regular examinations. On the first to us. visit blood was secured for Wasser- mann examination, FRANKLIN COUNTY and all those showing positive reaction were given the Dr. R. F. Yarborough, the health anti-syphilitic treatment later on. These officer of Franklin County, has sent us mothers were very carefully examined a copy of his report for the six months in the usual manner and given specific period ending December 31, 1935. Be- medical advice in order to contribute sides doing the general routine work to their safety. The mothers bringing falling to the lot of any county health babies were carefully instructed as to department having a minimum of three the feeding and establishment of proper units, that is, health officer, nurse, and health habits for the babies while clerk, Doctor Yarborough has the fol- quite young. The question of cleanli- lowing interesting comment on midwife ness in the prevention of diarrheal dis- control work eases and immunization against the "Midwife clinics were held at four communicable diseases was insisted points in Franklin County each month. upon. All of the children having had Every midwife in the county has had a infantile' paralysis during the year physical examination, including a Was- were visited and carefully examined sermann, blood pressure, urinalysis, and later by an orthopedic specialist. Sub- so on. They were examined carefully sequent treatment was rendered when as to cleanliness and general fitness for found necessary." the work of a midwife. Their bags BERTIE COUNTY

I containing their equipment had to conform to the minimum standards, and Dr. F. H. Garriss, health officer of

1 were carefully examined in the case Bertie County, has sent us a most in- of each one as to cleanliness and con- teresting summary of the birth and tents. death rate for 1935 in Bertie County. :

16 The Health Bulletin April, 1936

That county, of nearly 28,000 popula- gent children suffering from diseased tion, has about 60 per cent colored tonsils. He reported that satisfactory people. The white birth rate in the arrangements were made with the county was a little under 22 and the specialists, with volunteers from the colored birth rate in the county was medical profession, who were to give 32, the combined rate of both being a the anesthetic, and with the nursing little under 28. The white death rate profession, who had volunteered their was a little under 10 and the colored services without charge. They had ar- death rate a little over 15, making the ranged to operate on about three chil- combined death rate of a little over 12 dren at a time on days selected by the per 1,000 population. operators as suitable. They had funds The county experienced an unusually available for the relief of about thirty high infant death rate, that is, deaths children. of babies under one year of age for the year. Doctor Garriss reports the Death of Many Children Due startling fact that of the infant deaths to Carelessness With Drugs 27 of them who died under one year of age died as a result of whooping cough. Some one has sent us a clipping from the Xeivs and Observer giving an ac- The epidemic of whooping cough last count recently of the death of a child year was unusually severe. These in Bladen County as a result of eating definite figures from Bertie County af- some aspirin tablets. We herewith ford evidence of that fact. Nine of quote the item in full the babies dying of whooping cough "CHILD EATS ASPIRIN AND DIES were white and 18 were colored. We AS RESULT have not seen the analysis for any "Robert Livingston, the one-and-one- other county, but will await such re- half-year old son of Mr. and Mrs. Zeb ports with a great deal of interest. It Pait of West Bladenboro, who died yesterday from eating aspirin tablets, will be some time yet before the State was buried this afternoon following Vital Statistics Department is able to funeral services at Oak Grove Church. finish the compilation of such informa- "The small child, who was with his tion for last year for all the counties in mother and others in the house, went into a bedroom, climbed upon the dres- the State. ser, got a bottle of aspirin tablets and Doctor Garriss examined 440 expect- ate a large quantity. Efforts were ant mothers during the period of eigh- made by the family to rid the child of teen months ending with December 31. the drug and immediately started him to a nearby hospital, but he died before More than 95 per cent he reported were reaching there." colored women and were delivered by Not long ago the newspapers carried midwives. Of the total 440 cases, all the notice of a death of a child in Dan- were given the Wassermann test for ville, Virginia, as the result of eating on syphilis, and only 22, or about 5 per some candy-coated tablets thrown the porch of the child's home. The cent, gave a positive reaction. This is a tablets were in packages and were most interesting item in that it points promiscuous samples of a patent medi- to a light infection in the Negro women cine being advertised at the time. The of that county of child-bearing age. tablets contained strychnine, and the WILSON COUNTY child died in convulsions a short time Dr. W. H. Anderson, health officer of after eating the samples. We repeat again, drugs of any Wilson County, reported that during description should never be left within the month of January he had been the reach of small children. The older made chairman of a committee to meet members of a family who do this are killed with the eye, ear, nose, and throat all potential murderers. A child from eating drugs carelessly left within specialists of that county for the pur- reach is just as dead as if he had been pose of arranging operations for indi- deliberately given a dose of poison. iv i6ii §Mmm)nn ww PuHi5\edbM T/^^fcTftCARPLI/m STATE- B7\E&Un

This BidktirvwiHbe 3er\t free to ar\\j crftzery of the 5tateupor\ request.!

Entered as second-class matter at Postoffi.ce 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. 51 MAY, 1936 No 5

Mary Brown Hill and William Gilchrist Hill, children of Mr. and Mrs. Dudley B. Hill, of Wilmington. The Bulletin has never printed a finer picture of radiant health.

Dr. J. Buren Sidbury, of Wilmington, who always supplies our front cover for the May issue, sent us the photograph. Dr. Sidbury is one of the State's pioneer pediatricians. He has relieved the anxiety of countless parents and saved the life of many a baby. 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. Lee 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

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

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

CONTENTS PAQ1 Notes and Comment * Policies of Radio Station WBIG in Greensboro, North Carolina 4 Sunshine for Babies 6 Pre-School Age Most Important Health Period » Keeping the Child Healthy and in Tune for School 10 Good Health Habits Easily Formed 11 Malaria on the Increase -- •--- }j Program for an Undernourished Child—2 to 16 Years of Age IB Vol. 51 MAY, 1936 No 5

Notes and Comment By The Editor IN these May days, when the "lazy The two earlier months of this year Lawrences" dance around on the were bad on babies on account of the fences and the roof tops and the intense cold weather, the spread of fields and roads, the nights get shorter influenza, and the resulting complica- and the days become longer, the house tion of pneumonia in so many in- flies and the mosquitoes begin to stir stances. The ground lost, however, in and the babies therefore enter upon a February and March may be recovered little more dangerous period than be- in May and June, with careful atten- fore. Summer time is a grand period tion given to all the babies in the State. for the older people. Generally the It cannot be printed too often or in death rate from almost every disease too many places that some of the es- drops. There is less sickness and less sentials for safety to babies are a disturbance of every kind. But for screened house, the use of mosquito the babies, particularly those under a netting over the baby's bed to prevent year of age, it is a time usually of the flies from disturbing its sleep, increasing illness and greater hazards. clean bed and clean clothing (no mat- AVe are pleased to announce that the ter how simple or inexpensive those tabulations of the deaths of babies two items are), careful attention to under one year of age published some every morsel of food that goes into the time ago in the Health Bulletin baby's mouth, and a pure water supply numbered a great deal fewer than in in abundance. All babies should have the previous year. We will repeat : in boiled water, particularly in the sum- 1935, up to now there have been re- mer time, up to three years of age. ported 5,358 infant deaths under one The water should be boiled and allowed year. For 1934 the total number of to cool before being given to the baby. deaths was 6,196. So we see that the The State Board of Health death rate per 1,000 live births in 1934 has diet lists and time cards larger was 77.9, while the provisional rate for and publications setting forth 1935 was 67.2. One or two fractional many valuable suggestions as to kind points will be added to this when the the or type of food its final tabulations are completed and de- and preparation for babies layed reports are added, on or before and young children. This literature is the first of July. In case of maternal invaluable to any mother who will deaths the showing was equally as secure it and study it. The fact is, the good. Six hundred and five mothers mother should avail herself of the sacrificed their lives as a contribution literature the State Board of Health to the perpetuation of the race in 1934. has for her, known as "Prenatal Last year only 523 succumbed. The Literature," several months before the rate therefore for 1934 was 7.6 per baby's birth. Then, the publication 1,000 live births. Last year it was 6.6. known as "Infant Care" should be in —

The Health Bulletin May, 1936

the possession of every family with a which it is impossible for physicians to baby under one year of age, and it give in all cases. An increasing num- should be scrupulously studied. Then ber of practicing physicians in the there is another publication known as State are availing themselves of this "The Child from One to Six," prepared literature. They write and request it by specialists in the employ of the for their patients, and we are always U. S. Children's Bureau, which affords glad to comply immediately. Any physi- much valuable advice and help to cian would much prefer advising an parents toward properly caring for the intelligent person who has studied child from one to six, which all parents these questions and who knows some- know is a difficult period. This litera- thing about them and therefore who ture is available now to any family in can better understand his reasons for write to the State the State who will instructions and treatment often neces- Board of Health and ask for it. It is sary for children. Such physicians are provided free to individuals who re- coming more and more to realize the quest it. value not only to their patients but to This literature in no way takes the themselves. It is a mutual enterprise place of the family physician or the dentist. It is devised to offer sugges- all of it redounding to the benefit of tions and help on various minor details everybody concerned.

Policies of Radio Station WBIG in Greensboro, North Carolina

Edney Ridge, director of Radio from different small towns of the State. Mr.Station WBIG in Greensboro, The children are required to listen and North Carolina, has written us gain certain points in these programs, that his station has refused repeatedly and so their contests are not only be- to offer their facilities to a certain so- tween local bands but carry down to called patent medicine concern which the school children. The result, of is very active in this part of the South course, is that the children uncon- at present and has been for the past sciously absorb the advertising as do three or four years. This action on older people, and thus sales are in- the part of Mr. Ridge is most commend- creased. It is a subtle type of adver- able. In our April edition we criti- tising, a sort of slippiug-into-the-back- cized a parent-teacher association in door kind of advertising, a good deal one town of the State which had al- on the principle of the agent who rings lowed this concern to exploit its pro- the door bell and gets his big foot into duct, which is an ordinary common the door so that the housewife cannot salts, little prescribed by physicians close it in his face. for human ailments, by staging con- We learned from Mr. Ridge that this tests in the schools. We learned from stunt has not been confined to small Mr. Ridge that it was not a direct sales towns, but such a program was put on contest, which would not have been, in sometime ago in one of the city schools our opinion, as reprehensible. of Greensboro, under the guise of a Among the methods employed is to fraternal organization's campaign for stage, over certain radio stations, who something or other. In that case the accept this advertising, amateur con- contest had to be carried on by children tests between various string bands listening to broadcasts from other sta- :

May, 1936 The Health Bulletin

tions, such as Raleigh and Charlotte, "Unfair exploitation of others for which carry the advertising, as the personal gain must not be made praise- local station at Greensboro has refused worthy. to open their channels for such pur- "Dishonesty and deceit are not to be pose. We have known Supt. Guy B. made appealing or attractive to the Phillips of the Greensboro City schools, child. for a long time. We know him to be "Advertising Which interested in the cause of public health Discusses Inter- nal Bodily Functions, and we know that had he been given Symptoms, etc. the slightest information as to the "In hearty agreement with the nature of this advertising and the Columbia Broadcasting System radio methods pursued, that he would not station WBIG will permit no broad- have voluntarily given his consent. But casting of any product which de- when a great school system such as scribes graphically or repellently any the Greensboro City Schools are im- internal bodily functions, symptom- posed upon in such a manner, the atic results of internal disturbances, smaller schools in the little towns do or matters which are generally not not have much chance for resisting considered acceptable topics in social such methods of advertising. groups. This policy will specifically We take pleasure in not only com- exclude from radio station WBIG mending Mr. Ridge for his stand, but not only all advertising of laxatives we wish to pass along to our readers as such, but the advertising of any the statement of policies adopted by laxative properties in any other the Greensboro radio station, in which product. It will further exclude the it will be seen that they take a high discussion of depilatories, deodorants stand in this important matter. and other broadcasting, which by its nature, "In accordance with this responsi- presents questions of good taste in connection bility we list some specific themes and with radio listening. dramatic treatments which are not to be permitted in broadcasts for chil- "Commercial Announcements dren : "Believing that insistent sales talk "The exalting, as modern heroes, of and excessive advertising tends to dis- gangsters, criminals and racketeers credit advertising and prevents the will not be allowed. desired results, WBIG will, in the in- "Disrespect for either parental or terest of the audience and the great other proper authority must not be majority of advertisers, set the follow- glorified or encouraged. ing maximum allowances for commercial announcements "Cruelty, greed and selfishness must "A not be presented as worthy motiva- maximum of ten per cent of the tions. total broadcasting period may be devoted to the sponsor's commercial an- "Programs that arouse harmful nouncements, including contests and nervous reactions in the child must not offers, on programs broadcast after six be permitted. o'clock P. M. "Conceit, smugness, or an unwar- "A single exception of the ten per ranted sense of superiority over others cent ratio will be made on quarter-hour less fortunate may not be presented as programs, on which an additional al- laudable. lowance of forty seconds will be made. "Recklessness and abandon must not "Daytime programs, before six be falsely identified with a healthy o'clock, will be allowed a maximum of spirit of adventure. fifteen per cent of the total period for :

The Health Bulletin May, 1986 commercial announcements, with an "No programs or announcements additional forty seconds for quarter- that are slanderous, obscene, or pro- hour programs. fane, either in theme or in treatment. "WBIG is satisfied that the best "No ambiguous statements that may thought of many leading advertisers, be misleading to the listening audience. broadcasting indus- as well as of the "No advertising matter, or announce- reflected in these policies. They try, is ments, programs which may, in the set higher standards in broadcasting opinion of the System or WBIG, be than has ever been attempted before. injurious or prejudicial to the interests of the public, the station, or honest ad- Basic Advertising Policies vertising and reputable business in "Here are the basic advertising general. will always be policies of WBIG, that "No testimonials which cannot be in effect authenticated. "No false or unwarranted claims for "The management of WBIG will con- any product or service. tinue to cooperate fully with educa- "No infringements of another ad- tional, religious and civic organizations. vertiser's rights through plagiarism or It is the intention and purpose of this unfair imitation of either program idea station to serve this favored region or copy. with the best radio programs and the "No disparagement of competitors or best service competitive goods. possible. "No lottery or drawing contest. No "This station is operated, and will contest of any kind in which the public continue to be operated for the public is unfairly treated. interest, convenience and necessity."

Sunshine For Babies

(Condensed from a Children's Bureau Publication—Sunlight for Babies) MANY good things come from develop normally, his muscles will be above and not one of the least flabby, and his skin will be pale. He of these is sunlight. Now that may have rickets—a disease that af- we know more about the healing prop- fects the whole body but more strik- erties of the sun's rays—their power ingly the bones. to destroy bacteria and build up strong, It is said that the months of May, disease-resisting bodies — we should June and July is the season of the make the most of this great gift of year when the ultra-violet content of Nature. the sunlight is at its height. Hence, It is now known that sunlight is a spring is the best time to start giving most important factor in the life of a the baby its daily sun baths. Southern growing child, especially a baby. Nor- babies, it is said, can have outdoor sun mal growth of bone is dependent not baths all the year round, unless it is only on the food that the child eats but in extreme cold weather which the also on the direct sunlight that he re- South does experience sometime. But ceives, for the sunlight provides the normal babies may start their sun body with the power to utilize the baths the first mild sunshiny days in food. If a baby is continually deprived spring and keep them up through the of direct sunlight his bones will not summer and fall. They should be be- May. 1936 The Health Bulletin

A North Charlotte Well Baby Station. All this group were immunized against diphtheria at six months of age. All their mothers were given instructions in general infant care. Picture is an example of the excellent work being done by the Charlotte Health Department.

gun when the baby is about 3 or 4 be exposed to the direct sun for a few weeks old and continued throughout minutes. Care must be taken not to his childhood when he can be taught burn the skin. to seek the sunshine for himself. A slight reddening of the skin each day will gradually bring about pig- Direct Rays Essential mentation or tanning. Unless the baby The beneficial effect of sunlight is is accustomed to the sunlight through not obtained unless the rays reach the exposure at an open window the first skin directly. Either clothing or win- outdoor sun bath should be for 10 or dow glass will keep out the beneficent 15 minutes only. Each day thereafter ultra-violet rays. Therefore, sun baths the exposure to the sun should be in- in the direct sunlight are the simplest creased by 3 to 5 minutes. method of giving the baby enotigh Every few days the amount of body ultra-violet light. It is only when the surface exposed should be increased, skin begins to tan that any benefit may at first slowly, but as the days grow be expected. A good tan is evidence warmer, more rapidly. that the ultra-violet rays are being effective. Baby Should Have a Coat of Tan

How to Give the Baby a Sun Bath After the face and hands are used On the first sunny day in early to the sun the arms may be bared, at spring the baby may be put in the first one at a time, later both together. direct sunlight with the hood of the They should be bared for only a few carriage and the baby's cap pushed minutes at first, and the time increased well back so that the sun will shine daily. Soon the legs also may be bared, directly on his cheeks. He should be at first one at a time, and later both turned first on one side and then on the together. Gradually the baby gets used other so that both cheeks will be ex- to the sun. and by the middle of May posed to the sun and yet the eyes will in- the first of June sun baths may be be kept away from the direct rays. On given the whole body. When the face, this first day the baby's hands should arms, and legs are tanned the shirt 8 The Health Bulletin May, 19S6 should be takeu off for a short time sleeves. An ordinary bathing suit or daily, and finally the band and diaper. bathing trunks, a sleeveless slip, or a The sun baths may be lengthened until set of cotton underwear may be worn. the baby lies in the sun for an hour Sun baths may be given in the fields, in the morning and an hour in the af- in a city back yard, on a roof, or on a ternoon. porch, as well as on a beach. Care must be taken not to let the child's Sun Baths for Older Children skin become sunburned severely. The Though sun baths are of primary best time for sun baths is in the morn- importance for the baby they are also ing. of great value for the "runabout" and Tanning is the goal for which to the pre-school child. Sun bathing is strive, and the process must be gradual. more important for the child than sea The exposure should begin with the bathing, and it is accessible every- face and arms and increase slowly in where in spring and summer. Clothing duration and in the extent of body for sun baths should be low in the surface exposed, until the whole body neck, short in the legs, and without is exposed for two hours a day.

Pre-School Age Most Important Health Period

By Mrs. J. Hexby Highs mith

THAT period in a child's life known as the pre-school age — from two to six years—is probably the most important he will ever have from a health standpoint. It is important because in this period the foundation is laid for his future health. Great physical and mental growth takes place and he makes those ad- justments that are necessary to live in a socially complicated world. It is in this period when he forms physical, mental and emotional habits that are to determine largely the state of his future mental and body health, and whether or not he becomes a stable social asset as a citizen in his community.

The pre-school age is a period in which perplexing problems concerning their children's health confront parents. In passing from infancy to childhood many changes take place. A

Alice Russell Palmer, daughter of Mr. and Mrs. child completes his first set of teeth and J. R. Palmer, Macon, N. C. Mrs. Palmer says, "With the advice of our physician and starts building his second ; he doubles the aid of the State Bulletin we have a per- his weight, also his height, and usually fect baby." May, 1936 The Health Bulletin

contracts some or all of the contagious schoolmates. Poor sight or hearing children's diseases that are going the may make him seem dull in school rounds in the community, such as and cause him to become discouraged measles, whooping cough, chickenpox, and uninterested. The first step in get- and the like. Instead of children in this ting him ready to take his place well

period having the most watchful care equipped with other children is a and supervision regarding their physi- thorough physical examination by a cal development, they are frequently physician and a dentist in the spring left to themselves and are dreadfully or early summer. This will allow the neglected. Bad habits are allowed to summertime for correction of defects form with defects and abnormalities as and for immunization against diph- the result, and minor troubles that theria, smallpox and typhoid. could have been easily remedied are Questions that parents should ask permitted to become serious. themselves before starting their six- The safest way for parents to super-

year-old to school : vise the growth and development of are Does he see and their children during this important hear well? are his teeth sound and well period is to have them examined kept? are his nose and throat in a periodically by a doctor and a dentist, healthy condition? has he been gaining at least every six months. At such ex- steadily in weight? has he been grow- aminations little defects are often dis- ing in height? are his eyes bright, covered which are easily corrected, but which if they be allowed to persist, become difficult to handle. Advice and directions are given at these examinations for preventing as well as for cor- recting unhealthy conditions. Parents are learning that it is economy to go to a doctor to keep their children well, rather than go to him only to cure diseases that might have been prevented. They are no longer satisfied to have "puny," "sickly" children since they know that these are abnormal conditions frequently caused by some defect that is easily remedied. Nothing short of really healthy children should satisfy parents. The healthy child who has the best chance of growing into the healthy adult is the one who lives a regular life, has good health habits, eats well-planned meals at regular hours, gets plenty of sleep in fresh air, plays vigorously out of doors in the sunshine, and has good posture. Paul Craven, of Biscoe, North Carolina, writ- One specific duty of parents is to get ing to "Jack" in the dental picture show put on by the State Board of Health in his their child ready to enter school for school, says that he eats the right food, the first time, free of all defects and brushes and exercises his teeth daily, and goes to the dentist three times a year. Since physical handicaps. A physical defect he has sent his picture and is requesting one of "Jack's," he evidently wants to see how a child at with its puts a disadvantage he compares in looks with "Jack." :

10 The Health Bulletin May, 1986 cheeks red, muscles firm, posture erect? elimination, self-control and obedience? has he been vaccinated against small- If so, he is ready for school and the pox and immunized against diphtheria chances are he will not be a "repeater", and typhoid? has he good habits of not a liability to the State and com- eating, sleeping, exercise, bathing, munity.

Keeping The Child Healthy And In Tune For School

Is Your Child Ready for School? thorough examination is especially needed. The child who Is to enter school for A physical defect puts a child at a the first time in the fall should have a disadvantage with his schoolmates. thorough examination by a physician Poor sight or hearing may make him and by a dentist in the spring or early dull in school and cause him to- summer. This will allow the summer- seem time for correction of defects and for become discouraged and uninterested. Do not let your child reach school age vaccination ; also for immunization if needed. (School brings added danger of with a handicap that can be removed. getting communicable diseases.) If the Ask yourself these questions child has not been having half-yearly Does my child see and hear well? examinations up to this time a Are his teeth sound and well kept? Are his nose and throat in healthy condition? Has he been gaining steadily in weight during the last year?

Has he been growing in height? Are his eyes bright, his cheeks rosy, his muscles firm, his posture erect? Has he been vaccinated against smallpox and immunized against diphtheria, also against typhoid fever? Has he good habits of eating, sleeping, exercise, bathing, elimination, self-control, and obedience?

The Healthy Child

A healthy child has pink cheeks and red lips. His eyes are bright. His skin is smooth, his muscles firm, and his body straight and strong. He grows tall and gains weight month by month. He is active, alert, and interested in eveuything. He plays vigorously, creep- Margaret Merle Cates, daughter of Mr. and Mrs. ing, running, jumping, climbing, ac- W. D. Cates, Graham, N. C. Mrs. Cates says she found the State Board of Health litera- cording to his age. He is often noisy. ture indispensable before and after birth of is at mealtimes, and he her child. He hungry May, 1936 The Health Bulletin 11

sleeps soundly and long. His bowels of his teeth, beginning at the end of the move daily. He has no abnormal dis- second year. charge from eyes, ears, or nose. He Give him a well-planned diet, includ- breathes with his mouth closed. He ing milk, green vegetables, fruit, ce- does not have pains nor aches. reals, meat and eggs. Be sure that he has 11 to 13 hours of How to Keep Youe Child Healthy sleep every night and a daytime nap Take your child for a regular health of 1 to 2 hours. examination twice a year to a doctor Send him outdoors for play and ex- experienced in the care of children. ercise in the sunshine. If your child has not already been See that he has good habits of eat- given special protection against ty- ing, sleeping, exercise, cleanliness, and phoid, smallpox, and diphtheria, ask elimination. the doctor to give it to him and to Weigh him once a month; measure advise you how to guard him against his height twice a year. other diseases. Are you doing all this for your child? Take him to a dentist regularly —Children's Bureau, U. S. Depart- twice a year for examination and care ment of Labor.

Good Health Habits Easily Formed

By Mrs. J. Henry Highsmith

THERE is nothing that stands a person in good stead like good health habits formed early in youth. The secret of living to a ripe old age and meanwhile keeping vigorous and fit is usually found to be the observance of good health rules which have been practiced from youth up. So important are good health habits in keeping down sickness and in preventing those insidious diseases that steal upon man around middle age that the formation of health habits in children is considered a parent's first duty. Psychology has recently given us many helpful hints and suggestions for helping a child to form wholesome habits. One is that the thing to be learned must be made as pleasing and attractive as possible. The more satisfaction there is in doing a thing the first time, the easier it is to do it the second and third. Charles S. Boone, son of Mr. and Mrs. Charlie M. Boone, R.F.D. 1, Nashville, N. C, was Another is that the child should be one year old at the time this picture was taught as soon as he is able to com- made. He has been immunized against diphtheria, smallpox, and whooping cough. prehend it, what he is doing and why. He has been reared "right by the N. C. Health An intelligent reason for doing a thing Bulletin, and at fifteen months of age has never been sick." 12 The Health Bulletin May, 1936 makes all the difference in the case, quent change of paste and style of interest and application one gives to brush will help to keep up interest. the task whether he be a child or an The use of a mirror will be of great adult. aid. To know that he is keeping his Praise is also essential. A little word teeth clean and free of germs in order of encouragement now and then not to prevent their decay is the motive only relieves the process of monotony for his efforts. To be told that he is and fatigue but speeds up progress succeeding, that his teeth are being and leads to efficiency. kept clean and free of disease germs, Of course there must be regularity will redouble his interest and efforts, for any degree of success. To insist and to teach him the necessity of on regularity is to give it importance brushing his teeth regularly twice a and emphasize its value. It is a child's day will not only cause him to form conviction as well as an adult's that a the habit readily but will make him thing that is worth doing at all is satisfied with no other but a clean, worth doing well and regularly. healthful mouth. By way of applying these simple Other health habits that children rules, take the process of teaching a should be taught to form early in life child to form the habit of brushing are : eating regularly of the food served

his teeth at least twice daily. In the them without fuss or play ; going to first place, he should have an attractive the toilet at regular intervals during new brush, child's size, and a pleasant the day ; and going to sleep promptly tasting paste, to start with. A fre- when put to bed.

Malaria on the Increase Observance of All Practical Methods of Mosquito Control Urged

By Mrs. J. H. Highsmith

disturbing note sounded at the fly were said to be the two remaining A Sanitarians School - Conference insect pests that affect human health held at State College, February and happiness to any great extent for 18-21, was that malaria in North Caro- which no permanent and definite con- lina is on the increase. This was ad- trol has been found. However, enough judged from the fact that deaths from is known about malaria control which malaria has risen from 50 in 1933 to 78 if applied rigorously and persistently in 1934 and to 93 in 1935. The cause will greatly reduce the incidence as of this almost sudden rise has not yet well as the severity of the disease. been determined but the fact was suf- In addition to cooperating in the ficient to arouse keen interest among program of malaria control that is the sanitarians and to stimulate more sponsored by the State Board of determined efforts on their part to ef- Health, the observance of the more fect mosquito control. easy and yet practical methods of con- While much is now known about the trolling malaria was urged by malaria cause and spread of malaria — the experts attending the school. These anopheles mosquito — its control re- were mentioned as ditching, draining, mains a difficult as well as a perennial filling-in, straightening streams, oiling problem. The mosquito and the house stagnant pools, covering dump heaps, : :

May, 1936 The Health Bulletin 13 screening houses, and rain-barrels, personal use was composed of citron- keeping rain gutters open, stocking lily ella. 1 oz. ; camphor, 1 oz. ; oil of cedar, pools with fish and minnows, and Y2 oz. For bites, the application of spraying. ordinary soap was suggested, also the Pyrethrum sprays were recommended external use of alcohol. as being among the most effective, the For effective screening against mos- ingredients to be had from local drug- quitoes, an 18 or 20-inch mesh screen gists. It was brought out also that was advised, the regular 14 and 16-inch this spray used in large quantities two mesh used against flies having been hours in advance would repel mosqui- found ineffective against mosquitoes. toes at out-door gatherings such as The treatment of malaria it was barbecues, picnics and camping parties. emphasized, should always be under A repellant recommended for home and the direction of a physician.

Program For An Undernourished Child 2 to 16 Years of Age FOR several years women's clubs, parent-teacher associations, church groups and certain civic organizations have been interested in helping the undernourished child. They have done a great work in providing more and better food for this underprivi- leged group, especially in giving milk and free lunches to undernourished school children. But since malnutrition may be the result of other factors, as it frequently is, besides that of insufficient food, a program of preventive or restorative treatment calls for more than attention to food and diet. A child's nutrition may be interfered with by some physical defect, or faulty habit of eating or living, making necessary an examination by a physician to detect these causes. The Children's Bureau of the U. S. Labor Department has outlined an excellent program for the benefit of an undernourished child from 2 to 16 years, which is recommended and here given James Robert Massey, son of Mr. and Mrs.

DIET W. R. Massey, R.F.D. 1, Wellford, South Carolina. This baby was North Carolina's

The diet must include the following first in the year 1935 ; and was born in protective foods Rutherford County. He has been immunized Milk—One quart of whole milk against diphtheria, and also had the smallpox vaccination. The time cards, as well as daily, either fresh or prepared by dilut- other literature, are still a great help. — —;

14 The Health Bulletin May, 1936 ing evaporated or dried milk. To this any age group, but the older child, may be added other milk products, especially the child in his teens, needs such as dried skim milk, cream, aud larger quantities of each food than cheese. Milk is indispensable in the does the younger child. Undernourished child's diet. children of all ages should have a quart of milk; children in their teens Butter On bread or other foods. — may drink more. Egg—One daily. SLEEP AND REST Vegetables—At least one serving An undernourished child should have daily of a green leafy vegetable and more sleep and rest than the well- one serving of some other colored nourished child of the same age. From 2 vegetable. Spinach, turnip tops, beet to 6 years of age he should rest at least tops, cabbage, kale, chard. Carrots, iy2 hours during the day and should green beans, peas, beets, tomatoes have 12 to 13 hours of sleep at night, (fresh or canned), squash. going to bed at 6 or 6:30 or, toward Many vegetables may be used raw the end of this period, in some cases, such as cabbage, carrots (grated), let- at 7 ; during school years he should tuce, celery, watercress, tomatoes. rest after lunch for half an hour and Other vegetables, such as turnips, should have at least 11 to 12 hours of onions, parsnips, cauliflower, may be sleep, going to bed at 7 :30 or 8 o'clock. used, but not to the exclusion of green A child in his teens who is under- leafy or other colored vegetables. nourished needs 10 to 12 hours of Fruit—At least one serving daily of sleep and also should rest daily after a fresh fruit. Oranges, bananas, apples, lunch. Every child should sleep in a or other fresh fruit in season. Cooked bed by himself. dried fruit, such as raisins, prunes, apricots, and peaches are valuable EXERCISE AND OUTDOOR PLAY foods and should be used frequently in An undernourished child should play addition to fresh fruits. Other cooked outdoors in the sun for a part of each fruits may be given. day (except at midday in hot weather). Little is gained, however, by outdoor Cod-liver Oil—Two to four teaspoon- play on cloudy days in very cold fuls daily, especially in the North weather. If the temperature is below Temperate Zone. freezing, young children cannot exer-

In addition : Other energy and body- cise enough to keep warm. Moderate building foods play and exercise are recommended, but strenuous games and exercise may Bread Two or three times a day — have to be avoided until the child's whole-grain bread at least once a day. nutritional condition returns to normal. Cereals—Hot cooked cereal once or Purposeless running about indoors twice a day, served with milk or cream. should be discouraged by providing some quiet amusement. The physician's Starchy Vegetables —- Potatoes, advice should be sought with respect sweet potatoes, rice, barley, macaroni, to the amount of exercise that is or hominy once a day. desirable.

Meat or Fish—Fresh lean meat or HABITS OF EATING fish once a day if possible. Malnutrition is sometimes due solely The foods recommended for under- to poor eating habits. If your child is nourished children are the same for a finicky eater and refuses foods that !

May, 1936 The Health Bulletin 15

he needs, especially milk and vege- HEARTS tables, consult your physician as to The papers are full of accounts of how you may help him overcome the deaths from heart attacks. When a habit. man is young he feels that many years CORRECTION OF PHYSICAL of life lie ahead. Consequently he DEFECTS takes things easy and plans for the future. But when a man reaches mid- Certain physical defects may inter- dle age his ambition and his zeal in- fere with a child's nutrition and will crease. His mind and powers are at have to be corrected before the child's their best, and he plunges into his condition improves. A careful physical work with more enthusiasm and vigor examination by a physician will be than he did when he was younger. He necessary to discover these defects. also feels that his span of life is growing shorter, that he has less time in which to achieve his ambition, and this PARENTS REPROVED consideration also tends to increase his activity. He works too hard, gets nerv- To the Editor : Many are the accounts of killings on the highways. We ous and excited, tries to do too much, all know that we are no longer safe on and drops dead from a heart attack.

the roads. There is one kind of care- My advice to such men is : Slow down lessness that can be stopped. Parents Imitate the tortoise that beat the hare could keep their children off the high- by plodding along slowly and steadily. ways. Don't worry about your heart ! It is the Just the other day two young men strongest organ in your body, if you gave their lives saving a four-year-old give it a chance and don't worry about child. The men had a cause to be on it. — Charles Hooper in New York the highway. The child had no cause to Times. be there, and was altogether out of its place. There are some streets in Raleigh ATTENTION along which it is almost impossible to drive without hitting a child on the MISS ELIZABETH GRANT street skating. If parents haven't If Miss Elizabeth Grant will provide enough love for their child to keep it us with her postoffice address, we shall out of danger, then the law should take be glad to send her the special items it in hand for the sake and safety of of literature which she ordered on a the ones that must be on the highways postal card, under date of March 10, and streets. It is just as much care- 1936. lessness to let a child play or skate on While we are on this subject, we the streets and highways as it is to let want to remind our readers again that a drunken driver be on them and both it is necessary for them to provide us should be against the law. Carelessness with the correct signature and correct was the cause of the death of the postoffice address when they write us young men I referred to above, and requesting literature or other service. carelessness is the cause of the broken As these lines are written, we have in bones of the child, carelessness is the our hand a returned postal card bear- cause of the sad homes, and careless- ing a Rich Square postmark, in which ness can be stopped and it should be. the writer is requesting literature —Mrs. Fannie A. Hawkins in about babies, but in which no name or News and Observer. address is attached. 16 The Health Bulletin May, 1936

THE AMERICAN PUBLIC Dr. L. B. McBrayer, secretary and HEALTH ASSOCIATION treasurer of the North Carolina Medi- cal Society, writes us that the state- ANNOUNCES ITS SIXTY- ment is not correct. Doctor McBrayer FIFTH ANNUAL MEETING says, "The Hospital Savings Associa-

The oldest and most powerful asso- tion of North Carolina, Incorporated, ciation of public health workers in the has been organized by the State Medi- United States, the American Public cal Society and the State Hospital As- Health Association, will convene in sociation, and is strictly not for profit." are New Orleans, La., October 20-23 for its We glad to make this correction. 65th Annual Meeting. Our idea in making the statement was used in the sense that the profit from Drawn from every State in the the enterprise would accrue to the Union, from Canada, Cuba and Mexico, benefit of the hospital and the bene- officials from the various branches of ficiary. We simply used the term Federal, State, City and County loosely, and we appreciate Doctor health departments and other agencies McBrayer's setting us straight. active in disease-prevention and health promotion will gather in New Orleans. For four clays, the attention of the VALUABLE BOOK FOR health and medical worlds will be PUBLIC HEALTH NURSES

focused upon the deliberations and The J. B. Lippincott Company of recommendations of this band of Philadelphia have recently published a health specialists. book by Louise Zabriskie, registered The Annual Meeting of the Ameri- nurse. The title is "Mother and Baby can Public Health Association is the Care in Pictures." The book has much place where the report on the state of information which would be of value the nation in matters of public and per- to nurses engaged in malsinity and sonal health is presented. infancy work. The price of the book Dr. Thomas A. Parran, Jr., Surgeon in paper cover is one dollar. It may General of the United States Public be ordered from the publishers. Health Service is President-Elect of the Association and will be honored at SYPHILIS CAN New Orleans. BE CONTROLLED National headquarters of the Ameri- According to the best information can Public Health Association are 50 available it is estimated that about ten West 50th Street, New York, N. Y., per cent of the population of the and Dr. Reginald M. Atwater is Execu- United States have syphilis. It ranks tive Secretary. third as the cause of deaths in New York City. In 1919 Sweden passed a drastic control law. That country CORRECTION then had six thousand active cases. In In our March issue under the title 1934 the number had dropped to 431. "Hospital Care," we described briefly The essence of the control measure is the organization of some of the hos- that every person having the disease pital care associations which have must report themselves to a physician been formed in this State during the for treatment until cured. Free clinics

last two or three years. We made are provided for the poor ; but the is patient receive the following statement : "All of them point every must are organized on a commercial basis," prompt, effective and continuous treat-

etc. ment until the disease is eradicated. PuHis\edbM TflE, /PRTft CflKgU/IA STATE- B7\EUm

This Bulletin will be sent free to anu citizen of the 5tate upon 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. 51 JUNE, 1936 No. 6

WOOD SMETHURST, RALEIGH, N. C.

Even Now Beginning to Look at Life Beyond the Geology of the Sand Pile

Above is a picture of the young son of Mr. and Mrs. Prank Smethurst of Raleigh. Today Mr. Smethurst is Managing Editor of the News and Observer. Twenty-one years ago, when the Editor of the Health Bulletin went to work for the State Board of Health, Frank Smethurst was a reporter for the News and Observer. His "beat" covered the Board offices. During the intervening years he has done much to advance the cause of public health. Mr. and Mrs. Smethurst say that the boy is literally being raised according to Health Bulletin standards. 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 _ Golds boro G. G. Dixon, M.D _ _ Ayden H. Lee 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

Adenoids and Tonsil» 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 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 B 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 Midwivea

CONTENTS PAQl » Notes and Comment - Summer Dangers for Infants and Young Children 5 Malaria Historical, Geographical and Biological Factors 7 Taking Some of the Guess Work Out of Life 10 Department for Crippled Children Established 11 Department of Industrial Hygiene _ - 13 Division of Epidemiology 14 Summer Pleasures and Summer Safeties 16 :

Vol. 51 JUNE, 1936 No. 6

Notes and Comment By The Editor THE more we see, the more we pose these boys and girls will eventu- hear, and the more we read, the ally arrive at maturity, but I fear that many of them will be poor speci- more we feel the necessity for con- mens of manhood and citizens." tinual condemnation of the tendency Our friend who wrote the above is of the people everywhere to self-medi- possibly a little too pessimistic. The cation. Instead of our emphasis as a careful student of history may under- people being placed on positive health stand that in the long upward or and the things on conducive to health downward climb of the human race, and happiness, our tendency is to there have been many periods in prac- place the emphasis on aches and pains tically all countries of the world in and the drugs to relieve them. A pub- which morals and health were some- lic health nurse of wide experience in times at a low ebb. Somehow there North Carolina wrote us the other day have been, so far, a sufficient number as follows of survivors to carry on. It seems to be foolish for people to their "I am glad you wrote so emphati- waste cally in the last issue of the Health time and energy and sacrifice their Bulletin about the dangers of chil- health in so many ways when the posi- dren being given various drugs sup- tive course could be pursued with so posed to be for the purpose of reliev- much more profit to individuals as ing little aches and pains. That is well as the State. one of my stock worries. I am bom- barded continually with questions In concluding this paragraph, we about the efficacy of headache and want to call attention again to the various other remedies. I have been amazed and startled at the large num- proved fact that self-medication is a ber of children who carry a pocket dangerous procedure. Why, even a full of depressant drugs to school with practicing physician, when he gets them daily. They explain to me that they take these along in case of a sick, does not think it wise to pre- headache, and that such remedies have scribe for himself. And physicians been advised by So and So. Frequently should certainly know more about I see a child slip a tablet in his or her mouth. therapeutics, and drugs and their ef- "And another thing, from the least fect on the human body than any to the largest boys, it seems to me, other people in the world. If a physi- smoke cigarettes, and not infrequently cian, knowing the dangers of these I find the little girls smoking, too. things, refuses to trust his judgment Consequently, it seems to me I find more children underweight, with poor when he is sick and in an abnormal posture, and deficient nutrition than condition, how much more important at any time in my work. I frequently it is for the people who know nothing ask small boys how and where they about the dangers to exercise some get the cigarettes, and usually I am told 'daddy gives them to me.' I sup- care. : ; : ; ; ;

The Health Bulletin June, 1936

THE editor of the Health Bulletin are some of the things the health offi- was recently privileged to attend cers said "That an estimated 12,000,000 Ameri- the annual conference in Washington can men, women, and children suffer with the State and Provincial Health Departments and many health work- this affliction "That an estimated 3,000,000 new ers with the Surgeon General of the cases a year should be given treatment, U. S. Public Health Service. One but that only about 1,000,000 cases whole day in this conference was de- actually do receive treatment voted to a discussion of the menace of "That, in the opinion of Surgeon venereal diseases, particularly syphilis. General Parran, new head of the U. S. Two men presented papers on the pro- Public Health Service, the control and gram who are among the foremost eradication of this disease would con- physicians in the country. One was stitute a more important contribution the director of the venereal disease to society than discovery of a method clinic in Johns Hopkins Hospital and of immunizing against infantile paraly- the other occupying the same position

sis ; in the University of Virginia Medical "That syphilis is 'one absolutely con- School. trollable disease ;' that the cause and Among other things emphasized by mode of spread is known ; the diagno- these men, which to many people sis by blood tests is reliable, and that should be a startling disclosure of con- tried methods of treatment are effec- ditions, was the fact that the third

tive ; highest cause of death in the city of "That despite the medical world's New York is at present due to syphilis. competency to combat this disease, it Only two other diseases outrank that continues to spread because of public as a killer in the New York City mor- ignorance on the subject, because many tality reports, they said. One of the doctors fail to recognize early symp- hopeful features of the discussion was toms and because of lack of facilities a description of how the country of for free treatment of millions of suf- Sweden has set about to control and ferers who have not the money to buy eliminate this terrible disease from the cure. its borders. They explained how a * * * syphilis control law was adopted in the things the that country in 1919, when there were "Here are some of health officers proposed 6,000 known cases of the disease, and "Compulsory examination of the en- in 1934, as a result of this control law, tire population to search out the 10 per the number of active cases of the dis- cent said to be infected; ease in that country had dropped to "Providing, at public expense, clinics 431. for free treatment on a mass scale We are concluding this paragraph "Providing, also at public expense, by quoting from an editorial in the better laboratory service and informa- Washington Daily Neivs in connection tion for private physicians with a report of the meeting held at "Educational publicity. the Surgeon General's office, although we do not endorse all the proposals. * * * "Syphilis ranks with tuberculosis "A Major Menace" and cancer as a major cause of death. "State health officers, at an annual It causes untold misery- It denies conference in Washington, devoted a many married couples the privilege of full day to discussion of the dread, parenthood. It causes helpless, inno- widespread disease of syphilis. Here cent children to be born blind or deaf. :

June, 1936 The Health Bulletin

It cripples and finally drives insane Moore of Johns Hopkins Hospital. He many of its luckless victims. It pol- said lutes the wells from which posterity " 'If there were in this country a must spring. million cases a year of smallpox, ty- "If we, as Americans, are to preserve phoid fever, poliomyelitis, plague, the physical, mental and spiritual meningitis, Rocky Mountain spotted vigor of our society, it is high time fever, or any one of a dozen other in- that we start a conquest of this fections less serious, there would be a menace. public health war indeed. The public "The tragic seriousness of the prob- health official would not require to be lem was summarized by Dr. Joseph E. forced into action by popular panic' "

Summer Dangers for Infants and Young Children

By J. Buken SlDBUEY, M.D.

[Editor's Note: Dr. Sidbury prepared this paper for the special Baby Edition of the Winston-Salem Journal and Sentinel.]

PROBABLY the greatest single re- some needed rest and may help to responsibility in infant care is that establish a satisfactory breast milk of advising a mother when to supply. Certainly nothing can be lost wean her baby. Babies that are kept by such an effort. at the mother's breast for six months When it is necessary, or advisable, to stand a much better chance of celebrat- wean the baby during the hot summer ing their first birthday than those arti- months, it should be done gradually. ficially fed. Of the number of babies First one bottle and then two may be die before their first birthday who 75% substituted each day for the breast are artificially fed. feeding. This procedure may be fol- Babies who are deprived of breast lowed for one or two weeks till the milk are more susceptible to infectious baby is weaned from the breast. This and contagious diseases. Besides food gradual change will be less likely to which they get fi'om breast milk there upset the baby. is secreted in the breast milk immune If the baby has to be taken from bodies which give protection against the breast the important question many of these diseases. These immune arises, "Just what food is best for this bodies are not found in artificial feed- at this time?" This ings. baby question Because the baby is not gaining, or should always be decided by the physi- not satisfied, with the breast milk sup- cian and not by a layman. It is too ply is no excuse for weaning. Give the often made on the advice of a "kind baby a complementary feeding two or friend." The responsibility is too more times daily as needed. This feed- great to be taken lightly. Many babies ing should follow immediately after the are made sick by changes which were breast feeding and will supply sufficient not properly supervised. added nourishment to satisfy the baby Certain principles must be carried and cause proper rate of gain. Such out if the health of the baby is to be procedures often tide over a difficult safe-guarded. Some of these may be situation. This will give the mother summarized as follows: The Health Bulletin June, 1936

1. All milk should be sterile, there- make it ready for use. To this some fore free from bacteria. To accom- form of sugar may be added as direct- plish this, it is especially advised that ed by the physician. all milk be boiled from May to October There will be some families who can- and longer if the weather is hot. not get fresh cows milk. For their

2. Milk should be fresh and kept cold use one would advise evaporated milk until used by the baby. Milk sours diluted one-half with boiled water to very quickly in hot weather, and sour, which lactic acid may be added as was or contaminated milk will give the used in the boiled cows milk. baby "colitis" or dysentery. Do not let Other foods equally as safe and in milk stay on the back porch in the hot certain cases more practical are some sun after being delivered. This is the of the dried milks such as Dried Lac- mother's responsibility and not the tic Acid Milk, Klim Whole Milk, Dryco dairyman's. Every detail must be Dry Milk, S. M. A., Similac and other looked after to keep the baby well. dried milk. These milks have the ad-

3. All utensils used in preparation vantage of not being bulky and may be of the baby's formula must be boiled prepared simply by adding boiled each day for five to ten minutes and water. In case of one traveling with kept covered to prevent contamination a baby the dried milks are to be pre- by flies or insects which carry dis- ferred. It is advisable to make as few ease germs. changes as possible in the baby's milk 4. When using fresh cows milk, de- supply. Changing from one cows milk mand Grade A milk. This carries with to another cows milk in the summer is it a guarantee of proper inspection and apt to upset the baby. Avoid this when supervision of the cattle, of the barns, possible. of the dairymen and of the method of 6. During the summer months exces- distribution of their product. All herds sive heat and humidity are important of cattle should be tuberculin tested as factors in gastro-intestinal upsets. It well as tested for undulant fever. Your is important therefore to keep the baby Health Department should have this as cool. Put as few clothes on the baby its responsibility—to see that you get as is necessary for comfort. Keep the clean, undiluted, fresh milk. baby in the coolest room in the house

5. During the summer months some and give him daily during very hot preparation of lactic acid milk is prob- weather two or three cool tub baths ably the safest milk for the baby. It for twenty or thirty minutes. He will is a food that is easy to digest. It is a enjoy it as well as derive much good food which acts as a prophylactic meas- and comfort from it. ure against "upset bowels." It is in 7. The baby should be given all the every way the ideal food for the baby boiled water he will take at any time in the summer time. Unfortunately during the hot weather. During such some babies rebel against taking it. times do not force food. Let the baby

If it is started early very little trouble take what he will of his prescribed is encountered. diet, but not more often than four In towns where lactic acid milk is hours apart. Give the baby as few prepared by the dairy it can be de- feedings in the 24 hours as will satisfy. livered to you daily just as is fresh This will avoid some "intestinal up- sweet milk. Where such service is not sets." Overfeeding is much more apt available the fresh cows milk can be to cause trouble than underfeeding. The boiled three minutes and cooled, and baby will see to it that he is not under- then three drops of lactic acid added to fed, or at least he will protest. A good each ounce of boiled sweet milk will motto to follow in the hot summer time June, 1936 The Health Bulletin is "Water internally, externally, and child from one to three years of age, eternally." who is more likely to have gastroin-

8. Do not be afraid to let the sun testinal ailments. So often this child shine on the baby. The baby should is left to his or her own devices. With get a sun bath each day if possible. the arrival of the new baby not much The direct rays of the sun are the best attention, or certainly not enough at- health measure known to man. So the tention, is paid to this child. This is baby should be taken out of doors each true mainly because the little baby day, but his eyes and face should be must have the greater part of the carefully protected from the direct sun mother's time. As a result this little rays by the hood of the carriage or fellow gets many things to eat that the an umbrella. Direct sun rays will pre- mother knows nothing of and too often vent and cure rickets. The remedy is an upset follows. He should not be free. The most effective rays are those watched and supervised less than the that can be obtained between 10 :00 new baby but should be given more A. M. and 3 :00 P. M. strict supervision than ever. The rea- Sun baths may be started with safety son for this is very apparent. The little at 3 or 4 weeks of age. The duration baby will stay where he is put. The at onset is to be five minutes exposure older baby is rarely found where he on the front of the body and five min- was seen two minutes before, and is utes exposure on the back. At first the always getting into something he baby may be held in the nurse's lap. should not. The duration of the bath should be in- A careful, conscientious supervision creased to 30 or 40 minutes daily, in- of the points brought out above will creasing one minute each day from the save many sorrows and heartaches and start of five minutes. By this means a healthy, tanned, robust baby will be will in time help the State Health De- assured. partment a great deal in its untiring

9. During the summer time it is the efforts to reduce infant mortality in "knee baby" or "run around baby," the North Carolina.

Malaria Historical, Geographical and Biological Factors

By C. L. White, Jr., District Supervisor, Malaria Control

T is probably that malaria has In the early settlement of the United caused more suffering and disability States, the menace of malaria was a to mankind than any other of the factor of major importance. The first infections. There is no doubt that the colonists of our eastern seaboard ex- advancement of countries lying in the perienced a tremendous mortality in Tropical and Subtropical Zones has which malaria played a large part. been greatly retarded by this disease. When the second wave of migration Many historians believe that the down- passed across the Alleghanies after the fall of the great Greek civilization of Revolution, the pioneers who moved the Age of Pericles was due to the out into the great central plains again introduction of malaria. suffered terribly from this disease. ;

8 The Health Bulletin June, 1936

The first settlements were in lowlands to attack a new lot of red cells. At along the river valleys, and the clear- the time of this simultaneous discharge ing of forests and damming of water- of the young Plasmodia into the cir- courses created conditions ideal for culation, the patient has his recur- propagating malarial mosquitoes. rent attack of chills and fever. Quinine Today malaria occurs in a great belt is a specific poison for the Plasmodia, around the world, covering the Tropics which it destroys as they are set free and Subtropics, and extending from in the blood stream. Recently, ata- about 40° N. latitude in the United brine and other drugs have been used States to 30° S. latitude in South with notable success in the treatment America and Africa. In the United of malaria. States this line runs from southern It had long been noted that malaria Pennsylvania, through Ohio, Illinois, was prevalent in swampy regions where

Colorado and California ; but malaria there was much ponded water, and it is not a very serious problem north of was supposed that some specific poison Kentucky or west of Oklahoma. In was present in the air of such places. Europe the malaria area reaches much The word "mal-aria" means the bad- further north, to 60° N. latitude (in air disease. Several observers had Holland and Germany). guessed that mosquitoes might play a About 300 years ago a distinguished part in its transmission. Finally, be- Spanish lady, the Countess Chinchon. tween 1895 and 1898, Ronald Ross, an wife of the Governor of Peru, had an English army surgeon in India, found attack of fever and was cured by an in the body of a mosquito what he extract of the bark of a local tree, used thought might be the germ of human by the natives for that purpose. She malaria and then—working with birds sent some of this dried bark to Spain —proved that bird malaria is actually and the general introduction of this transmitted by these insects. In 1902 new remedy about the year 1640 was Ross received the Nobel Prize for the first important step in the history Medicine for his work on malaria. of malaria control. This extract was In 1898 Grassi and Bignami in Italy named cinchona, or quinine, after the completed the demonstration of mos- Countess. quito-transmission of human malaria. More than 200 years later, in 1880, The main problem was now solved. Laveran, a French army surgeon, ex- If a mosquito of a certain type bites a amined the blood of malaria patients person suffering from malaria, Plas- under the microscope and discovered modia are sucked out with the blood the germ of malaria. This germ be- and reproduce in the body of the mos- longs to the lowest group of one-celled quito. They pass from the stomach to animals, the protozoa. It is called a the salivary glands of the mosquito Plasmodium, and there are 3 different and, after several weeks, can be trans- species of Plasmodia associated with 3 mitted to "the next person bitten by the different types of malaria. Each germ insect. This process, however, takes enters a red blood cell, within which it place only in mosquitoes of certain proceeds to increase in size until it species belonging to the genus Ano- practically fills the cell. As it grows pheles. The prevalence of malaria in it becomes segmented. At the end of swampy regions in Southern United 24, 48 or 72 hours (depending on the States was explained by the habits of species) each full-grown Plasmodium the malarial mosquito. The females ruptures the blood cell and splits into of the Anopheles family lay their eggs a number of young Plasmodia, which in quiet water, and there the young are discharged into the blood stream wigglers spend their larva-hood, change June, 1936 The Health Bulletin

to the pupa state, and emerge from streams was made possible by another their water habitat only when they discovery. It was observed in Kansas have become winged adults. by M. A. Barber, of the Rockefeller Obviously, then, malaria can be con- Foundation, that, when finely powdered trolled by protection from mosquitoes pans green was sprayed on the surface (as by screening) or, better, by pre- of the water, the Anopheles larvae venting the breeding of malaria-bear- would eat it and be poisoned. As a ing mosquitoes. The most permanent result of treating mosquito-breeding results, of course, can be accomplished waters with parish green, areas like by removing accumulations of standing the Roman Campagna, which have for water entirely by draining them away centuries been desolated by malaria, or filling the lowlands. are now almost completely free from Another method, where pools can not the disease. This method of control, be eliminated, is to spray the water which is called larviciding, is also used with light fuel oil, which spreads over successfully in the United States. the surface in a thin film. The mos- Another major mystery remained to quito wigglers need air to breathe, the be solved. In certain regions in Den- layer of oil cuts off their air supply mark, in France, in Italy, there were and they suffocate. In ponds which abundant malarial mosquitoes but no one does not wish to treat in such a malaria. The area about Naples is a way, the breeding of mosquitoes can be good example. Anopheles mosquitoes controlled by stocking them with top- were everywhere but, although malaria water minnows, which eat the wigglers. was a scourge to the north and to the However, in this method of control it south, in this particular belt the dis- is necessary to keep the edges of the ease was very rare. It was noted that ponds clean of all vegetation and float- the Anopheles mosquitoes in these reg- age. By such procedures as given it has ions did not appear to bite human be- been found possible to control malaria ings readily but fed by preference on in the United States very effectively. the stabled cattle. This clue was fol- When tbe American methods of lowed by catching mosquitoes which fighting malaria were applied in were full of blood and testing the Europe, they yielded much less satis- blood to see if it was of human or factory results. In Italy, for instance, bovine origin. It was found that the great drainage projects were carried Anopheles mosquitoes in the areas in out, but malaria did not disappear. question actually lived almost wholly Experts of the Rockefeller Founda- on the blood of cattle. tion working in Europe at last found In the story of malaria we have an the answer to this apparent anomaly. admirable example of the complexity The American Anophelines thrive at a of biological adaptation and of the way high temperature and breed chiefly in in which a knowledge of biology can be pools warmed by the sun. In America, turned to practical account. The rela- therefore, drainage controls their tion of the three types of malarial breeding effectively. Malarial mos- parasites to their insect and mam- quitoes of the European species, how- malian hosts and the characteristic ever, prefer cold water (which is the breeding places of particular species reason the European malaria zone of Anopheles have formed a fascinating extends so far north). They breed by field of scientific study. The control preference not in warm pools but in the of mosquitoes by drainage, by stock- cooler water along the shores of ponds, ing pools with fish, by oiling and lar- rivers, canals and drainage ditches. viciding represents one of the major The control of breeding in such triumphs of modern science. 10 The Health Bulletin June, 1936:

Taking Some of the Guess Work Out of Life

By Mrs. J. Henry Highsmith

procedure has been found more this intelligence and wholesome atti- NObeneficial for staying off disabl- tude the health, happiness and efficiency ing diseases and lifting loads of of tomorrow's citizens can be counted worry than the periodic physical health on to surpass that of today. examination. It may not be the most Another good health forecast for the- generally popular means of preventing future is that babies and young chil- disease and illness, but it is one of the dren are being taught to consider the most effective and certainly inex- doctor as their friend, as the guardian pensive. Physicians and health work- of their health. This friendly relation- ers look forward to the day when the ship will not only stand them in good; physical health examinations will be stead while they are babies and young the more generally practiced measure children, but it will be a comfort and of maintaining personal health and ef- protection in maturity and on through ficiency, and incidentally of increasing the years. the sum total of human happiness. A close friendly relationship with Twenty years ago a physical exami- one's family physician—choose one nation at regular intervals was whom you can hold in the highest especially advised as a means of esteem, and consult regularly and con- staying off the ailments of old fidently—is the more modern and sens- age — the degenerative diseases, ible method of keeping one's self in- mainly of the heart, arteries and kid- fine shape physically. It is in keeping neys. This was to avoid premature with the more intelligent health stand- breakdowns and other dreaded condi- ards and practices of today. The good 1 tions feared for old age. But more physician who is made to feel that he positive health and a greater degree of is held accountable for the health and assurance is wanted today. One is not efficiency of his patients, will study to> willing to wait till he feels old age know his patients thoroughly, so as tO' creeping on to ascertain whether or not advise competently. The plan works he is sound physically. He considers advantageously to both parties. health too valuable an asset to take

chances on losing it, especially when EVERY DAY A NEW BEGINNING it is no more than a matter of neglect or delay. Finish every day and be done with taking this attitude Young people are it. You have done what you could. toward health and are doing something Some blunders and absurdities no-

about it. They make friends with their doubt crept in ; forget them as soon as

doctor, seek his counsel and relieve you can. Tomorrow is a new day ; be- their minds of further worry. They gin it well and serenely and with too are courageous. They want to know high spirit to be cumbered with your the facts about themselves so as to old nonsense. This day is all that is proceed intelligently with their plans, good and fair. It is too dear, with its without running risks or depending on hopes and invitations, to waste a mo- guess-work. That is the enlightened ment on the yesterdays.—Twin City spirit of modern youth, and because of Advertisers, Winooski, Vt. :

Jane, 1936 The Health Bulletin 11

Department for Crippled Children Established

[Extracts from Annual Report of the State Health Officer]

Department for Crippled Chil- child and to promote the co- THE operation of dren was established as a service the Medical, Health and Welfare groups. of Health on of the State Board Meetings will be held twice a April 1, 1936, for the purpose of co- year or more often if the oc- ordinating and broadening activities casion arises. b. Administrative activities for in the State in behalf of the crippled the needy crippled child will establishment is in further- child. Its entail the operation of estab- ance of plans developed over a period lished clinics, cooperation with of several months to provide a means local Health and Welfare officials, providing hospital care of cooperating with the Crippled Chil- and treatment and convales- of the Children's dren's Department cent care. United States Department of Bureau, c. The plan provides for the es- the Labor, in the administration of tablishment of a department provisions of the Social Security Act. of the State Board of Health to be known as the Department It has been developed in conjunction for Crippled Children, under a the North Carolina Annual Plan with medical director and staffed for Crippled Children, a brief outline by a State Supervisor, two of which follows Field Supervisors, trained and experienced in the care of the THE NORTH CAROLINA PLAN crippled child, and a whole- time Secretary. A. Objectives d. The twelve existing State register all crippled 1. Locate and clinics will continue to be children in the State. operated under the supervision 2. Effect and facilitate treatment of of the State Board of Health. these children. Local Advisory Committees until will serve each clinic for the 3. Follow up these children the age of twenty-one years. purpose of promoting the work of these clinics which are B. Description of Plan operated as units of the State

1. Financial participation by the Plan. State through appropriations for crippled children. C. The Needs for Crippled Children The greatest need for the care of a. N. C. Orthopaedic Hospital ($96,717). the crippled children in North Caro- lina is the establishing of additional b. State Board of Health Ortho- hospital beds. North Carolina paedic Clinics ($6,000). The Orthopaedic Hospital cannot care 2. Official State Agency — State for the institutional needs of all Board of Health the crippled children in the State a. A Commission composed of at the present time. There are over representatives of the North 1,200 crippled children who have Carolina Orthopaedic Hospital been examined and who are waiting and the Medical. Public for hospital care at this time. The Health. Nursing* Social Wel- total number of crippled children fare, Vocational Education, under 21 in this State is about 20,- and Civic leadership of the 000 (figured on the basis of 6 per State has been organized to 1,000 population). It is estimated act in an advisory capacity to that from 75 to 90 per cent of this the State Agency in its pro- number are in need of some type of gram respecting the crippled orthopaedic treatment. :

12 The Health Bulletin June, 1936

OBJECTIVES OF DEPARTMENT OF B. To secure expert diagnosis for these CRIPPLED CHILDREN children in all parts of the State.

1. Established clinics In assuming our duties in the De- partment we accept, as an Agency of a. Twelve State clinics. the State, the responsibility of deter- b. Two N. C. Orthopaedic Hospi- mining what are the needs of the crip- tal Clinics. pled child and of interpreting these c. Other clinics (under semi-public or private auspices). needs to the State and Federal Gov-

ernments. In turn, we assume the re- 2. Promote diagnostic clinics in iso- sponsibility of interpreting to the com- lated rural sections where need is indicated. munity the services offered by the for State and Federal Governments C. To provide expert treatment and meeting the needs of the crippled child hospital care. and undertake to cause these services 1. Clinics to be applied to the needs of the in- a. Minor corrections and treat- dividual. ments. It appears essential, therefore, that b. Post-operative treatment and the Department undertake these new hospital care. responsibilities by contemplating its 2. Hospital care. problem and beginning its activities with very definite objectives in view. a. N. C. Orthopaedic Hospital for children under sixteen years The problem, simply stated, involves of age. those effects which from birth, injury, b. Selected general hospitals. or disease cause children to suffer calcu- structural physical handicaps D. To establish a field supervisory and lated to hinder their adjustment to the follow-up service. ordinary mode of life and achievement. 1. Locate and refer crippled chil- In approaching this problem and in dren to clinics.

the solution of it, the following out- 2. Assist in clinical procedures. line of the Department's objectives is 3. Observe and supervise care of set forth patient in the home following treatment in clinic and hospital. A. To locate crippled children. 4. Safeguard results achieved in the clinical and hospital care of 1. Establish a registration bureau in the State Department of patients. Health. E. Engender public interest in the 2. Transcribe existing registration problem of the crippled child and of cripples. encourage the recognition of its responsibility to create opportunities a. State clinic registration, 1925- for the development of this group 1936. into as normal and useful life as possible. b. American Legion Child "Wel- 1. Through local Health and Wel- fare Survey, 1934. fare agencies.

c. Registrations at semi-public 2. Through civic organizations. and private clinics operated 3. Through the study of problems in the State. pertaining to the crippled child, collection of data and the compi- local Health, 3. Utilize services of lation of such information. Welfare, and School officials in the location and registration of 4. Preparation and publication of crippled children. reports and statistics. June, 19S6 The Health Bulletin 13

Department of Industrial Hygiene

By Carl V. Reynolds, M.D., State Health Officer [Extract? from Annual Report] DURING the past year work in these establishments, and of this num- industrial hygiene has been in- ber 60% were found to be exposed to augurated to extend the benefits siliceous dust hazards. Measures for the of preventive medicine to the million control of dust were found to be pro- and a quarter North Carolinians who vided for only 12% of the workers that are engaged in industry. The initia- are exposed to such hazards, and even tion of this important public health they are not protected since in many activity was made possible by the State instances such control devices as were Industrial Commission which employed found were either not regularly used for the purpose funds appropriated for or were inefficient. More than 75% of the administration of the Occupational the workers in the granite, mica, feld- Disease Act. The continuation and spar, talc and asbestos textile indus- broadening of this activity is assured tries are exposed to siliceous dust haz- by an additional appropriation of ards. The survey covered only a por- money received from Social Security tion of the siliceous dust industries of Funds allotted to the U. S. Public the State, but enough plants were Health Service, for distribution to the visited to make the results representa- several states. tive of conditions existing generally in Although several other states have the dusty trades. engaged in industrial hygiene work on In addition to the preliminary sur- a limited basis, North Carolina is the vey, the Department of Industrial first State to undertake a program suf- Hygiene cooperated with the U. S. ficiently comprehensive to include pre- Public Health Service in making a de- employment examination of workers tailed study of the occupational disease and engineering and medical studies of hazards in five asbestos textile plants. plants. The importance of such a pro- Their investigation involved the clini- gram is evidenced by the fact that 18 other states are engaged in or are com- cal and X-ray examination of 500 work- mitted to engage in this work. A ers and a study of their working en- happy situation exists in North Caro- vironments including a determination lina in that since its establishment our of the number and size of dust particles Department of Industrial Hygiene has in the air. Following this research, had the hearty cooperation of the State our personnel made a similar study of departments concerned respectively a granite cutting establishment involv- with labor, insurance, and workmen's ing 40 people. compensation. The work of the department is to By far the greatest occupational dis- consist of plant studies and pre-em- ease hazards in the State are those ployment examination of workers. The created by siliceous dusts, exposure to plant studies will include a clinical which results in the development of and X-Ray examination of all em- asbestosis and silicosis complicated ployees, and an engineering and clinical with tuberculosis. The first undertak- evaluation of their environment. The ing of the new Department, therefore, pre-employment examination of work- was a survey to determine the extent ers will be confined to those industries of the dust problem. During the fall which have been designated as subject- of the past year 103 plants were visited. ing the workers to siliceous dusts. It There were 4,406 persons employed in will include X-ray and clinical exami- ;:

14 The Health Bulletin June, 1936 nations of prospective employees. Much ease hazards to which workers are sub- of this work will be performed in injected. The Department should produce dustries about which nothing is known results which will be of general value with respect to the occupational dis- to both industry and medicine.

Division of Epidemiology

By Carl V. Reynolds, M.D., State Health Officer [Extracts from Annual Report]

a conquest against an infectious this informative group will do away IFor curable disease that is controll- with tabooing of such important in- able is successful we must have the formation. organized medi- concerted support of The prevention of venereal disease the public health personnel, in- cine, in Sweden, Denmark, Norway and terested social workers, and the press Great Britain is making grand and to impress upon the people the neces- telling advancement. The law of con- sity of taking advantage of opportuni- trol was established in Sweden in 1919. ties available to them. It must be re- In Sweden's six million population membered that our people are not re- 6,000 new cases were reported in 1919 ceiving or accepting protective agencies 431 in 1934. that are available. Smallpox, diph- During the last year about a fourth theria and typhoid fever are great ex- of the new cases were infected abroad. amples of communicable diseases that Of 431 cases 110 occurred in Stock- could be determined. Tuberculosis holm, 212 in other cities containing a certainly could be reduced to a minor total population of 1,500,000 inhabitants consequence. and 109 cases were in rural districts The one outstanding preventable dis- containing a population of four mil- ease that challenges the ingenuity of lion inhabitants. the medical profession, and particu- I shall now give a short account of larly public health officials, is the con- the requirements of the law against trol of syphilis—a controllable disease venereal disease in Sweden for your that is fast becoming the "captain of consideration and thought. The law death." contains the following principal points We, as physicians, should report our cases promptly and insist upon the in- "1, Every person suffering from ve- fected cases being treated until cured. nereal disease must submit to treat- We should seek the original source of ment by a physician and must follow infection and cause him or her to be his directions. treated. We should forget syphilis as "2. Every such person has the right, a loathsome and unmentionable vener- irrespective of the size of his income, eal disease and classify it as an in- to obtain free medical treatment and herited or accidental infectious dis- medicine, in case he is not being ease to be treated and controlled by treated by a private physician. This medicine available as any other com- includes free injections, free serologic municable disease. We should make examinations, as well as free certifi- known in no uncertain terms the dan- cates required by the public health au- gers arising from lack of control, and thorities as to complete recovery or it is the duty of the press and radio continued treatment. Hospitalization to broadcast this information. A de- in a special general ward is also fur- termined and concerted action through nished free of charge. -June, 1936 The Health Bulletin 15

'o. Every physician treating a new these diseases. For example, during •case of venereal disease must try to our poliomyelitis epidemic, had we had obtain information about the source of definite known measures to control the infection. disease, this office would have been "4. Against patients, who do not greatly handicapped in applying such properly follow up their treatment, and measures due to the fact that the aver- against individuals identified as the age delay in reporting cases was be- source of infection but unwilling to tween three and four weeks. come to treatment, certain compulsory The services of the Director of the measures may be taken. Division are available for consultation "5. A person who knows that he or relative to any unusual disease sit- she suffers from venereal disease and uation. who by carelessness causes its transmission, is subject to punishment of a BEWARE OF PERSISTENT severity up to forced labor. HOARSENESS "6. Every marriage partner prior to A recent bulletin of the American obtaining a marriage license has to Society for the Control of Cancer warns sign a statement certifying his or her against persistent hoarseness as a freedom from venereal disease in a serious symptom. When hoarseness is contagious stage. present, the bulletin says, the symptom "7. The local public health authori- is of such serious significance that its ties must publish information about cause should be determined in all cases the existence of the clinics for the by a thorough and competent examina- treatment of venereal disease." tion of the larynx. In the young and The Division of Epidemiology ex- occasionally in the middle-aged or old, pects to add to its staff a competent it may be due to benign growths of the physician to direct the venereal dis- larynx, but if there are no growths and ease control program, which is to be hoarseness continues, particularly in developed through Social Security the middle-aged or old, it most likely funds. The details of the plans for means the beginning of cancer, tuber- this program are to be worked out culosis or some condition that demands later. Suitable motion picture equip- immediate attention. ment, projector and films, have been Successful treatment of cancer of purchased to augment this work. the throat depends, like treatment for The North Carolina State Board of all other cancers, on early diagnosis. Health, in cooperation with the Rocke- The longer the delay in making the feller Foundation and Vanderbilt Uni- diagnosis and beginning treatment, the versity, is conducting an intestinal fewer the chances that the treatment parasite survey, especially for the pur- will be beneficial. pose of determining the number in- Cancer is not the dread that it once fested with hookworm. Seventy of the was. As a matter of fact there are 100 counties in North Carolina are to some diseases less hopeful and more participate in the survey. to be dreaded than cancer. Early diag- The encouragement of better report- nosis and treatment have placed this ing of the various notifiable diseases is disease in the more hopeful group, and

an aim of the central office. If control the large number of patients which measures are definitely known, delay every one knows who have been treated in reporting would cause a loss of and made well is proof that there is valuable time in the application of hope for cancer, the hope being in hav- these measures during the time of an ing treatment during the first stages of increased prevalence of any one of the disease. 16 The Health Bulletin June, 1936

Summer Pleasures and Summer Safeties

JUNE ushers in summertime, vaca- Parents whose children are going to tion, and pleasure time. Plans will camp this summer are advised to know be made this month for all sorts whether or not the camp in question has been approved by the State Board of recreational sports and vacation of Health, and to know also something pleasures for the young and the old. about the medical supervision the camp There will be camps for the teen-age will have, if any. boys and girls, the beach for an older For the beach goers, we would not group, the mountains for those who be joy-killers, but there are three dan- want a change with rest, quiet and a gers that prove to be every year all delightful climate, and only the baby the way from serious to fatal. The will be left at home. That is just as it least of these is excessive sunburn that is not only painful but carries the should be, for literally speaking home risk of becoming infected. The second is the best and safest place for babies is the danger of drowning, which, how- in summer. ever, is met with more frequently in possible benefits for life The camp rivers, ponds and inland waters rather for children have been generally recog- than at the ocean front. The third nized, and camps are now available to danger is connected with returning late almost every boy and girl. The out- at night when tired out from bathing door life, the regulated program of and dancing and when no one is mentally or physically capable of safely play, exercise and rest, the instruction driving an automobile for fifty or a in games, manual arts and certain hundred miles. Some of the most tragic helpful techniques, and the opportunity deaths met in connection with vaca- to live close to nature should be of tioning in past summers have been at great benefit to the child who has been the hands of physically exhausted drivers who fall asleep at the wheel. confined to books and school routine While the automobile is always a men- all winter. ace to be reckoned with, it is doubly But care should be taken to choose hazardous under such circumstances. a camp that is reasonably safe from a Apparently, parents of young chil- health point of view—one that has the dren are left out of the vacation pic- approval of the State Board of Health. ture. They themselves know that While this approval is no guarantee babies and young children fare best against infection and illness, it does at home, in summer, in their cool play indicate that the camp has complied suits, and with their accustomed play- with certain regulations that are in- things and play places, but they never- tended to safeguard the camper's theless feel the need of a change, and health. Briefly, the safeguards are think they too are entitled to a little these : The camp is located on normally diversion and rest. They are! But how dry ground, having good drainage to get it, and what price to pay for it whose general surroundings are favor- is the question. The baby's health and able to maintaining health and sanita- well being must be considered, but tion. It is remote from fly and mos- there are a number of ways parents quito breeding places, and is kept free can have diversion and a change of of piles of refuse, garbage and other scene. Short trips by bus, auto or kinds of filth. Its water, milk and train for a day or week-end are pos- food supply meet the requirements pre- sible for most people, these with or scribed by the State and local health without the children. Few people have departments. Its sleeping quarters are exhausted all the places nearby that clean, screened, free of vermin, and will afford visiting and learning some- provided with clean bedding. Means of thing from, and very few are familiar sewage and waste disposal must be in with all the spots of natural beauty accordance with regulations prescribed and interest of their immediate vicin- by the State Board of Health. And ity. A day or two at a time spent in swimming, bathing or wading in any the woods, or by some lake where stream, pond or lake which receives swimming, fishing, or picnicing may sewage, or is a potential source of dan- be enjoyed is not a bad vacation after ger is prohibited. all. Pu"blis\edbM TAE^°£T/iCAR?LlrtA STft^e> 7\E\Lan

This Bulletin will be seryt free to ar\\j citizery of the State upoi\ 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. 51 JULY, 1936 No. 7

Currituck County Group

Above is a picture of Dr. W. T. Griggs and a group of pre-school children at Powell's Point, Currituck County. Dr. Griggs found two of these children without physical defects. All of them had been immunized against smallpox and diphtheria. Most of them had been immunized in infancy against diphtheria by the family physician. We are indebted to Miss Idell Buchan, for many years the efficient County health nurse, for the picture. 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. Lee 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

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 request 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 15

Infant Care. The Prevention of months ; 15 to 24 months ; 2 to 8

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

CONTENTS PAQB Notes and Comment 3 New Hope Found for Stutterers 6 "Food Poisoning" ^ Sleep and Health 9 — 10 Child Guidance - Smallpox 15 Vol. 51 JULY, 1936 No. 7

Notes and Comment By The Editor

a rule, most physicians advise and he occupied a position around the ASyoung folks under twenty-one large conference table directly opposite years of age to abstain from the from this woman physician, an at- use of tobacco in any form, particular- tractive middle-aged woman of ap- ly cigarette smoking. Physicians also parently fine intellectual capacity, but advise every one, regardless of age. probably the most "nervous" individual against smoking to excess. this particular editor has ever looked Since the women and girls have upon. In the two-hour conference she taken up the habit of smoking, physi- smoked one cigarette after another, cians are probably asked more fre- lighting a new one from the stub of a quently to define what is meant by discarded one, and then reached out ''excessive smoking." Different doctors for more. This evidenced smoking to have different replies to this question. excess. Such an individual must be Quite a number of physicians advise a pain even to herself, let alone her that when a person has to stop in the family. middle of any active duty to light a In the expansion of public health cigarette and take a few puffs before service in North Carolina made pos- going on, or to stop in the middle of sible through funds available through a meal to light up and smoke, it may the social security legislation at Wash- be termed "excessive smoking," which ington, the State Board of Health has is detrimental to such an individual's been able to assist in the employment health. The editor of the Health of several additional nurses. These Bulletin holds to this view. While he nurses are to go out and be attached to has never used tobacco in any form, he the counties, either the whole-time looks on it with a degree of tolerance health departments or working under which the facts justify. He feels, how- direct supervision from this office. ever, that all about the evidences of Their work is to be that of general excessive smoking may be plainly seen. public health nurses, but many of them Some time ago at a conference in must work almost exclusively with Washington, attended by a score of women and children. It has become health officials from different states, necessary to send some of these young among the number was a woman doc- nurse applicants off for a special tor from a western state. It was a course of four months training in an business conference, and many vital institution located outside the State. questions concerning the health An effort was made here to select the agencies of the states involved were most capable and promising young being discussed. The conference lasted women out of the large group of ap- about two hours. The editor of the plicants qualified to take the course. Health Bulletin was in attendance, At least one young nurse had to be —

The Health Bulletin July, 1936 turned down on account of her habit and young men, who have to go out of excessive cigarette smoking. "While and look jobs and give satisfactory waiting in the ante-room to see the service, it would seem foolish in the doctor in charge of selections at the extreme to acquire a habit that would Board office here one day, she was ob- militate against satisfactory service as served to be smoking one cigarette af- well as be detrimental to health. ter another. This prompted the head The advice of the State Board of of the department to make a little fur- Health to girls and women and to boys ther investigation, going so far as to who have not yet acquired the habit obtain from a former employer of that would be to let it alone ; and to those young women a statement as to her who have already assumed the habit qualifications and habits. The reply of smoking like veteran men, that they was prompt, to the effect that she was make an effort to control their newly an intelligent, fine, capable young acquired habit. woman, but had to be let out of the other service because of her habit of excessive smoking. Her employer TVTE take pleasure in recording the stated that she would have to stop in fact that so far this summer there the middle of preparation to give a are no signs whatever of the return of hypodermic injection for the relief of infantile paralysis in epidemic form as pain, lay the syringe down, and light a was the case in North Carolina in 1935. cigarette and take a puff or two before In May, 1935, there were 44 cases of going on and finishing the job for the infantile paralysis reported to the State suffering patient. Board of Health. In the month of May This story is mentioned here in this this year only 6 cases were reported. connection simply to serve as a warn- The health officials do not look for the ing to the young girls and women who return of the disease in abnormal pro- have so recently become addicted to portion this year. Consequently, all the the habit of cigarette smoking. The boys and girls may make their prepara- men. having been accustomed to smok- tions to attend camp anywhere they ing for the most part a long time, are like in the State this summer. Out- not so likely to smoke to excess as siders may be invited in and urged to women, to whom the experience is new. come, and visitors from other states However, many men, as may be ob- will find health conditions just as safe served around in public gatherings, do as ever before the cases here last year, smoke excessively. The habit is costly and as they would find in any average and. like any other habit, grows on one, state. and should be controlled strictly or However, boys and girls, particu- abandoned. larly those who are going off to camp No one yet knows what effect, if any, this summer, and all persons who are this excessive smoking on the part of making the habit of attending picnics girls and women will have on the and making daily visits to various re- younger generation to be born from sorts in the State, should be protected now on. Time alone can tell. There against typhoid fever. All of them is not enough scientific evidence avail- should be immunized if they have not able from countries in which women had the immunizing treatment within have been smoking to excess for some three years at least. Every two years time, in such, for instance, as Mexico is better. They should also pick out that is, certain classes of women, to the kind of camp, if they expect to make a prediction safe or accurate. stay some time, or the kind of resort For girls and women, however, as boys for a vacation, that has voluntarily July, 1936 The Health Bulletin

requested and has the approval of the one of two sad stories—that the peo- State Board of Health as to their sani- ple of the State are too poor to shift tary arrangement and their health for themselves and get sufficient food conditions. For the boys and girls at- to maintain health, or they are too tending a camp for a prolonged period, ignorant and indifferent to their health say, one or two months, they should needs to make an effort to cook and certainly select a camp with a physi- eat the right food. cian on the staff, or at least a competent trained nurse and with a physician extremely close by whose services Y\/ E would like right here to impress may be obtained on call. upon our people the importance of The parents of the boys and girls keeping down fear this summer. Fear sent off to camp should make every of wars and rumors of wars, fear of reasonable investigation of the camp political results, fear of pestilences and management in so far as health pro- famine, fear of drought and flood, fear visions are concerned before letting of infantile paralysis or measles or their sons or daughters go to any camp, pellagra, in fact, fear of anything mor- even for as short a time as four or tal should be avoided. The tempo of six weeks. living is so fast, the * * * summer in North Carolina should be the time to build up "WTE have mentioned in these columns worn-out nerves which are sending so before this year the fact that there many women particularly to hospitals. seems to be a trend for an increase in Outdoor living can be indulged in in the prevalence of pellagra. We would the summer. The long hours of the like to call attention here again to the day should be divided so as to provide fact that 49 cases were reported for plenty of relaxation and plenty of time the week ending May 30th against 25 for resumption of the normal quiet cases for the same week in 1935. Natur- social contacts that make the "good ally reports for one week do not offer old days" so much remembered by the any great significance, but it is an in- older generation at present. For those dication of what may be expected un- who have to take their vacations in less every effort is made throughout their homes or back yards or fields and the State to combat this disease. Pre- farms or on their own premises in- ventive measures are simple, but re- stead of trotting off to some kind of quire constant application. Any relax- resort, the summer days should be the ation in vigilance on the part of the happiest of the year. population as a whole will mean an But, to repeat, fear of everything increase in cases and deaths before the should be avoided in so far as pos- year is out. It is hoped that this par- sible. In this connection the editor ticular week in May simply represents recalls a very dear relative of other an unusual occurrence and that the days. He had one expression—"all cases and deaths may be fewer this dangers are not death"—that made a year than last. lasting impression on our young mind, Since the above was written figures although he had possibly more troubles compiled in the department of epi- than any other dozen men of his ac- demiology show that 302 cases of pel- quaintance, and more varied kinds of lagra have been reported for the first troubles. His health, among other five months of this year as against 223 things, was not good, and yet he had a for the same time last year—an in- cheerful outlook which went far to crease of 79 cases. This increase tells make his life a success. ;

The Health Bulletin July, 1936

New Hope Found for Stutterers

Baffling Old Disease Yields to Mental, Physical and Social Treatment

By Mrs. J. Henry Highsmith STUTTERING, which has been consequently, successful treatment called a "pernicious living thorn must start from reshaping the patient's in the flesh" and is one of the mental and emotional processes. This oldest diseases known, is not to remain naturally is a complicated process call- one of the unconquered maladies that ing for medical, psychologic, reeduca- afflict mankind. It is now yielding to tional and social measures, and employ- treatment as the conditions and en- ing the group approach. The purpose vironments causing it are understood, is to reorganize the stutterer, and start changed or removed. him with a new chain of emotions and Dr. James S. Greene, medical direc- mental reactions. tor for the National Hospital for An effective means of treatment em- Speech Disorders in New York Gity, ployed by Dr. Greene is creating for his has materially advanced the knowledge patients a special atmosphere in which of the cause and cure of stuttering informality, encouragement and sym- during the past seventeen years in pathy hold sway, and in which there which his institution for the treatment is calm and peace—perhaps the first of speech disorders has handled 15,000 mental and spiritual calm the patient cases of stuttering and in addition sev- has ever known. In such an atmosphere eral thousands of other speech defec- old habits of a nonsocial, egocentric, tives. fearful individual are broken down, Stutterers, he says, are not speech and symptoms which complement his defectives as generally understood. stuttering speech respond to new and They can all speak normally under cer- wholesome suggestions. tain conditions. Their intermittent In this new environment, the patient spasmodic speech is not the result of emerges from his introverted shell, and some defective speech organism, but takes on a feeling of confidence and is conditioned by highly emotionalized belief in himself. He sooner or later states of mind. The adult stutterer us- gets his first hold of confidence in his ually gives a history of having been a speech situation, and finds himself ad- nervous, fearful child, often living in justed to a new environment of calm a parental atmosphere surcharged with assurance and emotional control. nervous tension. A nervous child living It is safe to conclude from the fore- in a home with high-strung nervous going diagnosis and treatment that parents, he says, is fertile soil for pro- there is much parents can do to pre- ducing the stutterer-type of personality. vent stuttering. The environment of According to Dr. Greene, the treat- the nervous child, especially its home ment of stuttering has always been a and family life should be made as baffling task because the basic prob- tranquil and normal as possible. Lack lem of the stutterer has not been fully of emotional control seems to play an understood. But opinions emanating important part in producing stuttering from different points of view and from therefore control of the emotions and different psychologists have now cen- avoidance of excitable conditions are tered on the fact that stuttering is an advised as measures against tbis old emotional personality problem, and disease. ;

July, 1936 The Health Bulletin

"Food Poisoning" (Third Article on Subject)

By Mary S. Batchelor, State Board of Health WHILE cases of food poisoning others from "fish poisoning." Both are not so common as to cause groups were probably wrong, since real a great deal of alarm, at this ptomain poisoning is exceedingly rare, season of the year, when hot weather and food infection is the same what- is upon us, when picnics abound, and ever the offending food may be. cold food is eaten in preference to hot. While it is rarely safe to make a it is well perhaps to sound a warning diagnosis without a careful investiga- that such cases occur much more fre- tion, this would appear to have been a quently than is generally supposed. typical case of what, for want of a In a small town of the State during better term, is called "food poisoning." last summer, one of the ladies of the This is by no means an uncommon oc- town entertained at a large party. A currence during hot weather, particu- great many of the younger bridge-play- larly where the foods involved are pre- ing set were invited and all agreed pared and allowed to stand for some that it was a very delightful afternoon. time without proper refrigeration, al- However, by the next morning, most of lowing ample opportunity for the the guests, who had passed miserable growth of bacteria. and sleepless nights, felt quite differ- Food poisoning is a term which is ently. As is usual in small towns, by used to describe an acute attack of the following afternoon practically the illness, generally associated with entire population of the town knew that nausea, vomiting, and diarrhea, which a great many of the guests who had may be attributed to the consumption partaken of the refreshments, as well of food containing harmful properties. as the thoroughly embarrassed hostess, The attacks may vary in severity from had suffered the greater part of the light cases, attended only by mild night and were still far from being nausea and diarrhea, to extreme cases comfortable. None of the victims were with fatal results. Usually, however, seriously ill, though the majority of the attack is over in a few days. The them were extremely uncomfortable, severity of the case probably depends and the occurrence was soon forgot- upon the number of bacteria ingested, ten, though it is doubtful if the un- as well as the individual's resistance fortunate hostess will ever feel the to the infection. same with regard to entertaining. To the average individual the term Of course there was a great deal of "food poisoning" immediately brings to conjecture, immediately following the mind a picture of decomposed or putre- party, as to which of the various dain- fied food. However, it should be under- ties had caused the trouble. Some of stood that the chief cause of food poi- the sufferers were quite positive that soning is not decomposed food, but is the shellfish salad was responsible rather food which is infected with an others felt equally sure that it was the organism closely related to the typhoid cake. Since no investigation was made, bacillus, called the Gartner bacillus. one guess was probably as good as the Even though it has been proven that other. However, all of the sufferers in the majority of outbreaks of food agreed that the party food was to poisoning the food affected is not al- blame, though some insisted that they tered in appearance, taste, or smell, the suffered from "ptomain poisoning" and idea still persists that "poisonous" food 8 The Health Bulletin July, 1936

must be tainted. It should lie remem- Transmission by means of rats and bered that it is as impossible to detect mice is perhaps the most common the presence of the Gartner bacillus in method of contamination. Such con- food as it is to detect typhoid, dysen- tamination should be scrupulously tery, or cholera infection in meat, milk, guarded against in all establishments or water, without scientiiic aid. in which food is handled, whether in In his book, "Preventive Medicine its raw state, or after it has been pre- and Hygiene", Dr. Rosenau tells the pared for human consumption. story of an outbreak of food poisoning While meat is the chief offender in in in veterinarian, Ghent, which a who cases of food poisoning, there is scarce- office inspec- held the of slaughterhouse ly a food which is immune. Of course tor, was so certain that the suspected foods which require a great deal of meat, in the absence of any abnormal handling in preparation for eating are signs, could have no connection with most likely to be contaminated. Like- the trouble, that he ate several pieces wise, foods which are prepared for of it to demonstrate its harmlessness. hours before the time for consumption Dr. Rosenau says further : "we admire and allowed to stand without proper his confidence, but learn a lesson from refrigeration not only run the risk of his tragic story." The veterinary sur- being contaminated by mice and rats, geon was attacked with severe cholera- but also allow for the multiplication of like symptoms, and died fiv^ days vast quantities of bacteria. For this later, the Gartner bacillus being re- reason, unless especial precautions are covered postmortem. taken, foods which are prepared for The bacilli of the Gartner group may picnics or for banquets at which large be transmitted to food in different numbers of people are served may be ways. In the case of infected meats, dangerous. the organism be present in the may All authorities agree that the pre- flesh of the animal before it is killed. vention of food infection starts with On the other hand, the meat may be the meat, or slaughterhouse, inspector. from animals that are perfectly A careful meat inspection service is a healthy, yet may be contaminated by sanitary safeguard, not only with re- the hands or equipment of a butcher gard to infection with the Gartner who has just handled a diseased car- bacillus, but in relation to other para- cass. For these reasons, all meat sitic infections. Absolute cleanliness should be subjected to rigid antemor- on the part of the butcher and his tem and postmortem inspections by assistants, acts as a further protection. persons skilled in this line. Absolute However, thorough cooking is the ulti- cleanliness should be practiced in mate safeguard. Foods which are ade- butchering, handling, storing, or trans- quately cooked and eaten immediately porting meats or meat products. It can rarely be accused of causing should also be remembered that pre- trouble. pared meat products such as sausages Refrigeration plays important of various kinds, meat pies, liver pat- an ties, and so on are particular offenders part in assuring us of the safety of our in the realm of food poisoning. foods. Cleanliness and thorough cook- Common gray rats and mice harbor ing may have little value where foods this infection. Abhorrent as it may are improperly refrigerated. In this seem, there is abundant opportunity connection, I should like to tell you of for contamination by rat and mice feces an outbreak of food infection which in butcher shops, refrigerator plants, occurred in the western part of the in restaurants, cafes, and homes. State last year, in which a dish of July, 1936 The Health Bulleti N

chicken salad was responsible for the This instance is mentioned merely trouble. for the purpose of cautioning against As it happened, a large number of the assumption that any refrigeration women in a certain boarding house paris proper refrigeration. took of chicken salad at the evening An insistence upon fresh food, which, meal, and then drove to a nearby town of course, presupposes adequate re- to attend a moving picture. During frigeration before purchase, the the course of the picture, they were attacked with severe cramps which ne- thorough cooking of all meats, or meat cessitated a hurried departure. In this products, protection of food against in- case, possibly because of the serious fection by means of rats and mice, and illness of one of the victims, a careful proper refrigeration within the estab- investigation was made. For some lishment responsible for the serving of time the salad was regarded as being food, whether restaurant, cafe, hotel or free from suspicion because of the fact home, will do much to eliminate the that as soon as it had been prepared it danger of food poisoning. had been placed within a mechanical As has been stated, food poisoning refrigerator. All of the people in- is not so common as to occasion a great volved were quite certain that it could not have been responsible. However, deal of alarm. However, it does occur upon further investigation, it was with sufficient frequency and severity to found that the mechanical refrigerator justify the exercise of painstaking care was at fault. Instead of having a tem- in the preparation and handling of perature of fifty degrees or below, its food. Our health and efficiency depend actual temperature ninety degrees more, perhaps, upon the food we eat was ; instead of refrigerating it was acting than upon any other single factor. as an incubator and actually promot- With this thought in mind, it cannot ing the rapid growth of bacteria. Fol- be too emphatically stated that any lowing its proper adjustment, no fur- precautions taken to assure the safety ther trouble was experienced. of our food are decidedly worthwhile.

Sleep and Health

By Mrs. J. Henry Highsmith SINCE Thomas A. Edison upset the makes the rule, and likewise fail to sleep health-chart by saying that take into account their own mental and up to his sixtieth year of life four physiological constitution and needs. hours of sleep a day sufficed him, and Recent experiments with dogs to that sleep is a matter of habit to be determine the value of sleep found that controlled and even diminished by the puppies can live two or three times as power of the will, there has been much long without food as without sleep. It questioning as to what amount of is stated that human beings can live sleep is necessary to maintain physical only about two weeks without sleep, and mental health. There is no doubt whereas they can live from fifteen to but that Edison's example and his sixty days without food. In the loss statement concerning sleep have been responsible for many persons getting of sleep the brain gets no rest, and insufficient sleep, even to the point of only those who "can't sleep" know the impairing their health. They fail to agony of a mind and brain exhausted recognize in him the exception that from lack of sleep. 10 The Health Bulletin July, 1936

Sufficient sleep for maintaining hours, and for the average woman 8 health depends on many factors, or 9 hours of sound sleep a day is con- but most of all on the soundness and sidered the minimum for keeping the depth of the sleep. One authority on mind and the body up to their best health and efficiency has said that five functioning powers. hours' sound sleep—a sleep in which People who begrudge the time they you are "dead to the world"—is far must, perforce, spend in bed for sleep more capable of restoring the body and to "knit up the ravel'd sleave of care," mind to normal capacity for work than should look well to their sleep habits. a ten-hour period of restlessness and Shorter hours will be necessary if one tossing in bed, with an occasional falls asleep immediately on going to nightmare. bed, and sleeps soundly in the early Since sleep is for rest and for re- part of the night. But all too fre- storing used-up energy, it is safe to quently people build up the wrong say that only when one rises thorough- sleeping habits. They read after going ly refreshed and invigorated from a to bed, take home work to be done at night's sleep, eager to be up and doing, night, or keep late hours eating, drink- has he had enough. The amount will ing and seeking forms of entertain- depend on the kind and intensity of ment or excitement. They insist on his work, on his habits of living and burning the candle at both ends, and eating, also on the amount of recrea- consequently pay the price in inefficient tion and play he gets, as well as on his labor, poor health and shattered age. But for the average man 7 or 8 nerves.

Child Guidance

By Sylvia Allen, M.D., Charlotte, N. C. who are in any sense distressed, by THE very title is appealing, everyone having tasted somewhere in unsatisfied inner needs, or at odds with life the results of lack of guidance their environment. "Children whose of balance or misguidance. It is not uncommon development is thrown out for us adults to be reasoning with our- by difficulties which reveal themselves be- selves thus, "I know what this fear in unhealthy traits, unacceptable havior or inability to cope with social means; it's an unfinished business of scholastic expectations." childhood, and I'll have none of it." and various The unfinished business of childhood This service is rendered in under various auspices. has a way of creeping into all the rami- communities the incomplete fications of life and coloring numerous In most instances mental common situations with strong emo- formulation of the science of necessitates private subsidy. tions of pain or pleasure, causing hygiene is or less still in the many molehills to assume the propor- The subject more field is not yet capable of tions of mountains. A molehill in the research and statistical comparison with other road is easily surmounted, but a moun- of mental health, yet it is tain in the road actually causes you to phases rapidly deliberately reaching that get out of your car, and creates con- and standard, and it is the belief of the sternation as to how to go ahead. The Child Guidance Clinic is an attempt to bring together all com- * Paper presented at the N. C. Graduate Nurses Association in annual session, October munity resources in behalf of children 9, 1935, Charlotte, N. C. -

July, 1936 The Health Bulletin 11

writer that it will be within the near punishment, rituals, exorcisms, chemi- future that we will find child guidance cal and physical restraint, etc. It will and mental hygiene an established part also interest you to be reminded that of or a correlation with the public the first time in which the psychologi- health movement. This is of necessity. cal keynote was sounded was in the I have only to remind you of the fig- early 19th century, about 1803 ures from the Mayo Clinic at Roches- Johannes Reil, a German, wrote a ter, which a year or two ago stated monograph suggesting that fear, grief, that they sent 56% of the persons who anger, love had something to do with came to them for abdominal operations deviations from the normal. However, to neuropsychiatrists. The present art as late as the 80's of the 19th century, of medicine consists, not only in the when Charcot, Bernheim and Mesmer actual diagnosis and treatment of the began their work in France, they were classical organic diseases, but also of entirely repudiated by men of science. the concomitant emotional factors They worked with such illusive factors which promote or retard healing. as suggestion, hypnotism, the dissocia- The community which has a child tion of personality, hallucinations, and guidance clinic soon learns that the it is of great interest to note that type of child desired by the clinic is Freud found the basis of his great ana- the potentially normal citizen who is lytical school in this work. showing some deviation in conduct or The development in the early 20th some reaction to environment which century has been amazing. Most of will ultimately thwart that person's you know of the early founding of the development or bring them into con- mental hygiene movement, May 6, 190S, flict with society. The recognition and in Connecticut, oriented upon the the treatment of such children is a manic-depressive psychosis of Clifford special technique which up to recently Beers, who was willing to share his has not been taught in the medical desperate mental sufferings with the schools and hence, has not been a part world for the sake of what it might of the equipment of even the finest of mean to humanity. There is little use physicians, but is now so permeating in reiterating the history of the last medical education that it will not be twenty-five years of the growth of the long before the pediatricians, at least, National Committee for Mental Hy- will have some willingness to face giene through the improvement of the these problems with the parents of care of the insane, the feeble-minded, their patients and much of this will the adult criminals, the juvenile crimi- not be left to the psychiatrist and the nals, the mild behavior disorders, the child guidance clinic, and this is as it preventive work of parent education— should be. However, it is questionable all of which have resulted in the pres- as to how much time the general prac- ent-day child guidance movement. "The titioner or the pediatrician can give to task of destroying ingrown prejudices these involved questions, the treatment and humanizing long-established prac- of which demands hours of consistent tices in each field was huge enough to and painstaking work. absorb the energies of the most zealous It is interesting to remind you of worker." the ancient attitude toward all nerv- The term "Child Guidance Clinic" ous and mental deviations, which be- was coined in 1922, though the essen- gan in the field of the supernatural tials of such a clinical scheme had with strong ideas of sin, retribution been creeping into practice for ten and demon possession, treated, as you years previously. In 1915 Dr. William will remember from your history, by Healy of the Judge Baker Foundation 12 The Health Bulletin July, 1936 in Boston wrote, "The idea that the their five years of service that the individual must be carefully studied most potent finding of causes in the in order that crime may be ameliorated behavior problems which came into has been steadily growing since the their hands rested in the parent-child day of Lombroso." The Chicago Juve- relationship. They stated further that nile Psychopathic Institute, founded of the two types of exaggerated parent- by Healy in 1909. was undoubtedly the hood, the over-protective parent re- pioneer in this field, though Witmer's sulted either in an over-submissive, im- Psychological Clinic at the University mature, undeveloped child or a nega- of Pennsylvania, established in 1S96, tivistic, revolting child who bucked the had in some degree blazed the trail. authority of the parent. The other The judges were among the most type of exaggerated parenthood, the eager students for this procedure and one who neglected a child, resulted in results, and Judge Harvey H. Baker an insecure child with feelings of being of Boston urged the establishment of unloved and misunderstood. This great a clinic there similar to the Chicago demonstration has gradually given one which served the juvenile court in away to locally supported clinics over that city. When Judge Baker died in the country, partially tax-supported 1915, a foundation bearing his name and partially privately subsidized, with was established by his friends in Bos- research still an underlying and pri- ton. In the meantime numerous psy- mary trend. chiatrists, psychologists and social Today common causes for referral

workers had been visiting Dr. Healy 's are such as : disobedience, negativism, service in Chicago and the idea was stubbornness, rebelliousness, nervous- carried to numerous states by them. ness, temper, stealing, truancy, lying, In 1912 and 1913 workers on these feeding difficulties, inability to get subjects were added to the Boston Psy- along with others, retardation in chopathic Hospital and the Johns Hop- school, bed-wetting, speech difficulties, kins Hospital. disturbing behavior in school, bad The beginning of formal training of habits, such as finger-sucking and nail- psychiatric social work was at the biting, placement problems, over- Smith College School for Social Work, activity, shyness, sleep disturbances, forced by the necessities of the war fears, day-dreaming. The most diffi- period. Even to date there are an cult problem before the staff is the inadequate number of workers in this selection of suitable cases, since all field. cannot be handled. Through several of the big founda- When a case is referred a consulta- tions, primarily the Commonwealth tion is held by the social worker with Fund backing the National Committee the person referring, and a careful for Mental Hygiene, demonstration description of the problem obtained. clinics were carried on, formally for This is then taken up with the psy- five years, from 1921. In 1922 there chiatrist in charge, and if the problem were seven such clinics in the country. seems a suitable one for such a clinic By 192S there were three hundred such the social worker makes a visit to the clinics, and it has been stated that home and school and slowly builds up about that year, forty thousand chil- as complete a history as possible of the dren were examined in such clinics. factors which have entered into the The Institute for Child Guidance main- child's developmental history, physical tained on a highly scientific basis in and mental, the hereditary background, New York under the leadership of the home relationships, the reactions Lawson Lowrey stated at the end of to society, the personality as seen by July, 1930 The Health Bulletin 13 others, the special interests, abilities Freud's psychoanalysis, Watson's be- and disabilities and this is in the haviorism, the German Gestalt psy- hands of the psychiatrist, who usually chology of unity from pedagogy and holds at least one consultation with the social work is now connecting itself guardian or the person closest to the closely with the work of the State patient. This is followed by a very institutions for nervous and mental complete physical examination, and in disease, and has helped to break down many cases adequate causes of the dif- the barriers between institutional work ficulty are found in this field and the and clinical medicine, so that there is general practitioner is called into the a close cooperation between these two service of the child referred. How- sources." ever, the mental and psychiatric exami- It is interesting that in a community nation of the child follows. The doctor where a child guidance clinic is at- is then in a position to begin to eval- tempted for the first time those per- uate the psysical, the emotional and sons who have had some member of the intellectual factors involved, and the family either ill or potentially ill in most cases, two if not three of these from a nervous or mental disorder or factors must be considered. If the dif- have seen some loved one go through ficulty is entirely in the emotional field, such an experience, are the ones from or mainly in the emotional field, it is whom moral and financial support are held within the scope of the clinic first obtained. The well-extroverted, treatment ; if the trouble is primarily a matter-of-fact persons of a community physical one, such as tuberculosis or have little idea of the power of emo- an orthopedic defect, it is referred to tional factors to make or break the the proper specialist in those fields. As happiness and efficiency of an indi- soon as the information is fairly ade- vidual. Hence the need of a tremend- quately gathered, a staff meeting is ous educational program. held, so that all members of the staff may bring their knowledge to bear on THE FIRST SIX YEARS the situation. These staff meetings include the social workers or teachers A baby at birth has few well de- closely concerned. veloped physical or mental traits. He Thus, "beginning as an adjunct to has, however, many potentialities that the courts, the child guidance clinics may or may not become actualities, de- have developed an independent status, pending on the surroundings in which establishing close communication with he is placed. Behavior patterns are schools and social agencies, and now engrafted early. moves toward university affiliations", The kind of adult the baby will be- says Dr. George S. Stevenson in his come depends on his heredity, his pre- 1934 publication, "Child Guidance natal growth and development, his pre- Clinics." He continues, "Beginning in school years and the later years of his isolation as a professional anomaly, it childhood and youth. Those wise in has shared techniques with teachers automobile mechanics say that the life and social workers, and now has a of an automobile depends largely on part of the rapprochement between the way it is driven during the first psychiatry and general medicine. . . . thousand miles. The first six years It has lost its rigidity and become a of the child's life therefore are of flexible instrument for varied uses. peculiar significance. His personality "The child guidance clinic, with its depends in a large measure on the way psychiatry based on general medicine, he is handled during these early years. pediatrics, endocrinology, the school of —Evelyn M. Carrington, in Hygeia. —

14 The Health Bulletin July, 1936

WHAT PEOPLE MUST KNOW sanity, apoplexy, locomotor ataxia, or disease of the liver, bowels, brain, They must know the widespread nerves, blood vessels, or of any organ prevalence of the venereal diseases. or tissue, instead of the true cause— They must know the far reaching syphilis. Georgia's Health. havoc wrought by them. They must know that they are infectious and communicable. CLEANING TEETH They must know that gonorrhea and OBLIGATORY IN ITALY syphilis often remain in a latent state Upon orders from the Minister of for years after a supposed cure. War, the army doctors are expected to They must know that the disappear- see that all soldiers clean their teeth ance of active symptoms does not mean after meals. For this a room has been a cure of gonorrhea, nor does the dis- specially equipped. Whoever neglects appearance of visible symptoms mean to do so must report. In the Aviation the cure of syphilis. Headquarters in Rome, next to the They must know that they are not great dining hall there is a room where infrequently carried into the home and everyone connected with the establish- family after a supposed cure. ment from the Minister down must They must know that in the female, clean his teeth. A guard is appointed gonorrhea has such a wide range of to check up on everyone to see that manifestations that there may be no he carries out the orders. "Forward indication whatever of disease, or there March, to Clean Your Teeth !" Not bad. may be any and every symptom of fe- —Health Digest. male trouble up to the most severe and critical illness. They must know that a part of the THE CASWELL NEWS so-called female trouble of married The above is the name of the official women is due to gonorrheal infection, publication of the Caswell Training is innocent infection, and that thous- School at Kinston. Volume I, Number ands of women die or undergo serious Three lies before us. Quoting from a mutilating operations from the same statement at the head of the editorial cause. page it is "Published monthly for the They must know that most of the benefit of Caswell Training School and persons who are blind from infancy for the information of the citizens of are victims of gonorrheal infection of North Carolina." The editor is Dr. the parents. F. M. Register, superintendent of the They must know that most syphili- institution. Miss Hazel Wertman and tica are normal looking persons, and Mrs. Fannie Harlan are associate edi- that many of them are unaware of tors and Miss Mary L. Utley is busi- their real condition. ness manager. It is a neat, readable They must know that for only a publication printed on good paper. It short period are there skin eruptions carries some advertising and the sub- and that superficial sores and ulcers scription price is fifty cents a year. appear in but few cases. A marked copy of the closing para- They must know that all of them are graph of one of Dr. Register's edi- doomed to death at an early age torials should be sent to the head of (unless properly treated) and death every State institution in North Caro- returns will be in accordance with the lina. It is this : "Visitors do an organ or tissue affected—such as heart institution a lot of good. Visiting day disease, paralysis, Bright's disease, in- is ere/7/ day at Caswell."' July, 1936 The Health Bulletin 15 Smallpox

By John H. Hamilton, M.D., Director State Laboratory of Hygiene NORTH Carolina is inviting small- Thus, in brief, is the picture of the pox to visit the State. During terrors which epidemics of smallpox the 1920's the disease was very had for our people only one hundred prevalent, there being from 1,500 and eighty years ago. to 3,800 cases per year during most of Smallpox was once so common that that decade. The amount of smallpox everyone expected to get it some time vaccine distributed by the State Labo- during their lives. In fact, at one time, ratory of Hygiene enables us to make it was more common than measles is a fairly accurate forecast as to the today. Since every one expected to have future prevalence of this disease. For the disease, some people would have the years 1920, 1921 and 1922 less than themselves inoculated so they could 150,000 doses of vaccine per year were have it at a convenient time. No one distributed. In 1923 we had 3,352 cases who had not had smallpox would con- of smallpox, and in 1924 we had 3,845 template a long trip until after they cases. Evidently we became tired of had been inoculated with smallpox and having smallpox since the amount of bad recovered from the disease. When smallpox vaccine increased in 1923- inoculated with smallpox, a person 1926 to 250,000 doses per year. This would probably be just as sick as if he was followed by a decrease in preva- had caught it in the usual way. How- lence in smallpox, there being only ever, he would be sick at home and 1,594 cases in 1926. This apparently would have his own nurses and doctors. restored onr confidence and the amount In spite of his clangers and the distress of smallpox vaccine distributed during which he suffered, he was better off that year decreased. In 1928 there were than if he waited until he contracted 2,419 cases of smallpox, which again the disease in the natural way. aroused our fighting spirit for during Then in 1749, a boy was born who that year the State Laboratory of was destined to be the pathfinder of Hygiene distributed approximately means of protection against this loath- 470,000 doses of vaccine. In 1929 there some disease. Edward Jenner was the were only 589 cases of smallpox. Since name given to this boy. His father was then the use of smallpox vaccine has an English minister. As a school boy, decreased. During the year 1935 less Edward Jenner studied hard. He was smallpox vaccine was used than in any later apprenticed to a surgeon in his year since 1922. Presumably we be- home town of Glocestershire. He con- come indifferent to the dangers of tinued to study and later became a smallpox as soon as its prevalence is pupil of the famous John Hunter. decreased. When we use less smallpox While he was still a student, a young vaccine we invite the disease to return. girl came to him one day for medical Our experience with the disease during advice and said, "I cannot take small- the past fifteen years should keep us pox because I have had cowpox." This on the alert. If we go further back into statement made a strong impression the history we have most dramatic on the young medical student. Edward demonstrations of the dangerous poten- Jenner was not only a good student, but tialities of this disease. he was a careful observer. He soon The disease was brought to America noticed that some people who worked by the Spaniards about fifteen years with cows did not develop smallpox after their discovery of this country. It when exposed to it and could not even spread rapidly from Mexico, and within be inoculated with it successfully. On in- a short period of time about three and vestigating this strange condition, he a half million Indians died of smallpox. found that people who milk cows were A little later it was estimated that likely to infect themselves with a dis- nearly one-half of all the Indians in ease of cows known as cowpox. Cowpox America died of this disease. In 1752 in man was a rather mild disease, but Boston had a population of 15,684, of was sufficiently severe that most people which 5,998 had previously had small- who had it would remember the ex- pox. During an epidemic, there were perience. Jenner began a painstaking 5,545 persons who contracted the dis- investigation and inquired of farmers, ease in the usual manner, and 2,124 dairy maids and other people who came took in by inoculation, while 1,843 fled in contact with cows if they had had from the town to escape the infection. cowpox or smallpox. He found that 16 The Health Bulletin July, 19m those who had had cowpox had not viduals. Undesirable reactions are gen- had smallpox, and that those who had erally due to misdirected efforts to pro- had smallpox had not had cowpox. For mote the comfort of the vaccinated several years he collected his evidence person. No shields have ever been de- until he was convinced that the simple signed that are not more dangerous cowpox would protect against the than an uncovered vaccination. All dreaded smallpox. In 1796, when he such devices should be condemned. was 47 years old, a dairy maid by the Most of them are definitely dangerous. name of Sarah Nelms came to Doctor No shield should be used. Neither Jenner with a cowpox infection on her should the vaccination be covered by hand. The Doctor wished to protect an ointment of any kind. If any cov- one of his little patients from smallpox. ering is indicated, it should be sterile, He was convinced that cowpox would porous, gauze, attached loosely with protect, so he took some of the material adhesive tape, several inches from the from the pustule on the hand of Sarah vaccination. Most infections of small- Nelms, the dairy maid, and transferred pox vaccinations result from scratch- it to the arm of James Phipps, his 8- ing. Fingers carry contaminating bac- year-old patient. James had a typical teria and should not touch the vacci- take but was scarcely sick at all. Doc- nation. tor Jenner was most anxious to see if The immunity conferred by a single James was really protected against vaccination usually lasts longer than smallpox, so about a month and a half the traditional seven to ten years. The later, the Doctor inoculated James benefits conferred extend to twenty with smallpox. No disease developed. years or more. In most individuals re- The Doctor was anxious to prove his vaccination reinforces the protection. case so he then inoculated ten people For those that have been exposed, or who had had cowpox several years be- are in danger of exposure, immediate fore. None of them developed the dis- vaccination is definitely indicated. A ease. He then felt so sure that his person who is immune to smallpox, will observations were true that in 1798 he not have a primary take, even with the presented a paper to the Royal Society, most potent vaccine. Failure to secure which rejected it with discouraging a successful take cannot be regarded hostility. However, Doctor Jenner con- as dependable evidence of immunity, tinued his investigations and continued unless the vaccine used is known to be to write and talk about his work. potent. Our satisfactory smallpox The smallpox vaccine of today is a record during the past few years can vastly improved product to that of be attributed solely to smallpox vac- Jenner's day. Even the technique of cine. The disease will return when- vaccination has improved. The product ever we have a high proportion of un- of today, however, does have definite vaccinated people in our population. limitations. It is perishable and will Vaccination is our only effective wea- retain its potency only when it is kept pon against smallpox. Healthy carriers cold. At a temperature below freezing of the disease are unknown. Since it will remain potent for years. Heat smallpox can spread only when a rapidly destroys the value of this vac- susceptible individual comes in contact cine. All vaccine distributed by the with a person who has the disease, it State Laboratory of Hygiene is potent can not become prevalent except when when it leaves the laboratory. Fre- we have a high percentage of unvacci- quently it has lost its potency, that is nated individuals in the community. its ability to cause successful takes, Individuals can be protected only by within a few days after it has arrived vaccination. Communities may avoid at the doctor's office. Since it is dis- the embarrassment of an epidemic tributed by mail it may be subjected to when the individuals making up the heat either in transit, or in the post community are vaccinated. It is in- office, or in the doctor's office. In the conceivable that we will permit small- winter steam pipes, or stoves, may pox to become again the devastating supply the destructive temperature menace that it was some four hundred when the vaccine is placed close to years ago. It is easy to visualize its these sources of heat. Summertime returning as we know it fifteen years atmospheric temperatures may also ago. It is for people in North Carolina diminish the potency of the vaccine. to determine whether they want small- With a satisfactory vaccine nearly pox or vaccination. If they do not any technique of vaccination will give have vaccination they can rest assured satisfactory takes in susceptible indi- that they may have smallpox. PuHis\edb4 TfiE, /TOffl CfiRgUflA STATE. D^ARDs^nmUin

This £)u]1elir\willbe 3er\t free to arvg crtizerx of the 5tateupor\ request !

Entered as second-class matter at Postoffi.ce at Raleigh, N. C, under Act of July 16, 1S9U. Published monthly at the office of the Secretary of the Board, Raleigh, N. C.

Vol. 51 AUGUST, 1036 No. 8

Ready For Public Health Work

Fifteen nurses who recently completed a special course in public health nursing at Peabody College, Nashville, Tennessee. They have been assigned to work in different counties, in accordance with the program sponsored by the State Board of Health and the Federal authorities in Washington, D. C, and made possible through the Social Security Act. )

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. Lee 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 _ _ _ _ Charlott* J. LaBrucb Ward, M.D _ Asheville

Executive Staff

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 request to the State Board of Health, Raleigh, N. C.

Prenatal Care (by Mrs. Max West) Baby's Daily Time Cards : Under 6 months ; Prenatal Letters (series of nine 6 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 IB Infant Care. The Prevention of months ; 15 to 24 months ; 2 to 8

Infantile Diarrhea years ; 3 to 6 years. Table of Heights and Weights Instructions for North Carolina Midwives CONTENTS PAGE Notes and Comment - 3 Rats and Our Health - 4 Dust as a Cause of the Diseases of the Lungs 7 Report of Bladen County Pre-School Work 9 Resolution Adopted by Joint Committee on Health Problems 10 Do You Know About the Volta Bureau? 10 Random Observations 11 Carbuncles on the Face 13 Public Health Officers Given College Degrees 14 Finds North Carolina Proceeding on Right Lines in Health Work 15 Vol. 51 AUGUST, 1936 No. 8

Notes and Comment By The Editoe FOR the first time in nine years ciently to awaken every sleeper on that The Health Bulletin is late in side of the hotel. reaching our readers. The delay This writer had hoped that the new has been due to the failure of the de- crop of automobiles would be equipped partment of the State government re- with horns which are less raucous, sponsible for letting printing contracts but instead of that all the newer cars to place these contracts early enough seem to be provided with the loudest for the manuscript to go to the printer horns in the history of the automobile at the usual time in order to com- service. The only time an automobile plete the publication ready to begin horn should ever be blown is occasion- mailing on the first of the month. We ally in starting to back out on the regret the delay and we hope it will street into traffic, and very seldom to not occur again. warn careless pedestrians. There are * * * many other useless and unnecessary

TX a letter to one of the daily papers noises which contribute to our in- a few days ago we noted that Mr. creasing nervousness as a people which Lindsay Russell, of Wilmington, com- could with a little forethought be en- mented on the efforts Mr. George B. tirely prevented. Elliott, of the Atlantic Coast Line Railroad, has been recently making to combat the unnecessary and disturb- A 8 every well-informed person knows, ing noise prevalent everywhere on the the business of catering to tourists streets of the towns of the State, from all over the world is at the present the smallest to the largest, particu- time one of the most profitable. Entire larly through the late hours of the nations are making an effort to secure night. It reminds us that one of our visitors from other nations. The State friends who lives here in one of the of North Carolina is peculiarly situ- hotels in Raleigh has complained bit- ated. Its geographical position places terly with little results. Our friend it in the position to cater to year- says that from one o'clock at night to round travelers. In the summer daybreak an automobile horn is al- months the sea coast attracts visitors most constantly blowing. To help the who like water sports. The mountains racket along the street cleaners and also attract visitors who like that sec- garbage cleaners come along about tion, and now with the development three or four o'clock in the morning of the Great Smoky Park and the big and rattle the large metal cans suffi- Federal highway in that section, the The Health Bulletin August, 1936 tourist traffic is coming to be the most coming to realize that a traveler will important industry in the State. In certainly never come back to a place the winter months a large number of that is found dirty and undesirable. people find the climate agreeable both The trouble is, however, that so many on the coastal plains and in the moun- of the travelers only make the route tains. The State system of roads one time ; but the sooner these filling makes it possible for tourists to travel station people understand that while from point to point with great ease travelers coming down from Massa- and facility. chusetts may not come back again, they There is just one important factor will be sure to pass the word along that the commercial interests of the up and down the line to let any place State, as well as the other part of the alone that does not conform to modern citizenship, has failed to appreciate, standards of cleanliness.

and that is the extreme importance If the State is to attract visitors it of providing safe water and sewage must make them comfortable, provide disposal at all of the hotels and board- them with safe water and safe food ing houses, and particularly roadside of every description, toilet facilities of eating places and filling stations. The the most approved type, freedom from State law does not give the State flies and other insect pests through Board of Health at present the right thorough screening and cleanliness. to regulate the sanitary conditions in They must be provided with food filling stations situated outside the properly prepared and served in an suburban areas and in isolated places. attractive manner at reasonable Every effort is being made to bring prices. They find these things in other about safe conditions in this respect. parts of the world, and if our State An increasing number of filling sta- is to compete successfully with other

tions which serve food and drink along sections of the country it must im- with their automobile products are prove its methods in this respect.

Rats and Our Health

By George B. Lay. Jr., Biologist U. S. Biological Survey, With Headquarters at N. C State College for Rodent Control THE Norway or wharf rat is the series of articles in the State Health most destructive animal in the Department Bulletin to depict the world, according to the opinion of direct effect of the presence of rats scientists. The Norway or wharf rat and their injury to the human race is our common barn and warehouse through the spreading of diseases, pol- rat and is very prevalent in North lution of water sources and food, and Carolina. In North Carolina alone by the carrying of certain fleas and this rodent does annually about ticks which transmit dread diseases $6,000,000 worth of damage, not in- of humanity. cluding the vast amount of loss to our When I say that rats carry and State through sickness of human spread diseases of many kinds I am beings and even the death of scores of putting it mildly, for we do not know individuals. As important as the for certain the names of all the dis- monetary loss due to rats may be in eases which this animal does carry and North Carolina, it is my purpose in a spread. We know that rats carry filth August, 1986 The Health Bulletin

and disease germs on their bodies, in strict rules of sanitation and where their mouths, on their teeth, and that garbage is collected regularly and kept they deposit, wherever they go, fecal in tight containers until collected have matter containing other disease germs better health conditions generally. and organisms. A list of the diseases Every one of these advanced sanitary of which rats are known to be car- policies tends to materially decrease

riers would fill a page in this Bulle- the rat population. Old towns and tin. The list of diseases which rats cities, built when our nation was probably do carry, but proof of which young and filled with poorly construct- we do not actually have as yet. would ed wooden homes and business houses, be equally as long. are more likely to have large numbers Typhoid disease germs may be car- of rats and are more often visited by disease outbreaks. Where dogs are ried in many ways : by flies in contaminated milk and foods of many properly cared for and strays gotten kinds, on polluted meats and vege- rid of, rabies is less prevalent. Rats tables, in our water supplies unless are known to carry this dread disease, properly treated and in other ways. and rats have actually been caught Rats do, without question, when they which had infected both dogs and cats rob your garbage can and remove with the disease. Rats have, in rare pieces of food waste, carry off with instances, been known to pass this dis- such material disease organisms. Rats ease on to man by biting. will carry pieces of partly-eaten food In the North, where houses have to from one place to another, several hun- be built to protect man from the coldest dred feet or more removed. They weather, the rat is not usually as ser- store such food for future use and ious a pest as in the South and prob- during the interim the disease germs ably causes a less injury to the human increase in numbers rapidly. Wher- race through the spreading of diseases. ever these rats brush against any ob- In the West, which is a newer section

ject, the germs are scattered ; and of our country than the South, the rat whenever and wherever they knaw on is not so plentiful and carries less of a other foods, they pollute that food sup- disease threat due to more modern ply and may scatter disease. construction of homes and business Many infectious diseases can be and buildings. Better sanitary laws, more probably are spread by rats. As luck frequent collection of garbage, the use

will have it, however, human beings of tight garbage containers, better are not frequently bitten by rats, health laws of many types and the dis- hence rats probably do not carry disposal of garbage and trash regularly eases from one person to another in modern incinerators serves to de- where direct contact with the blood crease the number of rats in that com- stream is necessary to the spread of munity. When a home or business

the disease ; but, where a disease needs house is made weather, storm and entrance merely to the food tract of wind proof, it is also made practically the human being through the eating rat proof. Where trash is removed of polluted foods, these rodents do aid from under homes, from cellars, from in disease spread. outhouses, when yards are cleaned up It is a notable condition that, where and kept clean, where food and feeds rats are least plentiful, disease out- are kept in adequate containers of breaks of most kinds are not as fre- metal or thick boarding, where spilled quent and the number of cases is lower feeds are collected periodically from

per thousand inhabitants. Cities with areas where animals feed ; in other The Health Bulletin August, 1936 words, where the public tries continu- by disease is one and the same, and ally to cut down the food and hiding continued efforts on our part are nec- places necessary to the rat, these ani- essary for us to obtain results in this mals are less numerous and the citi- fight. zenship of such a community—in town In subsequent articles I plan to tell or in the country—is more nearly free you more of the rat and its ways and of diseases spread by rats. the manner in which people can help The battle against the rat and the in preventing the spread of sickness fight to cut down sickness and death and death by these animals.

Group in Bertie County Receiving Preventive Typhoid Treatment

The picture shown above was sent to us by Dr. F. H. Garriss, Health Officer of Bertie County. This clinic was held at the Hermitage Farm, located on the banks of the Chowan River, and was attended by over three hundred white and colored people from that and adjoining farms. At the conclusion of this work, during the month of June, Dr. Garriss and his associates had given three complete treatments to more than twelve thousand people, about half the population of the county. The value of a modern, efficient, well-organized health department to the average county is invaluable. It is now recognized that any county group with sufficient population and taxable wealth that does not maintain such a department is losing in every way. August, 1936 The Health Bulletin

Dust as a Cause of the Disease of the Lungs

By H. F. Easom, M.D., Director

Division Industrial Hygien e, State Board of Health .

UST is possibly the oldest source Among the silicates, that is, com- D of disease among workers in cer- pounds of silica, asbestos and talc are tain industries. As early as 430 known to be harmful in certain con- B.C. a Greek physician commented on centrations, but these minerals are its injurious effects on the lungs of much less widely used than those con- workmen. The literature of practi- taining free silica. It happens that in cally all civilized countries contains North Carolina there are four plants accounts of dust diseases, indicating using asbestos and three engaged in that all races are susceptible and that mining and milling talc. harmful dusts are encountered in many The lungs are in free communica- and varied industries. Probably the tion with the outside and are thus ex- most outstanding example of this is to posed freely to dusts or other impuri- be found in the gold mining industry ties iu the air. However, there are of South Africa where the so-called certain mechanisms which act as bar- "dusted lung'' became at one time a riers to the entrance of dust. The commonplace disease. In this country nose is lined with very coarse hair it is only in recent years that atten- which acts as a filter. Also, the lining tion has been so sharply focused on of the nose and upper air passages is this subject, mainly as a result of moist and tends to arrest the progress numerous damage suits involving large of dust particles. Another protective sums of money, and of rather extensive mechanism is in the form of very small engineering and medical studies re- hair-like projections on the lining of vealing the presence of very definite the nose, pharynx, trachea, and bron- health hazards in certain industries. chial tubes. These have a wave-like action toward the outside and tend to Fortunately not all dusts cause keep the particles from entering the harmful reactions in the lungs. The air spaces of the lungs. In spite of all ones known to be most dangerous are these protective mechanisms, a certain those containing free silica and cer- amount of dust gets into the air sacs. tain silicates. Silica is the most con- Even large quantities of the harmless stant constituent of the rocks and dusts such as soot seem to cause no minerals which make up the earth's serious trouble, but the continued in- crust. Thus it is that those occupa- halation of dust containing silica or tions associated with mining, granite certain silicates often leads to a con- quarrying and cutting, foundry work, dition whereby the elastic air-contain- driving of tunnels, the handling of ing lung tissue is replaced by inelastic sand and gravel are frequently exposed scar tissue. This condition is known to silica dust in large quantities. It as silicosis or asilicatosis, depending has been estimated conservatively that on the type of dust causing it. As this about 500,000 workers in the United condition progresses the breathing ca- States are exposed to silica dust to a pacity of the individual becomes less harmful degree. A recent survey of and less, and for some reason he be- 103 plants in North Carolina employ- comes much more susceptible to tuber- ing 4,407 persons revealed that 60 per culosis and other respiratory diseases cent of the workers were exposed to than the average person. Once the silica-containing dusts. condition has become well developed, 8 The Health Bulletin August, 1936

practically nothing can be done by workers by establishing a Division of medical science toward clearing it up Industrial Hygiene as a department or relieving the patient's symptoms of of the State Board of Health. This shortness of breath and cough. Even was brought about through the co- after the worker is removed from the operation of the U. S. Public Health dusty plant the scar tissue continues Service, the North Carolina State to form slowly in his lungs. Board of Health, and the North Caro- The length of time required for a lina Industrial Commission. It will worker in these harmful dusts to be- concern itself with any condition come disabled depends on the amount which may injure the health of indus- of free silica or silicate in the dust, trial workers and will act as a source the size and number of particles in the of information for other interested air he breathes, and the length of time State departments. he is exposed. It is only the particles In the beginning the personnel of too small to be seen by the naked eye this department will be concerned that are able to enter the lung. Larger chiefly with studies of plants having dust quickly settles or its entrance into a potential dust hazard. All persons the lungs is hindered by the protec- will be examined and X-rayed before tive mechanism of 'the nose and upper being allowed to engage in occupations air passages. creating harmful dusts. In addition, The solution of the problem of dis- workers already employed will be examined and X-rayed and estimations eases caused by dusts lies in preven- of the amount and nature of dust in tion. Once they have developed it is the air in various plants will be de- too late. Prevention consists in the termined. With this information in proper selection of workers and the hand it will be possible to recommend control of dust at its source. Indi- changes to keep the dust concentration viduals having active pulmonary tu- at a level in which an individual can berculosis or extensive healed lesions, safely spend working lifetime with- chronic non-tuberculous lung conditions a out serious injury to his and organic heart lesions should not health. be allowed employment where they will be subjected to the inhalation of ANNOUNCEMENT high concentration of free silica or Dr. John H. Hamilton, director of silicates. By far the most important the State Laboratory of Hygiene, an- means of prevention at our disposal nounces that the prices on all arsphe- is the control of the dust at its point namine used in the treatment of of origin. This may best be accom- syphilis has been reduced, the reduced plished by sucking up the dust where prices going into effect July 15, 1936. it is created by using a properly de- The .6 and .9 gram ampules of neo- signed exhaust system. Other control arsphenamine Merck are now 12 cents

methods which may be of value in cer- each. The 4y2 gram ampule of neo- tain instances are the substitution of arsphenamine Merck are 50 cents each. wet in place of dry processes, isolation All sizes of the sulph-arsphenamine are of dusty processes, and the use of re- 12 cents each. Shipments will be sent spirators. The practice of good house- collect unless cash accompanies the keeping in any plant will materially order. reduce the amount of dust in the air. The reduced prices are made to phy- North Carolina has recently taken sicians of the State only and are to a great step forward in the protection aid and encourage adequate treatment of its million and a quarter industrial of syphilis. August, 1936 The Health Bulletin

Report of Bladen County Pre-School Work

R. S. Cromartie, Health Offi- Just such communities will be the Dr.cer of Bladen County, has sent steadying influence which will pull us a report of the work for pre- this old State safely through the school children in that county which troubled years ahead. is very encouraging. Of 337 white children eligible for school this fall, for the first time 237 attended the Orthopedics Includes the Entire Body clinic or round-up and one-fifth of There is considerable popular mis- them were found to be normal physi- understanding regarding one special cally. In his letter transmitting his field of medicine called orthopedics. report Dr. Cromartie said, "The pic- This is due to the fact that the name is not derived from the Latin word pes, ture enclosed (Carver's Creek School) meaning foot, but from two Greek is from a rural community and was words orthos, meaning true, straight or a hundred per cent complete in at- free from deformity, and paedos, meaning child. tendance at the pre-school clinic. This community has a wide-awake parent- Orthopedics has the entire body as its field, and individuals of all ages teacher association, and they request- come under its scope. There are two ed that we send a report of the clinic kinds of deformities : the congenital, to The Health Bulletin as The or those with which an individual is born, and the acquired, or those which Bulletin reaches practically every develop subsequent to birth.—Dr. Garry home in the community." Hough, Jr., in Hygeia.

::;:mimi% ' ,fm VliX

CARVER'S CREEK, BLADEN COUNTY, BEGINNERS

Every child in the district who is to begin school for the first time this fall attended the round-up and received the examination. 10 The Health Bulletin August, 1936

Resolution Adopted by the Joint Committee on Health Problems in Education of the National Education Association and the American Medical Association, June, 1936

Whereas at the annual meeting of upon them brings about a sense of

the Joint Committee on Health Prob- false security : Therefore be it lems in Education of the National Resolved by the Joint Committee on Education Association and the Ameri- Health Problems in Education of the can Medical Association, held at St. National Education Association and Louis, Mo., February 25, 1936, a pre- the American Medical Association,

sentation was made by Major Joel I. That this committee apprehends the Connolly, of the Chicago Board of possibility of danger to the health of Health, relating to possible health school children from apparently safe, hazards in apparently modern plumb- modern and sanitary plumbing installa- ing installations in public buildings, tions in school buildings. And be it and further Whereas it was manifest in the said Resolved, That the said Joint Com- presentation that plumbing fixtures mittee earnestly recommends to all which have been generally regarded school boards and school executives as safe and sanitary in design may in that surveys be instituted by compe- fact constitute a real and serious tent engineers to ascertain whether or health hazard by reason of the danger not the danger of back siphonage and of back siphonage and contamination consequent pollution of water supply of water supply mains, and mains exist in plumbing installations Whereas the probability exists that within their jurisdictions, and that such apparently modern, safe and such surveys be followed by prompt sanitary plumbing installations may corrective measures. And be it exist in numerous school buildings in further the United States, and Resolved, That these resolutions be Whereas the existence of such ap- offered for publication to all journals parently safe, modern and sanitary dealing with public health, health edu- plumbing installations and reliance cation and general education.

Do You Know About the Volta Bureau?

"We consulted several specialists, something positive in the way of help and all of them confirmed our fears, must be offered immediately, if the but none offered any solution of our individual is not to spend desperate problem." Thus the mother of a small years in a bewildered effort to adjust deaf child wrote to the Volta Bureau. himself. The parents of a deaf child The sentence might be quoted verbatim must be told that the child can be from many letters written by parents taught to speak and can be success- of deaf or hard of hearing children, fully educated, and that this educa- or by hard of hearing adults. tion may be begun at home immedi- The knowledge that deafness is ately, even if the child is not more present and that it is incurable comes than two years old. The parents of with the force of a major calamity. a child whose hearing is only slightly It is so crushing in its effect that impaired must be given advice as to August, 1936 The Health Bulletin 11 his adjustment. The hard of hearing instruction, hearing aids, social con- adult must be told about lip reading, tacts, psychological difficulties. While about hearing aids, about social ef- the Volta Bureau is not equipped to forts in his behalf. do employment service, it gives infor- The Volta Bureau was established mation in regard to the fields of activity that are open to the for the purpose of furnishing all this deaf and the hard of hearing. information to all who ask for it. Its The Volta Review, a magazine for services are free. Alexander Graham parents and teachers of the deaf and Bell, the son of a hard of hearing for the hard of hearing, is on the mother, the husband of a deaf wife, reading table of many physicians. the lifelong friend of every one handi- Pamphlets dealing with all phases of capped by deafness, used the money deafness except medical problems are received as a prize for inventing the available to all who ask for them. telephone to found the Volta Bureau Lists of such pamphlets and sample so that any one confronting the prob- copies of the magazine will gladly be lems of deafness might be assured of sent free of charge. The Volta Bureau help. Advice is given as to schools is located at 1537 35th St., N.W., and pre-school training, lip reading Washington, D. C.

Random Observations

By Mrs. J. Henry Highsmith

Harnett County Organizes for Health question, in which the American Pub- Protection lic Health Association has been asked Harnett County has recently taken to co-operate. In compliance, a com- the forward step of organizing a mittee on the Hygiene of Housing has county health department. Dr. W. B. been appointed by the A. P. H. A., of Hunter of Lillington is the health of- which Dr. C. E. A. Winslow of Yale ficer. When the new service which University is chairman and R. H. began June 12 is completely organ- Britten of the U. S. Public Health ized the personnel will consist of one Service is secretary. whole-time health officer, Dr. Hunter, two public health nurses, one sanitary Slum Clearance and Better Health officer, one clerk, and twenty weeks Slum clearance is a civic and health of a dental health program. Harnett project that several nations are under- makes the fifty-fifth county in the taking as an economic recovery pro- State to provide for a county-wide gram. England seems to have led the health service. way in this. Within the past four * * * years about one million new houses To Study the Effect of Housing on have been built in England and Wales, Health about half of which were subsidized Just what effect poor, crowded by the government. Recently a new housing conditions have on health is slum-clearance project has been start- a subject that is attracting more than ed by the English government which nation-wide attention. As a matter of within five years is expected to de- fact, it is of such importance that the molish all officially condemned slums Health Section of the League of Na- and do away with overcrowding. tions is undertaking a study of this Whether there is any direct connec- : —

12 The Health Bulletin August, 1936 tion or not with the housing program, plants by sight, which should be one it is interesting to note that the infant of the first steps toward getting ready mortality rate of England decreased for a vacation to be spent in the woods from 65 per 1,000 in 1932 to 5S.6 in or mountains. 1934. First and early treatment after con- In line with the program and pur- tact has been made should be to bathe pose of the Federal Housing Admin- the affected parts in hot salt water, or istration, many cities in America are hot soap and water, using a strong undertaking slum clearance but in alkali soap. A brush should not be modified forms. A statement of slum used as there is danger of breaking conditions found recently in a central the skin and making the infection Pennsylvania city by A. J. Bohl, deeper. A strong solution of Epsom treasurer of the Pennsylvania Public salts and water is also recommended. Health Association, is interesting and If the infection persists, see a doctor is here given for further treatment. "In these slums exist about ninety per cent of the city's commercial pros- Swimming Is Not Always Free From titution. About the same percentage Danger of the felonious assaults occur here, together with eighty per cent of the Swimming is a sport not without liquor law violations, and seventy-five its dangers, even to the so-called good per cent of the highway robberies and swimmer. There are perils for the larcenies. Generally, ninety per cent over-confident and unwary as there are of all the crime in the city is com- for those just beginning to learn. Espe- mitted here or, if elsewhere, is com- cially is this true for those who swim mitted by residents of these areas. in rivers, creeks and ponds, where From a health and sanitation stand- there is no supervision or means of point, also, the picture is of the dark- rescue. It is in such places that est hue." drownings occur much more frequently * * * than at the seashore, at supervised Beware of Poison Ivy lake beaches or in municipal swimming Poison ivy or poison oak may be an pools. unpleasant aftermath of an otherwise Some of the more frequent perils pleasant vacation spent in the moun- met by the uncautious swimmer are tains or woods unless one is careful from reckless diving—not knowing the

to avoid contact with these plants. depth of the water ; from unsuspected Only one who is highly sensitive to step-offs, obstructions and currents plant poisoning and who has suffered being unfamiliar with the bathing

the inconvenience as well as the pain place ; from over-exertion or staying of this infection knows how much bet- in the water too long for one's

ter it is to avoid it altogether rather strength ; from fool-hardiness, espe- than run the risk of contacting it. cially on the part of young swimmers, Poison ivy, poison oak and poison and from cramps. sumac grow in nearly every section Cramps in the stomach are usually of this State. They may be found due to excessive eating or drinking or near streams, ditches, and growing on too much exertion without "cooling off" or about fences. Each contains an before going in. Cramps in the feet acid secretion which is very poisonous and legs are primarily due to the un- to individuals who are susceptible. accustomed exercise that these mem- Consequently it is well to know these bers have been suddenly called on to do. :

August, 1936 The Health Bulletin 13

Two good rules for all persons going water may hide sticks, stones, glass in bathing to remember, especially if and tin cans which could cause serious bathing or swimming in rivers, creeks injuries. It conceals its depth and and ponds, are: first, never go into the does not allow quick recovery if one water alone. Unforeseen mishaps may should go down in it. Such waters occur to the most accomplished swim- take many innocent victims in North mer. Second, consider all dark and Carolina every year. muddy waters unsafe. Turbid or muddy

Carbuncles of the Face

STUDY of 31 cases of carbuncles Two precautions are emphasized in A of the face which were treated at this study of carbuncles that should be the Los Angeles Hospital over a of especial value to every person. One period of eight years affords some in- is that picking, squeezing or cutting teresting information regarding this into bumps or pimples on the face is dangerous and painful infection. In dangerous. A harmless pimple may the first place, according to a report thus be transformed into a dangerous of the study made by H. P. Totten, infection. Says the author, it is a per- quoted in a current medical publica- nicious practice too frequently in- tion, the organism causing the infec- dulged in with disasterous results. The tion is a normal inhabitant on the ex- other is that complete rest in bed is ternal surface of the skin. Its mode of recognized as essential in the treat- entrance may be through a scratch, ment of carbuncles. This is said to be abrasion or some other minor injury. the sheet-anchor of successful treat- Entrance usually takes place along a ment. A complete rest of all parts of hair follicle or the adjacent sebaceous the body, and particularly the face, is gland, whence it invades the deeper advised. There should be no talking layers of the skin. Nineteen of the 31 and the necessity of chewing should be cases started as pimples or pustules obviated as much as possible. The in- which suggests entrance through a hair fected area should be made as im- follicle. Five started as small painful mobile as possible to prevent further swellings which suggests gland involve- extension of the process. ment. Three began as inflammations of As to treatment, it was found that the skin, two followed insect bites and about one-half of the cases responded one developed during a series of boils. to non-surgical treatment, comprising quiet rest The patients ranged in age from 18 for the most part of and the application of hot moist dressings. He to 73 years. There were 18 males and quotes : "The use of continuous hot 13 females. Most of the patients were moist dressings of boric acid or mag- in good health. Three of the 31 died nesium sulphate solution is an effective 1 female and 2 males. measure in localizing the infection and Characteristic local symptoms of increasing the strength of the leuko- carbuncles are marked swelling and cytic barrier of defense by stimulating hardening of the portion of the face the flow of lymph and blood to the area. An additional benefit derived is involved with pain that varies accord- the relief of pain." ing to the amount of tension developed. The best surgical treatment found, Fever varies from 1 to 6 degrees with according to the report, was that pulse in accordance. In severe cases "drainage and relief of tension are safely effected in the refractory cases there may be chills, headache and in- by means of central cauterization with tense pain. phenol and the electric loop cautery." — —

14 The Health Bulletin August, 1936

Public Health Officers Given College Degrees ADD to the list of the thousands departure in education. Every county of graduates of the current sea- has its health officer, but every county son of commencement exercises needs ten times as many men as the of high schools, secondary colleges, uni- officer and his staff. Now and again, versities, et cetera, some forty or more for one cause and another, we face public health officers who have re- sickness and death and the threat of ceived degrees at the conclusion of a them. The health officer is on the job. course at the University of North We think of him only in emergencies. Carolina at Chapel Hill. But his best and most enduring service These men for the most part have is measured by the failure of the been engaged actively in the public emergency to occur. Raleigh Times. service. Most of them already held degrees in medicine or sanitary engineering. Yet they took time off in the HONORING WILL ROGERS heated spell to go to the University Will Rogers is to be honored in a better to equip themselves for work in one of the most imperative public serv- manner that would be most pleasing to ices. Of a class numbering fifty, the him were he still living. The major forty-odd finished the course and are moving picture circuits of the country returned to their posts with the dis- are to contribute half a million dollars tinction of having been given diplomas for what the newspapers describe as guaranteeing their fitness. a hospital, but what is very likely to health officers make a com- Public be a sanatorium, at Saranac Lake. pany familiar to the people of every This will be known as the Will Rogers county, but in spite of their importance Memorial Hospital. they have not received anything like The plan was revealed in Chicago a the attention their labors deserve. In short time ago times of epidemics we know that there by Will Hays, czar of the is a health officer and lean upon him. moving picture industry. But ordinarily his life is one of rou- Will Rogers' interest in and sym- tine. It is the routine of preventive pathy for those suffering from tuber- medicine, of sanitary precaution, of culosis is a part of the Will Rogers official observation. The health officer tradition. guards the in the public places which It will be recalled that, during the is fed. He sees to it that what the campaign to raise a large fund for a public drinks is served in cleanliness. Will Rogers Memorial. The Sanatorium He is something of a Czar of a benefi- Sun suggested that at least a part of cent type, witbout whose order no one this fund be spent for sanatoria for may cater to the people at large. When those needing treatment by tuberculosis the epidemics come along, he goes into specialists. Apparently the proposed his place more spectacular action, but Saranac Lake hospital is not to be a and his duties for the most part have part of that general fund, but it is emi- to do with keeping epidemics from get- nently fitting that his name be given ting headway. an institution dedicated to the re- Recognition of public health officers building of shattered health in the as a class, their instruction at the tuberculosis health country. Sanator' University, their graduation, mark a turn Sun. August, 1936 The Health Bulletin 15

Finds North Carolina Proceeding on Right Lines in Health Work

Dr. Carl V. Reynolds Encouraged by Visit to Canadian Health Meeting

By Mrs. J. Henry Htghsmith

rpHINK of it!" said Dr. Carl V. Points wherein the Canadian pro- ** Reynolds, State Health Officer gram is similar to that the State Board of Health, under the direction for North Carolina, on return- of Dr. G. M. Cooper, is now at work of the ing from attending a meeting on are, according to Dr. Reynolds, the State and Provincial Health Authori- lecture or "refresher" courses for doc- ties of America held recently in Van- tors held periodically at conveniently located places; the health centers couver, B. C, "a country having a where mothers come for prenatal con- maternal death rate of only 2 per 1,000 sultation and advice from local physi- live births and an infancy death rate cians ; and the public health nursing of only 2D. That is what I found in service available not only at the centers but to the people in their homes. Vancouver and throughout the Prov- "I was particularly impressed," said ince of British Columbia." Dr. Reynolds, "with a system of public The significance of the above rates health nursing which they have in is evident when contrasted with North Canada. They call it the Victorian Carolina's which for maternal deaths Order of Nurses for Canada. It is a national organization with is about 7 and for infant deaths is 66. headquarters in Ottawa. Its primary object is But Dr. Reynolds is not dismayed by to provide bedside nursing care for the wide difference in the two rates, or the sick in their own homes on a rather is not to remain so. On the visiting basis. Patients are charged for other hand, he returned encouraged each visit on the basis of an average cost, but no patient is refused care and assured. His assurance lay in the because of inability to pay. The order fact that North Carolina is proceeding provides a general nursing service for on the same program to reduce the men and women and children regard- number of deaths of mothers and less of race, color, creed or financial status. Nursing care is given only babies in the State that has succeeded under the direction of a physician. so well in this Canadian Province. Nurses employed under the Order are "What Vancouver and British Colum- required to be graduates of recognized bia have done, North Carolina is now training schools and to have had postgraduate training or experience in pub- prepared to do, and we too will get lic health nursing." results," he said assuredly. "Another plan in our State set-up The measures by which Vancouver on which I was reassured." said Dr. has been successful in her maternity Reynolds, "was that of coordinating and infancy program and is attracting and consolidating the units of work common to all departments, like more than nation-wide attention among filing, mailing and issuing circulars and health workers have been prenatal care, literature. The value of this system hospitalization for certain cases, post- was shown to be not only practical, natal and infant care. "But the real but more economical, more efficient and more desirable given full secret," said Dr. Reynolds, "is coopera- when cooperation and fair trial," tion—cooperation on the part of obste- a he said. tricians, pediatricians and the nurses. Concluding the interview, the Doctor Each of these groups is alert and said it was a great meeting, that North actively cooperating, each recognizing Carolina is on the right track in her the necessity of its services to the suc- health work and that he looked for cess of the program." progress and results from now on.

IfiMuib fibd Publi5\edb4 TAE,/J°RmCAR?LIrtA STATE. B7AE\Lin

This Du]lelir\willbe ser\t free to ar\u crhzer\ of the 5tateupot\ request!

Entered as second-class matter at Postoffi 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. 51 SEPTEMBER, 1936 No. 9

' : T":M v.;-/.:-/ c::

«,

CARL REYNOLDS BALL

This fine baby is the son of Mr. and Mrs. Robert Randolph Ball of Pasadena, California, and the grandson of Dr. Carl V. Reynolds, State Health Officer for North Carolina. His excellent physique bears testimony that he is being reared according to the health teachings of his illustrious grandfather, and the practice prevailing in California, where every infant born has a much better prospect for living out his first year than in North Carolina. 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. Lee 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, Ph.G " Charlotte J. LaBruce Ward, M.D Asheville

Executive Staff

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.

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 request to the State Board of Health, Raleigh, N. C.

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 Public Health Should Come Through Public Schools 6 Nurses: A Historical Sketch 11 Dead at Twenty 14 "Rats and Our Health" No. 2 16 Vol. 51 SEPTEMBER, 1936 No. 9

Notes and Comment By The Editor

are publishing in this issue that we look at the good old days WEsome interesting material writ- through the eyes of a doctor—the good ten by other people. The first old days when half the population item to which we would like to call died before the age of twenty in Eng- attention would be the article entitled land, which was the most advanced in "Public Health Should Come Through civilization of any country in the world Public Schools." This was a paper read at that period. The writer says that before the North Carolina Health Of- those good old days were days of star- ficers Association in Asheville last May. vation and plague, of malaria and diph- It was written by Professor C. F. Car- theria, and infant mortality and early roll, superintendent of the Swain County death. It is true, and while a great schools. Mr. Carroll has for many deal of progress has been made in re- years been intensely interested in cent years, we still have too much of health education. He has given the this sort of good old days for our problem of public health and preven- best interest. tive medicine intense thought. Through A third article which we are pub- the courtesy of the officials of the lishing this month is an article writ- State Health Officers Association and ten by Miss Josephine Kerr, a register- the State Medical Society we are privi- ed nurse of the Charlotte Sanatorium leged to publish this article. Mr. Car- at Charlotte. Miss Kerr's article was roll makes some proposals which would published in the April issue of the be hard to carry out, but for the most Southern Hospital. The title of the part his thought and argument are article is "Nurses : A Historical along the same lines that the State Sketch." Miss Kerr's article will be Board of Health has been advocating found exceedingly interesting, particu- for many years. larly at this season of the year when Another article which we are pub- so many of the nurses are at work in lishing was sent to us by Dr. L. B. the city and country schools all over McBrayer, secretary of the Medical the State. The nurse is primarily Society of the State of North Carolina. trained to carry out the physician's It is an editorial entitled "Dead at directions in caring for a sick patient, Twenty." It was published in the but for the last few years there has Detroit Medical News some time ago. grown up a great body of public

The author is Dr. David I. Sugar, of health nurses who are engaged in the Detroit, Michigan. This is a most in- important work of preventing as much teresting article. It will be noted by sickness as they possibly can. The ef- the reader that the author suggests ficient, well-trained, educated nurse The Health Bulletin September, 1936

commands the respect of the public controlling malaria, and one that until everywhere today. It is something more now has been almost entirely neglect- than a coincidence that in Miss Kerr's ed." article she mentions the powerful sup- There probably has been too much port given by the novelist Charles neglect in the matter of protecting the Dickens in aiding nursing reform near- malarial patient, especially the ambu- ly two hundred years ago. The coinci- latory one, who suffers from chronic dence is that in the paper we are pub- or latent malaria from mosquitoes, but lishing by Dr. Sugar from the Detroit of course there has been persistent ef- Neivs he also reviews Dickens' "Pick- fort in many sections to treat such wick Papers" as an illustration. malarial patients in order to control * * * them as factors in the further spread T\URING the months of August and of the disease. It is probable that no September in the State of North modern improvement or modern dis- Carolina the malaria-bearing mosquito covery in the field of disease preven- is more active than at any other sea- tion has been of more genuine value son of the year. In the average year we to a larger number of people than the probably have more malaria in this simple act of thoroughly screening State during September than almost houses. Few people are so poor today any other month. This year will prob- but that they could make sufficient ably be no exception to the general sacrifice to afford screens for their rule. Despite every effort at malaria homes. A house tightly screened, if the control, including the thousands of dol- screen doors and windows are kept lars spent by commercial interests and tightly closed, practically excludes all farmers and others in putting into ef- mosquitoes and house flies and other fect large drainage projects, all of insect pests from sleeping and living which helps some, despite the careful quarters. Screened homes have added medical treatment as preventives, and much to the comfort and safety of finally in spite of the increased use of people everywhere. Dr. Garriss is sure- screens in keeping mosquitoes out of ly right in the statement that greater houses, we still have malaria. True, and more widespread efforts should be today malaria is nothing like as wide- directed by every one in this State to spread or as serious as it has been eradicate malaria from within our bor- many times in the past, but too many ders. It is still a public health prob- people suffer from this disease for us lem that demands attention until it is to look upon it with complacency. In a no longer present. letter from Dr. F. H. Garriss, health While discussing this subject it is officer of Bertie County, some time ago, well enough to remind our readers Dr. Garriss makes the following state- again that the large majority of mos- ment : quitoes do not carry malaria, but the "I am afraid we are not paying mosquitoes that do not carry the dis- enough attention to the chronic malar- ease are a nuisance and a menace to ial carrier. It is almost impossible in the health of babies and children this section to eradicate mosquitoes, especially. We were interested very but if there was some way of con- much in this connection the other day trolling the carriers, or of keeping in looking at a picture in the New malarial mosquitoes away from them York Times which presented two men until they could be thoroughly treated in the Matanuska Valley wearing nets or freed of malarial infection, our over their hats and tightly fastened mosquitoes would not become infected around their shirt collars to protect and so transmit the disease to others. their faces from the mosquitoes present I believe this is our surest method of in that section this summer. As most September, 1936 The Health Bulletin

of us know, the Matanuska Valley is in meant eighty or eighty-five miles, like Alaska, and this picture was of two nearly all of them travel now-a-days." men who were among the colonists who He said. "If you do not run your car settled in that section as a relief pro- over fifty miles, it will not be damaged ject more than a year ago. There they in the least, but if you run it up to have a farming community in the wilds eighty or eighty-five for a few miles of Alaska resembling such a community after the oil is thinned down, you in the pioneer days in the middle west. would damage the bearings." The farmers who went up there were His remarks put us to thinking and recruited from Michigan, Minnesota, to observing, and on that trip it and Wisconsin. They were aided by the seemed to us that at least fifty cars Government in building homes and passed us running at a speed which starting their farming operations. could not be less than eighty or eighty- The interesting point to us, however, five miles an hour. Not one of them in the sketch was the necessity for pro- could have stopped in less than a quar- tection against the myriads of mos- ter of a mile, and the only reason that quitoes prevalent in that far northern serious accidents did not occur to any country this summer. Mosquitoes are of them was that no careless driver found almost anywhere in the world, came out of a cross-road in front of and malaria is one of the most wide- them, and that the folks they were spread diseases in existence today. meeting kept well to their side of the road. The serious part of this question is that so many otherwise responsible TSTE cannot refrain from once again people seem to have no sense of speed discussing the excessive automo- whatever when they are driving their bile death rate, and once again to re- automobile. Their sole obsession is to iterate our belief that excessive speed get there and in the quickest possible is one of the chief causes of so many time, and ninety-nine out of a hundred fatal accidents. Naturally liquor, de- of them have little or no business fective eyesight, and ordinary careless- when they do get there—nothing which ness and indifference contribute a part, could not have waited for a consider- but there is no one cause equal to that able time without any loss to anybody. of excessive speed in accounting for Our educational authorities, along the large number of fatal accidents. with their other responsibilities, should This was brought home to the writer undertake to teach the sense of speed a few days ago more forcefully than to the young folks in the schools, and ever before. We had taken our car to to be effective it would have to be com- the garage very hurriedly on the way menced at a very early age. out of town on an official mission. The trip required about a hundred miles NOTE FOR PHYSICIANS driving in excess of the time allotted Dr. James M. Northington, Editor of for changing oil and so on. Wishing Southern Medicine and Surgery, of to be sure that the car would not be Charlotte, announces in his August damaged, we asked the young me- issue that the Annual "Brush-Up" or chanic's opinion on that point. He postgraduate course for physicians will turned and looked us straight in the be held again this year. The tentative eye and said, "You do not drive fast, do date set is September 24 to 26. The you?" We replied that it depended on place, of course, is Charlotte. Doctor what he called fast, that our rate was Northington says that "plans are now around forty-five miles an hour, never being laid for a strictly practical in excess of fifty under any circum- course of helps in bedside and office stances. "Well," said the mechanic, "I medicine." : :;

The Health Bulletin September, 1936

Public Health Should Come Through Public Schools*

By Charles F. Carroll. Jr., Superintendent of Swain County Schools, Bryson City, N. C.

COMING before you, a technically It is my understanding that a public trained group of health special- health officer is a person who is usually ists who live by, in, and for those a graduate in medicine, but who, even health concepts and practices about though he be a licensed physician, is which I can have at best but partial not a practicing physician. He is pri- knowledge, I naturally suffer a feel- marily a sanitarian who is engaged in ing of embarrassment. To add to this arousing, stimulating, and guiding embarrassment, the presence of persons people to help themselves by "prevent- whom I know and by whom I am ing disease, prolonging life, and pro- known makes it unwise, to say the moting physical health and efficiency least, for me to represent myself as through organized community efforts an expert in any field of endeavor for the sanitation of the environment." whatsoever. My friends would see To effect this desired condition, the through my attempt to do that. public health officer necessarily be- I remember the story of the old comes a health educator in the hope woman who went into the side-show and with the reasonable expectation of a circus and saw, or supposed that that he will be able to guide public she saw, a man read a newspaper thought into his own channel of through a two-inch board. (This was thought and into his own plan of ac- back in the days when the word tion. He is successful in direct propor- streamline had not been coined and tion to the manner in which the people when women vowed that they would respond of their own volition and not in not permit the existence of cotton and proportion to his thinking and acting woolen surpluses even if they had to for the people. Thus, I maintain that encase themselves with three or four the public health officer is primarily a more petticoats). The old woman, look- teacher or else he is something other ing first at the man who pretended to than a public health officer. be able to read the newspaper through What progress have you made as the two-inch board and then looking teachers of health? With the supply of at, and feeling of, herself, got up in reliable statistics in your possession great excitement and screamed out you can doubtlessly answer that ques-

"Let me out of here ; this ain't no place tion in a most satisfactory and concise for a decent woman to be with these manner. I can only give an opinion thin things on." I fear that the at- Considering the youthfulness of your tempt to disguise expertness on my work, insofar as we measure time, I part would be as transparent as the think you have accomplished much, old woman thought herself to be, and particularly since you work with such yet, I do feel that every man, who be- a wide, diversified group of people lieves in the importance of health edu- yet, I believe that you should "pull cation, should stand up in every com- your punches," so to speak, from cer- pany and proclaim the belief that is tain portions of your clientele, and pay in him, so that by common counsel and more attention to the most receptive by common action we may accomplish portion of your clientele. What do I that upon which we have set our mean? Just this—in order to popular- minds. ize and establish your work you have September, 1936 The Health Bulletin beeu compelled to eater too much and tists, dental hygienists, nutritionists, too long to the adult groups. You can psychologists or psychiatrists, and defend yourself against this construc- health educators. That is the ideal set- tive accusation by stating that public up, I said, but since the State of North health means the health of all the Carolina is either unable or unwilling public; also, that your very existence to provide that which tends towards as a governmental function depends the ideal, we shall stay on the practi- quite largely upon the goodwill and cal level and recognize the probability esteem of the adults—the group which, that during the next few years in 95% financially speaking, makes the proverbial mare go 'round. But. looking at the problem of public health in the light of ultimate accomplishments, do you not think it better to start at the bottom? Working with adults you can do nothing more than to inform them, to give them knowledge of basic health

facts ; but there is no direct correlation between knowledge and habits. Because of its very nature, the school m is best suited for improving habits, W and habits are the foundation stones of healthful living. The schools reach the whole population, and there is no other means for reaching all the people so effectively. There is a growing feeling among public school educators that the best way to attack the adult education problem today is not so much through an extensive adult education program such as has been in operation on a widespread scale in recent years but by preventing illiteracy and deficient traits and characteristics among the children. Teach the children in their formative years, and while there is greater probability of their learning, Robert Randolph Ball and appreciating, and practicing correct health principles and yoii have Recently the State Board of taken the proverbial stitch in time. Health had the pleasure of a visit Applying the same idea to your prob- from Mrs. Robert Randolph Ball of lem, do you not agree that it is better Pasadena, California, with her two to make the approach to public health fine sons, Robert Randolph, III., and through the schools? Carl Reynolds. Mrs. Ball, formerly For an ideal school health program of Asheville, is the daughter of Dr.

it is recommended that we have a and Mrs. Carl V. Reynolds. While personnel made up of several individ- in Raleigh, Randolph championed uals who contribute to school health as the cause of public health, finding

specialists, to wit : school physicians, the work of the State Laboratory of school nurses, physical educators, den- Hygiene of extreme interest. 8 The Health Bulletin September, 1936

of the school districts in North Caro- thing basic to the entire educational lina public health physicians, nurses, program and thus satisfy the basic and dentists will constitute the only needs of those for whom the schools professional personnel at the disposal function. of school health programs. Upon this Equally desirable as the administra- assumption, therefore, and with the tor's point of view is that classroom further feeling that you see therein teachers themselves possess knowledge what is probably your own best oppor- of, and manifest real, sympathetic in- tunity, I want to make a few sugges- terest in, a modern health education tions in the hope of improving the program. Every classroom teacher, for present situation. satisfactory service, according to op- You yourself visualize the magnitude portunity and corresponding responsi- and the ramifications of the public bility, should have a clear understand- health problem, but unfortunately ing of health ; be ready to support and there are too many potential deputy health officers in the role of school

teachers and supervisors, even as I, who do not see or feel the problem as you do. Accepting the philosophy that "it is not an evidence of intelligence to do a thing yourself but to get somebody else to do it for you," why don't you take steps toward utilizing this potential strength and energy? You reply, "O, it is the duty of the school administrators to put the depu- !" ties to work Yes, and no ! We should see the problem and the opportunity, but we don't see it because you have not taken the steps to show us how we can help you. As much health education will get into any school health program as the administration in charge approves, and the extent to which health education is approved will be in close proportion to the administration's own concept of the relative value of knowledges. If, for instance, the idea should prevail that the school's chief responsibility is to teach bare facts, then bare facts State Health Officer for a Day will receive greatest attention. On the other hand, if the school recognizes its On a recent visit of Carl Reynolds chief responsibility to be training for Ball to his grandfather, Dr. Carl V. citizenship, with due consideration to Reynolds, at the State Board of the child's physical, mental, social, and Health, he was shown all the courte- emotional welfare ; or, as Herbert sies befitting his age and honor,

Spencer expressed it, that "the first even to the extent of being allowed requisite to success in life is to be a to occupy his grandfather's office good animal," then the school will chair and serve a day or a part as establish and maintain a militant State Health Officer—a pose, no health education program as some- doubt, highly prophetic. September, 1936 The Health Bulletin cooperate with reference to the general ties which do, or can, contribute to a or special health work of the school ; sound health education program. lie keen to observe pupils intelligently Whether this department or agency in relation to health; and be able to would function under the State Board correlate and apply health teaching in of Health or the State Department of any situation in the school. Public Instruction is of secondary im- Too many of us administrators and portance. I am interested solely in teachers in North Carolina do not satisfying a real need. For the direc- possess these necessary qualifications torship of this department or agency, for conducting a satisfactory school I would recommend a person with pub- health program. Why? Because the lic health training and, if possible, with subject of health education was not some background in pure educational included in our courses of preparation work. for the positions we hold. Why was it The director of health education not included? Because it was not re- within and through the schools could teaching cer- quired for obtaining our be of invaluable assistance in many, tificates? Why was it not required? many ways, some of which are as fol- We might as well seek to learn who lows : killed Cock Robin. (1) In collaboration with the direc- For many years the State Board of tor of the curriculum, he could take Health has been carrying on a very steps toward placing health on a par acceptable type of health work within with other subjects now being taught. all the time i f has the schools, but I do not believe that health education of the Board -vf been in the name can be taught, or should be taught, in there has been Health. Simultaneously, a cold formal manner such as we would carried on in a fairly acceptable way teach arithmetic or French, if it is to a type of health v. ork un- haphazard be made productive of satisfactory re- der the sponsorship of the State De- sults ; but I do believe that knowledge Cordial partment of Public Instruction. of health principles should be taught relations existed all the while have formally as a prerequisite to the prac- departments and between the two tice of correct health principles. There- sometimes one department knew what fore, I contend that we have gone far seeking to do. But. my the other was enough in treating health as an inci- dear friends, cordial relationships and dental matter, and that somewhere with what spasmodic acquaintance within the curriculum there must be conducive each other is doing are not found a place for that subject which school health program. to a productive is basic to all other learning. in North Carolina to- What we need (2) The director of health education day is a health education program could work with the division of certi- within the schools that is militantly fication with the view of requiring all purposeful in every respect, and that in-service and pre-service teachers and is supervised by, and is responsible to. supervisors and administrators to pre- one definitely known agency. There- pare themselves for conducting a health fore, I recommend that consideration education program. As stated prev- be given to the idea of establishing in iously, too many of us now in service North Carolina at the earliest possible are not prepared to handle this re- time a department or agency whoso sponsibility simply because we were chief duties will be the promotion of not required to be prepared. But it is health education in the schools by co- not too late to prepare ourselves, and ordinating and making more extensive certainly it should be comparatively and intensive the various health activi- easy to make it mandatory that all 10 The Health Bulletin September, 1936 new teachers be thus prepared. tion of the school plant at regular in- Teacher-training institutions will co- tervals. And wby not give publicity to operate readily once the fact is known the percentage ratings? How much that there is a demand within the more important, if any, is the sanita- schools for this type of training. And tion of a small cafe than a school should teacher-training institutions be- plant housing scores and hundreds of gin this type of work, let us remember children for even longer periods of to insist that we keep too much theory time? Through the press you warn out of the process. Also, let us insist people of unclean eating and drinking that the teachers themselves be ex- places. Why not warn children and amples of health and that they become parents against unclean schools? proficient through the laboratory (4) The director of health educa- method rather than through the lec- tion could work most effectively with ture method. the division of instructional service (3) The director of health educa- with the view of integrating and cor- tion could work most effectively with relating the entire subject of health the division of schoolhouse planning. education with all other phases of edu- How many schoolhouses in North Caro- cation. How can natural science or lina are not conducive to healthful liv- social science instruction, for instance, ing on the part of their tenants? Poor be integrated with health education, sites ; incorrect orientation ; inade- and vice versa? Until health becomes quate or impure water supply ; inade- basic to all other parts of the educa- quate toilet facilities ; improper light- tional program, health is the step-child

ing ; inexcusable seating facilities ; lack of the curriculum. of fire protection, etc. A person's habits (5) The director of health education are influenced by his environment, and can work most effectively with the if we expect good habits to be formed director of the budget. As long as there let rightful by children us assume our is any degree of discretion to be exer- responsibility and make it possible for cised by the director of the budget, you them to form good habits. can figure that he is going to exercise In connection with the question of himself in favor of those objects of environment, let us remember that cost in which he is most interested. after all is said and done the upkeep The director of the budget can and of the school plant is of greater im- should be interested in the question portance than the type of plant. Public of health, if approached properly, and health officers in North Carolina could when that is done equipment and sup- render no greater service, in my opin- plies necessary for a health education ion, than to encourage the employment project will be provided. And in con- of school janitors who do not have to nection with this, I wish to recom- go into a huddle with themselves to mend strongly that before the begin- decide whether dirt is dirt. An incom- ning of another school term you, as petent janitor can thwart any health leaders of thought and action in mat- education program that may be under- ters pertaining to health, exercise your- taken. And while trying to make a self in behalf of the placing in every sanitarian out of a janitor, why not school in North Carolina an adequate require him to dress the part of a sani- first-aid kit and that you train at least tarian. Cleanliness is as contagious as one person in every school to adminis- dirtiness, is it not? ter first-aid intelligently. Have you In connection, too, with the question stopped to think how many school com- of a proper and sanitary school plant, munities in this rural state have no I would recommend a careful inspec- physician available and how easy it September, 1936 The Health Bulletin 11 would be for an injured child to be strengthen the schools and the teach- lost some time through lack of prompt ing personnel you will not accomplish and competent attention? the greatest amount of good. I believe Summarizing—I feel that at the the thinking element of the teaching present time it is incumbent upon you profession welcomes your attempts to to lead the fight in North Carolina for make it more intelligent for the job at better public health. You are trained hand. Why not use us as your partners. for the work and you are better trained than anybody else. Your work through the schools and with the teachers will * Address delivered by invitation to prove the best means of approach to the North Carolina State Health Of- your task, but unless you take steps to ficers Association, at Asheville.

Nurses: A Historical Sketch

By Miss Josephine Kerr, R. N.

HE young woman of today who bless the art of nursing and make it a T enters a school of nursing begins religious duty, so that it was no longer her work with the heritage of an only loved ones who were ministered ideal of beauty and tenderness with to, but all who were sick and needy. which the human mind has endowed Many of the good women of that time woman from the beginning. As she were so converted to the ideals taught studies the fascinating pages of her by Our Lord they began to work history of nursing, she finds there a among the poor, going from house to galaxy of noble names of women and house, making friendly visits. Poverty men, who by their lives as nurses is so closely aligned with sickness that have made the world a better, safer they found many occasions to render place to live in. She will learn also nursing service, thereby making them- that they have built, with unselfishness selves pioneers of our present day and intelligence, a foundation upon visiting nurse service. The first and which has developed a profession most famous of this band was Phoebe, which demands the finest qualities of a friend of St. Paul, who in the year young womanhood. 60 A.D. became the world's first dis- The profession of nursing as we trict nurse and deaconess. Until the know it today is comparatively young, third century the world relied upon but as an art it is one of the oldest. deaconesses for skilled nursing service Nursing had its beginning when the and today we still have the deaconess world's first mother cared for and nursing orders. nursed her child. For them, the help- In the beginning of the third cen- less ones, she learned to create means tury a group of noble Roman women, of meeting emergencies and preventing who were converted to the faith, were imbued with its ideals they dedi- them ; then, the successful mother, out so of the kindness of her heart, passed cated their lives to the care of the along the results of her experiences poor and sick. St. Fabiola turned her and in this simple, practical way defi- palace into a hospital and nursed the nite methods of nursing procedures patients herself. St. Paula established were given to the world. hospitals at home and abroad and not Just as Christianity raised woman to only nursed but passed along her the dignity she enjoys today, so did knowledge so that she is considered one Our Lord, when He came on earth, of the first nurse educators in the world. 12 The Health Bulletin September, 1936

Following this era men too became unselfish sacrifice, without which a nurses and by the ninth century mon- nurse's life is merely a daily round of asteries had become centers of nursing arduous toil. Reared in a home of as well as educational institutions. wealth and culture, like Phoebe and During the Crusades monks played a Fabiola of old, she heard the call to prominent part in caring for sick pil- service and prepared to dedicate her grims as they traveled to the scenes of life to the care of the sick. The work Our Lord's life and part of the thrill that Florence Nightingale did in Scu- of a knight of this age was found in tari among the soldiers of the Crimean protecting and nursing the pilgrim on War is one of the finest chapters in our his way. During the Crusades and the history. Perhaps you are familiar with organization of the religious orders the story of her visits at night through such names as St. Francis of Assisi, the wards with her lamp, when the St. Clare, St. Elizabeth of Hungary, soldiers kissed her shadow on the wall. St. Hildegard, St. Catherine of Sienna This story was the inspiration for are a few of those whom we in the Longfellow's immortal tribute to her twentieth century boast of as nurses in his poem, "Lady of the Lamp." and their followers members of our "A lady with a lamp shall stand profession today. In the great history of the land With the passing of the age of chiv- A noble type of good alry and the abolishment of monas- Heroic womanhood." teries, the art of nursing as it had existed for centuries, entered a decline We come now to the establishment and the process of reconstruction was of modern nursing in America, the de- difficult. In this dark period of nurs- velopment of schools of nursing and ing, a saintly priest, Vincent de Paul, organizations within the profession. had a vision of social reconstruction. With the growth of the number of His unselfish work among the poor to graduate nurses alumnae associations alleviate their suffering won him the were organized and these nurses, real- honor as the first to inaugurate a sys- izing the benefits of such contacts, tem of social service and at the same began to see the advantage of broader time the gratitude of humanity. Out contacts. Included in the features of of his efforts developed the order of the World's Fair in Chicago in 1892 the Sisters of Charity, an order that was a congress of hospitals. In this has filled a human need for three hun- congress a nursing section was pre- dred years. Nursing reform bad an- sided over by Isabel Hampton, princi- other powerful champion in the 17th pal of Johns Hopkins School of Nurs- century, whom we cannot fail to men- ing. The outcome of this group meet- tion, the novelist Charles Dickens. His ing was the organization of the Na- forceful pen did much to induce public tional League of Nursing Education, opinion to bring about needed changes that body which outlines the curricula in the care of the sick. In Martin for our schools today! In 1896 the Chuzzlewit his pen portraits of Sairey American Nurses Association was or- Gamp and her colleague, Betsy Prigg, ganized ; every other nursing organi- depict the nurse of that time. zation is an integral part of the A. N. May 12, 1S20, was the birthday of A. and our membership for 1935 is the founder of modern nursing, Flor- 110,626, which perhaps represents the ence Nightingale. Called by some the largest body of professional women in patron saint of modern nursing, Flor- the world. About 1900 state associa- ence Nightingale's life holds out to us \ tions began to organize. In Raleigh on high a ideal of devotion to nursing, an October 28, 1902, the North Carolina September, 1936 The Health Bulletin 13

State Nurses Association was begun her but to assure her of sufficient by Miss Mary Wycbe wbo was tbe first training and you of capable nursing President and wbo is now honorary service. president.* Society should give the same serious Prior to this date registration for consideration to the education of a nurses bad been discussed in this and nurse that it does to members of other foreign countries and we are exceed- professions because it is the nurse who ingly proud that North Carolina was carries the responsibility of the pa- the first State in the Union to .suc- tient's welfare between the doctor's cessfully pass the nurses registration intermittent calls ; because tbe nurse law—in 1903. Cape Town in South is with you, carrying a grave respons- Africa was the first country to pass ibility at the two biggest moments in a registration law—in 1891. What do your life—birth, when she wants to we mean by registration? It is that fall down and worship at the sight of process by which the public and the a new little life ; death when not in- nurse are protected by law from those frequently she alone is there to give who cannot or do not come up to a you bodily comfort and spiritual con- standard set by state examinations. solation. Only graduates of schools fully ac- It is a long way from Phoebe to che credited by the Standardization Board nurse of the Twentieth Century ; from are permitted to take these examina- St. Fabiola's hospital to our magnifi- tions. In North Carolina our schools cent modern institutions, yet we have are visited and checked regularly by before us always the great task of still our educational director, who reports trying to perfect our art and improve her findings to the Standardization our knowledge of nursing. We urge Board. These reports are checked with higher education for our nurses but tbe requirements and the schools are we do not forget that the root of all graded accordingly. real nursing is ever the inherent nurs- The nursing profession exists only ing instinct with its eagerness to ac- because of a need of humanity and it tually serve and help those who are is the aim of this profession to meet sick and needy, with heartfelt human that need in the finest possible way. interest and sympathy. The trend now is toward placing nurse In closing, the thought that I wish education under the supervision uf to leave with you is expressed in the colleges and universities. The actual following lines, which to my mind nursing care of a patient is one of the epitomize the real ambition that finest of fine arts and a nurse should dominate the life of every real nurse. be well prepared in theory and prac "My life shall touch a thousand lives tice. In the United States there are In some way 'ere I go about 1,600 schools of nursing ; a From this Dear Land of Promise to number of these are offering a com- Tbe Land I do not know. bined liberal arts and nursing program So this is the prayer I always pray, leading to an A.B. degree. Our North And this is my hope each day, Carolina law requires at least a high Let my life help the other lives school education for entrance to our It touches by the way." schools of nursing, but girls who have —Southern Hospital. nad college work are given the preference. Our State Board of Nurse Ex- * Miss Wyche died at her home near aminers has requirements which must Henderson Saturday, August 22, 1936. be met by our schools of nursing be- Her name and memory will be honored fore a nurse is permitted to take ex- throughout the South for a long time aminations, not to make it hard for to come.—Editor. 14 The Health Bulletin September, 1936

Dead at Twenty

By David I. Sugar, M.D. THIS is the hundredth anniversary it that they with their songs and novels of the "Pickwick Papers" and in limned the leads to light ; the military common with many of you lovers man will claim that with his mass of Charles Dickens we re-read them killing, elbowing out possibly greater this past winter holiday season. As a killers, the louse, the mosquito, and the story there is no more delightful en- rat, he directed civilization. The phil- tertainment. On re-reading it you prob- osopher with his belly-ache and his ably have all yearned for the return ranting, howling through his nose, of those good old days. Life in the thinks he has done much. The inventor Pickwick Papers of a hundred years and the tradesman and the explorer ago seemed beautiful and tranquil. and the transportation engineer could Merrie England! But was it? Remem- all claim ascendancy and priority in ber that in this book Dickens describes developing the good life. The medical the doings and the leisurely life of the man has done more than all combined gentry whose time for the most part to make the modern world more liv- was spent in the pursuits of sport. In able, to establish living on its present fact the Pickwick Papers was intended easy basis. by the publishers to be a running Let us look at those good old days chronicle, subordinate, and to supple- through the eyes of a doctor. Let us ment a series of prints and wood-cuts, look at the times of Dickens and the illustrating the sports and hobbies of times before him from a medical point the English gentleman. Dickens was of view. hired for this job as an afterthought Living in the present time and under after several of the better known hacks modern medical organization we take of the publisher had turned down the many things for granted and we have assignment. The illustrations were to go back and recollect how things planned first and were of the primary were in another day to appreciate our importance. Therefore the "Pickwick advantages. One hundred and seventy- Papers" are in no part or intention a five years ago 50 per cent, or half, of true cross-section picture of the times the English population died before the in which Dickens lived. As a hired age of twenty. The working class had man Dickens did his job as directed, even less chance. paid How- the same as any workman. In factory towns like Manchester, ever, through these papers Dickens England, the youthful population was leaped to fame and fortune and in physically worn out before manhood, Copperfield later works such as David and the average life of the laboring truer, and Oliver Twist, he gives a classes was only 22 years. The working life those so- more factual picture of in class was dead at 22 years of age. called good old days. His living as- Think of it ! Long hours of employ- sured, genius evolved, mirroring the ment, drunkenness which gave the only life of the masses. escape from dreary reality, undernu- History, or interpretation of times, trition, lack of sanitation and bad liv- depends entirely on who is writing. ing conditions, and epidemics were the The ecclesiastical gentlemen will have causes. Medical science has changed us believe in all honorable sincerity this. that they influenced the stream of his- Contrast that with the present. To- will have day any child, black or white, rich or tory ; the poets and writers —

September, 1936 The Health Bulletin 15 poor, born in Detroit has an expectancy He has shown how this black death of life of 52 years. Or, to say it an- was spread by the bite of the flea that other way, they will live two and a lived on rats. Killing the rats got rid half times as long as in the good old of the fleas and the means of the days. spread of the infection. You never hear In the old days of that time every of a case of this plague in this country one was dirty. Even kings had no bath any more. Thus medical science and rooms or wash stands, and seldom medical progress protect you. washed at all. A Belgian authority of Before the time of a Dr. Jenner, the the 18th century advised that if bath- English physician who gave vaccina- too difficult an undertaking, ing were tion against smallpox to the world, it linen at people ought to put on clean was unusual to meet one in London least every six weeks. Under these cir- whose face was not marked by small- cumstances the entire population was pox. There was a popular belief that

; disgrace. lousy to be lousy was no one who had cow pox was immune to Even kings had lice. smallpox. Jenner put this belief to a In the good old days, the caress of a scientific test. The result was the dis- paramour, the bite of a louse, and covery in 1798 of vaccination, and this typhus or something, all too frequently practically secured the eventual aboli- coincided. To be romantic then was to tion of this disease. In Detroit we have be brave. lately gone several years without a Diseases weave in and out, increas- single case of smallpox. ing and decreasing in importance in Diphtheria used to be a dreaded dis- the stream of history. You never hear ease. It still is for that matter, but of a case of the black death, the great even when developed to an alarming plague, in this country. It is hard for extent it can with antitoxin be suc- us to realize that this plague, the black cessfully controlled. Indeed it is the death, that began in the 14th century unusual thing nowadays to lose a case. and lasted several hundred years in Von Behring, a German, and Kitasato, Europe killed 25,000,000 people. a Jap, developed and prepared a When this plague of the black death serum, an antitoxin for the treatment reached London in 1665 every other and cure of diphtheria. As a result to- house had a death. A mother was day, 97 per cent of the diphtheria cases taken at this house. A baby at this that formerly would Have died are next. A husband next door. On the saved from a horrible death. This ter- average every other house must give rible disease of childhood has been a corpse. Death stalked abroad. Death conquered. was at the harvest. So ghastly was The good old days ! We would not the death rate there wasn't time to return to them. They existed for the bury the dead in the usual manner. A most part in the mind of the narrator, wagon was driven down the street and the chronicler. And most writers live the driver shouted, "Bring out your in a phantasy world, and therefore as dead," "Bring out your dead." The history they give us their dreams. dead were gathered and piled in the The good old days were days of star- wagons like cord-wood and buried in a vation, and plague, and malaria, and common grave. This was in the good dirt, and infant mortality, and early old days. death. The doctor has eliminated these These present days are the good plagues in civilized modern countries. days, and medical science and the doc- He has discovered a serum that both tor made them good, and keep them prevents and cures this black death. good. Detroit Medical News. 16 The Health Bulletin September, 1936

"Rats and Our Health" No. 2

By George B. Lay, Jr., Biologist, V. S. Biological Survey, with Headquarters at N. C. State College, for Rodent Control in N. C, S. C, Va., Georgia and Florida RATS — the common variety or plague was nothing in the world but wharf rat—carries diseases into bubonic plague, a disease carried by fleas and with the fleas travelling about our homes by means of both fleas on the rats' bodies. Bubonic plague has mites, and, in tropical countries and killed more people than all the wars

these fleas and mites, carried by rats, of history combined ; and that we know cause serious outbreaks of such to be true. If the many diseases, which rats do carry but which we do not fully scourges as typhus fever and bubonic understand, could be attributed to plague. In North Carolina—and we rats, we would find a much higher total should be thankful of the fact—these of human suffering and deaths charge- two diseases are not prevalent and out- able to the animal. breaks are sporadic and usually quickly It is perfectly true that "black - death ' does not stalk the world as it stamped out. Rabies is another dis- did for 50 years of the fourteenth cen- ease which can and is sometimes trans- tury, for our health authorities are mitted by rats. now actively fighting all diseases and Endemic typhus fever has been re- our doctors are better equipped and instructed in means of prevention of corded in North Carolina in several scourges. But, if it were not for Fed- different towns within the past year. eral, State, county and city health of- In three or four towns in this State, ficers, and cooperation from many other people have died due to the fever, sources, we of today would still be faced with terrific outbreaks of such which is carried by a mite which is diseases as bubonic plague. Epidemics sometimes host upon the common rat. in San Francisco, Seattle, Hawaii and In all instances, which were called to New Orleans, since the turn of the cen- my attention in North Carolina last tury, were stopped before reaching serious proportions through measures year, a rat campaign was put on in the taken by the United States Public community and rats were practically Health Service and other cooperating eradicated therein. Of course, the in- agencies. fested places had to be cleared of the As I stated at the beginning of this mites and that was taken care of by article, rabies are carried by rats. Especially, where a small fox terrier trained entomologists. Since the rat attempts to kill a large wharf rat it campaigns mentioned, no cases of the is likely that the rat, if infected with fever have been reported in those lo- rabies, will pass the disease on to the calities and no further deaths. In other animal. In fact, we do not know the seriousness of this rat-dog rela- Charleston, S. C, particular care is tionship with regard to rabies. We do taken by Dr. Leon Banov, city health know, however, that the disease can officer, to bait several blocks in all and is passed on from rat to dog and directions from any typhus case, im- then to man. Also, cats are known to have transmitted this disease from rats mediately upon suspicion of the case. to human beings. Effective but fairly safe bait is used We might list a number of diseases by the City of Charleston, recommended which rats help to spread, to our suf- by the Federal Government. Other fering and harm, but space forbids. We do wish to reiterate again, that cities are fighting for better health in rats can be largely decreased in num- similar ways, by control of the rat. bers if we will take the time, care and History tells us that London suffered pains to rat-proof, clean-up and stay a loss of half its population years ago, cleaned-up. Keep your yard and when a plague, known as "black death" premises as clean as you would want swept England and Europe. That your dishes on your table to be. Publis\edbM TAI^°RIttCAR?LI/m STATE. B7\B\Un

This Bulletin will be sent free to arwj crhzery of the State upor\ request !

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

Vol. 51 OCTOBER, 1936 No. 10

HEALTH CENTER FOR COLORED PEOPLE NEAR LINDEN, CUMBERLAND COUNTY

The above photograph is the first one we have received of a group as- sembled at one of the Maternity and Infancy Centers recently established through the aid of Social Security funds, obtained from the Children's Bureau at Washington. A similar opportunity is being offered to more than sixty other communities in the State at present. Dr. M. T. Foster, Cumberland County Health Officer, who is in charge of this Center and several others like it in that county, sent us the picture with the following comment: "All of the persons shown in this picture were present at the Linden Health Center last month. At these Centers we give prenatal care, well-baby guidance, advice as to diet and general care. In addition, the Center is used as an immunization point, particularly for diphtheria and smallpox." 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. Lee 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, Ph.G _ - _ - Charlotte J. LaBruce Ward, M.D _ _ — ..Asheville

Executive Staff

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 dn 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 ; 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. to 15 Breast Feeding Diet List : 9 to 12 months ; 12 to 3 Infant Care. The Prevention of months ; 15 to 24 months ; 2 Infantile Diarrhea years ; 3 to 6 years. Table of Heights and Weights Instructions for North Carolina Midwives

CONTENTS page Notes and Comment 3 Suggestions for a Program of Syphilis Control 5 Fifteen-Year Record of Diphtheria Cases and Deaths Occurring in New York State and in North Carolina 9 The Importance of Birth and Death Registration 10 Noise H An Anonymous Letter on a Subject Too Long Treated Anonymously 12 2,200 Wayne Adults Have or Will Have Syphilis 13 The Challenge I 4 15 A Health Menace That is Multiplying ,- Vol. 51 OCTOBER, 1936 No. 10

Notes and Comment By The Editor IN this issue of the Health Buixe- an effective law applying to each tin, we are publishing a paper writ- county in the State. That law required careful reporting from the medical pro- ten by Dr. H. Lee Large of Rocky fession and attempted to stop the prac- Mount. Dr. Large was for several tice of counter or drug store prescrip- years City Health Officer of Rocky tions by department store salesmen and Mount. He has been a member of the soda fountain clerks. An excellent start State Board of Health since 1931. The was made towards the control of these diseases, organized facilities were es- subject of his paper is SUGGESTIONS tablished in a number of the FOR A PROGRAM OF SYPHILIS State's larger cities where indigent and itiner- CONTROL. hope that all of We our ant patients could be effectively treat- readers will go over very carefully Dr. ed, as well as the local sufferers. After Large's paper and study his sugges- two or three years efforts, however, tions. In addition to the publication of for various reasons, chief of which was Dr. Large's paper on this subject, we luck of funds, control measures were are publishing extracts from editorials allowed to lag. So far as we know, the in the Wilmington News and the Wil- law has never been repealed, but was mington Star, the Kinston Free Press, simply made impotent through restric- and a very recent article from the tions placed on county expenditures, Goldsboro News-Argus. All of these and through the lack of interest on the papers and many others in North part of certain groups of the people Carolina today are publishing import- who should have felt the gravest re- ant information for their readers on sponsibility for the work. The excel- the subject. The State Board of Health, lent beginning made at that time is all in cooperation with the Federal Health having to be done over again. Prac- officials, are making plans to deal with tically a new generation has grown up the whole problem of venereal dis- during these seventeen years who know ease control in a scientific and effec- nothing about the efforts made then. tive manner. It is very necessary for The most encouraging feature in the the public to be informed before any present situation is the widespread in- progress can be made. terest of the newspaper fraternity of About seventeen years ago, Dr. W. this State. The State Board of Health S. Rankin, who was then State Health now, as always, feels its responsibility Officer, in cooperation with representa- keenly and will exert every effort tives of the United States Public within its power to eradicate these Health Service, secured the passage of diseases. The Health Bulletin October, 1936

"C1 OR several years we have been be- the problems of milk supply, dairy moaning the fact that Eastern regulations, etc. The prison farm man- North Carolina as a whole had not ager told him that he did not want anything to happen to lessen the sup- developed its dairy industry. Much has ply of milk. The manager said that been written by the agricultural peo- "we get the prisoners who are not in ple, as well as the Board of Health good health, who have bad teeth, and folks, about the lack of a sufficient who are otherwise below par and do supply of fresh milk for the people of not make good road workers," etc. He said, "I have found that by giving our eastern sections. The editor of the these men milk in abundance as soon Health Bulletin has contributed his as they arrive, that within a few weeks mite towards the discussion in the on such a diet, with the necessary vege- past. For about two years, he has had tables and other accessories to the nothing to say. As late as three years milk diet, they improve in health and ago. on a trip of 100 miles east of weight, and make good workers." This Raleigh, the editor was able to see man had found for himself what nutri- from the public highway going and tionists and health officials, physicians, coming only one lone milk cow, with and agriculturalists have found for the exception of a dairy herd near one themselves and have known for a long of the larger towns. During the past time. It is to be hoped that the eastern July and August his work took him section of the State will develop its through about twenty-five eastern commercial dairy interest as well as counties. provide for an abundance of dairy

The purpose of this sketch here is to products for every family in the sec- suggest to the folks over at the Agri- tion. cultural Department that they make a Some years ago, the editor had some new dairy survey in eastern North lively correspondence with the official^ Carolina. There was hardly a mile of of one of the greatest dry milk can- the trip traversed but what numbers ning establishments in the country. In of fine milk cows were in sight at all the correspondence, the editor urged times. They were tied out by the road- them to establish a factory in North way and were in bunches and singles. Carolina for the canning of their pro- In fact, in the very shadow of the ducts, insisting that this State had the Wright Memorial on Kill Devil Hill, climate suitable almost for the year he observed a large herd of dairy round outdoor care of dairy cattle and cattle, right on the banks, facing the an abundance of proper food for the Atlantic Ocean. The east has certainly cattle. The summation of the corre- aroused itself, and while there may be spondence was that the officials of this some places throughout the section many million dollar corporation would where there is still a scarcity of cows. consider coming to North Carolina only such places are becoming fewer and at some future time, if they could be smaller. A fine illustration denoting certain that the State was interested the radical change in sentiment enough in the production of dairy pro- throughout the east may be noted in a ducts to guarantee a year round supply story told the editor a few days ago. of raw milk for their factories. A State official who had visited the By this, the editor feels that the manager of the Caledonia Prison Farm eastern section is certainly on the way in Halifax County informed the editor with its dairy industry and nothing that on an official visit to that farm could promise more for the health and he was discussing with the manager prosperity of the whole section. October, 1936 The Health Bulletin

TN a communication to the editor. for a competent physician and then Dr. James M. Northington. of Char- guard the victim from meddlesome handling. See that there is no danger lotte, Editor of Southern Medicine and from the wreckage catching fire. If Surgery, calls attention to a matter of the patient is conscious and complains importance to all athletes their and of pain from a broken leg or arm. etc.. families and friends. Says Dr. North- the limb should be immobilized. Of ington : "The football season is at hand. course, any bleeding should have in- A lot more harm than good is done by stant attention by ligation if possible lusty first-aid. Many a broken neck or by pressure when not possible to results fatally because somebody grabs stop by ligation. the head and gives it a jerk. Many a In all accidents to football players simple fracture is made compound." the victim should not be touched until This caution should be exercised not a competent and experienced physician only on the football and baseball fields, reaches him. That should not require but in all other accidents. It is well to more than a few seconds. There should remind again that including homicide be in attendance even in all practice and deaths from automobile accidents games at all times an experienced phy- there are around 2,500 deaths annually sician. Many a promising youth has in this State from violent and acci- given up his life in a practice game for dental causes. the lack of instant medical attention. In the case of accidents on the high- You may not be able to help the victim, ways it should be realized by everyone but you can refrain from making the that the first thing to do is send a call injury worse.

Suggestions For A Program of Syphilis Control

By H. Lee Lakge, M.D.. Rocky Mount

(Dr. Large is a former City Health Officer and is now a member of the State Board of Health.)

RESIDENT ROOSEVELT, in his better homes in which to live, and to P message to Congress. June 8, improve the conditions under which 1934, said: they work, for it is by productive work "Among our objectives I place the that most people live. security of the men, women, and chil- They are not content merely with dren of the nation first." subsistence, and protection from the in- This security for men. women, and clemencies of weather, and against the children concerns itself primarily wilds and ferocities of nature. They with : want comfort and convenience and beauty of surrounding in their homes, Decent homes to live in, and safe, productive employment, and Opportunity for productive work, they want to be protected from the Safeguards against misfortunes hazards that mitigate against these which cannot be wholly elimi- achievements—in short, men and wom- nated." en want to be happy.

In their onward march of progress Of such hazards physical disability men and women constantly strive for occupies a first place. Physical dis- 6 The Health Bulletin October, 1936 ability usually results either from in- States, as did permanent injuries from jury by external physical forces, or automobile accidents ; and furnished, from the ravage of disease. in the same year, 10 new cases for Before the day of required safe- every one case of diphtheria, for every guards against injury from industrial three cases of tuberculosis, and for mechanical devices, and the education every five cases of scarlet fever, that of workers against accidents, the toll occurred. of industrial injury constituted a much A plague that is responsible for 10 greater hazard than at present. per cent of all insanity ; 18 per cent of Prior to double tracking and the all diseases of the heart and blood development of safety train control de- vessels, and for many of the still-births vices in railroad transportation, de- and the deaths of babies in the first struction to both life and limb was weeks of life. great. This plague that is wrecking lives, Of modern devices of human destruc- and filling institutions all over the land tion the automobile is outstanding, and with its insane, blind, feeble-minded the death rate and permanent Injury and unemployables, and the conquest lists resulting from this agent in re- of which is the next great objective of cent years is awakening a public re- public health, is Syphilis. sponse that bids fair to bring it under Syphilis has occupied a position of control. security from attack as a public health But the captains of the hosts of problem because of the traditional pub- death and human disability, since time lic view that it is a venereal disease, immemorial, have been the infectious and therefore, a matter of immorality, diseases, that is, those diseases caused and not to be thought about, much less by minute living things known as talked about, by nice people. This moral germs or microbes, and the intangible prudery must be replaced by rational viruses. public appreciation and understanding Since the turn of the century Asiatic that syphilis is a widespread, infec- Cholera, Bubonic Plague, Yellow Fever, tious disease, ranking with cancer, and Malaria have yielded to the ad- tuberculosis and pneumonia as a cause vance of sanitary science. of death. Tli rough the forces of combined Syphilis is caused by a corkscrew medicine and public health the ravages shaped, living organism, the spirocheta of Smallpox, Typhoid Fever, Diphtheria pallida, which has a rather short exist- and Tuberculosis been have reduced ence outside the body, because of its directly proportional to public co-oper- delicacy or low viability. It can only ation. We can justly be proud of our live on moist surfaces, and does not record of control of these diseases in resist drying or disinfectants, which North Carolina. combination of weakness makes it a There remains, however, a plague disease of intimate contacts, for only that annually disables one-half million in the mouth and vagina, and under Americans, and which we have failed, the foreskin, are found, year in and or may we say refused to attack. year out, the conditions which per- A plague that does a hundred-fold petuate the infection. the of the damage dreaded infantile Syphilis is usually transmitted in paralysis,, by which disease we, in sexual contacts, or by kissing, but may North Carolina, became so much be acquired by contact with infected frightened last year. moist articles, such as dressings and A plague that in 1934, disabled five articles of common use, as moist towels times as many people in the United or drinking and eating utensils. October, 1936 The Health Bulletin

It is characterized by a very insid- characterized by a skin eruption, or ious course, and because of this the breaking out, over the entire body and victim of the disease may never have may resemble measles or chickenpox, his suspicion as to his condition being generally accompanied by some aroused until he has progressed to fever, headache and sore mouth or some disastrous late residt such as throat. The blood Wassermann has be- beginning total blindness, paralysis, come positive by this time. irremedial heart disease or insanity. Following this period of visually It is a disease of long chronicity. obtrusive lesions, that is the initial tending to relapse by periods as the sore, and the skin eruption, syphilis underlying lesions of the disease pass assumes a very unobtrusive visual role, through definite cycles of activation during which, because sores have dis- and suppression. appeared, the unwary victim believes The disease is difficult to eradicate he is well, but in reality he has entered from the body once it has gained en- the period of latency, or chronic syphi- try. lis, the period during which the course The first visual manifestation of of the disease is run below the thres- syphilis is a sore or lesion appearing hold of attention. It is during this at the point of entry of the infection. period that, unless checked by ade- This initial sore usually appears with- quate treatment, the disease does its in 12 to 40 days after exposure. It may most destructive work. No structure of be a more or less inconspicuous affair, the body is immune to the termite-like appearing on the genitals or about the burrowing attack of the syphilis germ, lips and mouth, usually not being very with widespread tissue destruction and painful, and runs a slow course, last- irreparable damage to vital organs, the ing for from three to four weeks. This end result. The heart, arteries, brain is known as the initial or seronegative and bones are apt to receive the brunt stage of the disease, the term "sero- of attack in latent syphilis. negative" meaning that the disease has It may truly be said that the treat- not progressed far enough to cause ment of latent syphilis is the diagnosis sufficient reaction in the body to make and adequate treatment of early syphi- the blood positive for the well-known lis, because there is little hope of other Wassermann test. Diagnosis in this than alleviation to the victim of the stage, however, can accurately be made disease who first presents himself for by finding the squirming corkscrew treatment with advanced heart and shaped spirochete in the sore by the blood vessel damage, extensive involve- dark field examination, which exami- ment of nervous structures, or begin- nation should always be made on any ning insanity. sore arousing suspicion of the disease. In attacking syphilis as a public It is urgently important to the vic- health problem, the combined efforts of tim that diagnosis be made at this physicians, public health officials, edu- stage, because this is the period during cators, and the public are required. which opportunity is greatest for cure The fundamental approach, I believe, from adequate treatment. If treat- is education. All people should have ment be delayed until the blood Was- adequate appreciation and understand- sermann becomes positive, the oppor- ing of the disease as an infectious dis- tunity for cure is reduced from about ease problem. The public should sub- 86 to 64 per cent. stitute rational thinking for moral The stage of the initial sore is us- prudery. ually, though not always, followed in Education of the adult population is a few weeks by an eruptive stage, necessary, and should be pursued in :

8 The Health Bulletin October, 1936

every practical way. but I believe our determine whether a suspicious sore is greatest teaching effort should be syphilitic or not. They will demand directed among the youth of the land. darkfield examination. and that fundamental concepts of the They will not permit tbeniselves to disease and its control should be taught believe that six or eigbt shots of 606 in the public schools, because it is here will cure them of syphilis. that the greater percentage of Ameri- Second to education, the next funda- can youth gets its training for future mental in attacking the control of citizenship. In North Carolina, it is syphilis, is that adequate and well now compulsory that children in the directed treatment should be available public schools be taught the physio- to all infected persons. The indigent logic effects of alcohol and narcotic- should be treated free, and the low drugs, and certainly more people are wage earner should be treated at a not ravaged by these drugs than by cost commensurate with his ability to syphilis. pay. Mr. and Mrs. Average Citizen, and Since the inadequately treated syphi- their sons and daughters of upper high litic, in a large percentage of cases, school age, should know that syphilis ultimately becomes a charge of society. is a very treacherous infectious dis- it seems only fair that if public facili- ease having a more or less insignifi- ties are provided for treatment the in- cant beginning so far as concerns vis fected individual should be compelled

ible outward manifestations, and pur- to take advantage of it. suing an insidious but inevitably dan- The physician undertaking the treat- gerous and destructive course, unless ment of syphilis assumes the inescap- checked in its earliest, detectible be- able responsibility to his patients of ginning. thoroughly familiarizing himself with They should know that even in the modern concepts of diagnosis and the earliest detectible stage the disease is pathology of the disease, and with the hard to cure and requires from one to action and value of the medicinal two years of adequately systematized agents used in treatment, and the fur- and administered treatment, even after ther responsibility of familiarizing and all visible sores have healed. equipping himself with modern diag- They should know the meaning of nostic apparatus. "Wassermann test" and dark field ex- Surgeon-General Paran, of the United amination. States Public Health Service says They should understand the meaning •Syphilis must be the next great of, and necessity for spinal fluid ex- plague to go. Our children will hold amination, that is, that it is necessi- us criminally careless and incompetent tated by involvement of the brain I an if. with the means at hand, we fail to spinal cord structures by the disease. end this scourge within our genera- They should know that a child can tion. This is one contribution we know probably be born of a syphilitic mother, how to make toward a safer and free of the disease, provided the mother happier world for them to live in." has received proper treatment during the first five months of her pregnancy. We desire to commend some of the Mr. and Mrs. Average Citizen, and county and city health officers who are their sons and daughters of upper high making an earnest effort to immunize school age, possessed of the funda- the children of their communities mental facts concerning the disease against diphtheria at this time. News will not permit themselves to be told of such activities coming through our to wait for a positive Wassermann to clipping services is gratifying. :

October, 1936 The Health Bulletin

Fifteen Year Record of Diphtheria Cases and Deaths Occurring In New York State and In North Carolina

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

THE group of figures given below figures will offer convincing evidence for New York State (exclusive of that we may solve our diphtheria eradication problem in only one way New York City) and North Caro- and that is exactly as New York State lina should not only be of interest to has done—through immunization. T all health and quarantine officers in The New Y ork figures offer proof North Carolina, but to all of our citi- that diphtheria may be controlled by zens. The success of immunization the immunization of 33% of pre-school against diphtheria is clearly shown by children and 50% of school children. the New York statistics. Although Our efforts should be directed toward North Carolina has made considerable this goal. progress, there is still much to be To immunize such a large per cent of achieved in the eradication of diph- our children population will require theria from our State. Naturally, con- much time and effort and the expendi- ditions in our State are different in ture of considerable money, but the re- many respects from those existing in sults will be worth all that it costs. New York State. But a study of these The comparative figures follow

North Carolina and New York State (exclusive of New Y'ork City) Diphtheria Cases and Deaths, with Kates, per 100,000 population, 1921—1935, inclusive.

North Carolina NeivYork State Case Case Year Cases Rate Cases Rate

1921 243.3 176.0 145.8 113.2 S2.5 S6.6 71.2 52.0 40.0 28.0 22.0 11.3 12.0 7.4 6.5

(1935 N. C. population estimated.) : : — : : —: : :

10 The Health Bulletin October, 1986

The Importance of Birth and Death Registration

By H. G. AA'illiams, M.D. V. S. Census Bureau THERE is an increasing flood of For establishing identity. requests for certified copies of For tracing ancestry. birth certificates by residents and For child health programs. former residents of the State of North To prove date of birth Carolina. In many instances these are For entrance not available because of negligence of to school. For first work permit. doctors and those in attendance. Fail- For automobile license. ure to register births cause much dis- For right vote. comfort and trouble when the child to For right to marry. tries to enter school in larger cities, For right to enter Civil Service. or obtain employment in many indus- For entering military service. tries, or attempts to enter military For social security benefits to service. More and more industries in- blind, dependent children, aged. sist on copies of birth certificates to For settlement of pensions. establish proof of age before employment may be secured. To prove place of birth The Bureau of the Census at Wash- For passports. ington, D. has sent a representative C, For immigration and emigration. to the State of North Carolina who For establishing citizenship. will carry on a promotional campaign for the State Bureau of Vital Statis- To furnish birth statistics. tics. Dr. H. G. Williams will interview Deaths should be registered local registrars, doctors, and under- To prove the fact of death takers in most counties of the State For life insurance claims. in an attempt to secure complete birth For settlement of estates. and death registration. Many residents of North Carolina do To prove facts about deceased birth death not know the value of and For circumstances of death. registration. Many doctors are lax in For time and date of death. completing and turning in birth cer- For age, sex, and color. tificates. people find it difficult Many For nativity. to establish proof of age and resi- For names of husband or wife and dency when a birth certificate has not parents. been filed. There has been two instances in this last year where lives were To furnish official statistics saved by the fact that individuals who For health departments were condemned to die were able to To establish causes of death. prove by birth certificates that they To prevent disease. were under age. Some of the reasons To plan health programs. why births should be registered are For life insurance rates. To prove the fact of birth To establish premium For proving parentage. For mortality statistics For inheritance of property. By place of death. For settlement of insurance. By residence. For legal dependency. For estimating population. —

October, 1936 The Health Bulletin 11

All births and deaths should be Statistics will be glad to check their

registered because it is a State law. records to see if the birth was regis- The Bureau of Vital Statistics urges tered. all parents to insure registration of all "Registration of birth is proof of new born children. If you have not received a card of notification of birth citizenship and your interest in regis- within three or four months of the tration of births and deaths is proof birth of the child, the Bureau of Vital of good citizenship."

NOISE From American Journal of Public Health DURING the past few decades in- quiet suburb. Although fatalities have fectious diseases have been bet- seldom (if ever) been reported from ter understood, and controlled to noise directly, the eardrums of heavy a considerable extent. The incidence of artillerymen may be burst, and it is a such diseases as tuberculosis, diph- well-known fact that boilermakers be- theria, and typhoid fever has declined come deaf. markedly. Drinking water has been Another aspect of noise that is an- purified. Sewage disposal is carried out noying, to say the least, is the ambig- in a decidedly more sanitary way than uity of its direction. To puzzle about in earlier days. Streets are being kept the source and the unfamiliarity of cleaner. Dwellings, though universally sounds that are distracting, often pre- not yet what they should be, are more vents one from devoting his attention sanitary. Coincident with these notable to more important things. Intellectual achievements from a public health workers are more affected by noise standpoint there has crept into our than others. Nevertheless, some experi- lives a new public health problem ments with industrial workers indi- noise. This has come about largely as cate that noise prevention in factories the result of the extensive mechaniza- tends to increase the quality and quan- tion of our daily life by such devices as tity of output and the workers have the automobile and the radio. quite generally voiced greater satisfac- Noise is unwanted auditory stimula- tion with quieter conditions and felt tion. Thus it may be seen that other- lessened fatigue. wise beautiful music may be noise. Watson has demonstrated that noise Unlike garbage or street dirt, noise has is an elemental fear-producing stimu- the peculiar property of radiating in- lus. It is one of two things that will stantaneously in every direction from frighten a baby that has lived in a its source to annoy every one within protected environment and has never the zone of its penetration. experienced fear. From a physiological Loudness is one of the most distress- standpoint noises tend to increase mus- ing attributes of noise. Its intensity cular tension and thus the energies of may be measured in units, called deci- many people are insiduously dissipated bels, by which the noise of a busy city without their awareness. Although un- street corner can be accurately com- awakened by noises at night, their ef- pared with that of an automobile horn, fect on muscle tension deprives persons the roar of a jungle animal, the loud of adequate recuperation during sleep speaker of a neighbor's radio, or the hours and unfits them for the ordeals boisterous cocktail party in the wee of another day. The persistent accumu- hours of the morning in an otherwise lation of such effects may be tolerated a

12 The Health Bulletin October, 1936

by some people better than by others, noise as it is to expectorate on the but it is safe to say that millions are sidewalk. When the public gets suf- stimulated and harassed when they ficiently conscious of the need for pre- should rest properly to promote well- venting unnecessary noise, ordinances being. may not only be passed, but enforced, There is little doubt that the people to protect every one. Hospital zones are of the United States are among the now protected by law. If such measures

noisiest. Much of it is unnecessary. are good for the ill, they will un- New York City has done much re- doubtedly help to keep many not

cently to lessen its noise. Many cities, acutely ill from being uneasy or dis- including London, Rome, and Paris, eased. With noise on the increase, within the last year or two have com- cities must be planned in the future pletely controlled the automobile horn to protect their citizens. The proper by ordinance. Despite belief to the con- construction of dwellings, the arrange- trary, there was a reduction in auto- ment of streets and parks, with sound- mobile accidents in these cities after absorbing trees, shrubs, and vines, and these ordinances went into effect— quiet, efficient, transportation systems fine demonstration that drivers could leading to decentralization of over- use their heads instead of their horns. populated regions, hold possibilities as In some cities for many years anti- yet but little realized. noise societies have been organized to This problem, so essential to co- arouse the public consciousness to the operative living, should be a challenge

importance of noise prevention. The to. education. Children should be taught responsibility of manufacturers and noise prevention as well as cube root. merchants in these matters is clear. There was a time when we were ignor- Quiet automobiles, street cars, radios, ant of and indifferent to the conse- home devices, will be in demand to re- quences of polluted water supplies. place the noisy ones. Individuals have That is now interesting history. There a great responsibility. The time should will be a time when society will look not be far distant when it may be as back and say, "How could they exist much a breach of good manners and with such a jumble of barbaric noises public health to emit an unnecessary to harass the equanimity of man."

An Anonymous Letter On A Subject Too Long Treated Anonymously

a 'E have been very much in- occurs to them to instruct their chil- W.'terested in many things pub- dren, who are in school, and otherwise lished in the Health Bulle- in public places, to be careful of toilets, tin, one of them is in relation to and other means of contagion. If one acquainting the public to the great dan- should tell the parents there is danger ger in the spreading of venereal dis- of this kind they would laugh you to eases. Preach it MORE, LOUDER, and scorn, and say 'There is only one way PLAINER, for it is no exaggeration to to catch a "bad disease",' as they call

say that there are great numbers of it. and that is by sexual contact. No people all over the country that don't one ever has it except they are know what the name "venereal dis- 'crooked'. If one of their family con-

eases" means, people who are supposed tract it, they try to keep it a secret, to be good citizens, decent, etc. It never and 'doctor' it themselves. In the mean- : —

October, 1936 The Health Bulletin 13

time, all the family wash hi the same "As long as people boast that they basin, use the same towel, drink out do not read, and as long as they scorn of the clipper. don't same They know advice from any one, you people up the first word in sanitation. If you tell there in the Health Department have a them they should be careful, to use hard and thankless task. The bright every precaution, they take it as a ray is that all the rural people are not grand insult. All this time they are this kind. But our children are all mingling with people of the community, thrown together often going to spend the night some- at school. where. No wonder this disease is "Keep up the good work and may it spreading. Next to the 'love of money', be crowned with more success day by 'Ignorance is the root of evil,' truly. day. Good luck to you. A Mother."

2,200 Wayne Adults Have Or Will Have Syphilis

TOTAL of approximately 2,200 Details of the plan for the nation- Wayne County adults have or wide fight to curb the disease were A given in article will have syphilis. an by Dr. Parran, written for the Associated Dr. Thomas Parran, Surgeon General Press. of the United States Public Health The first requisite for the attack is, Service, says however, an appreciation and under- "One adult out of every ten has or standing of the problem by the public. will have syphilis." For centuries people have considered that it was immoral to even speak of Wayne County's population is ap- the disease proximately 55,000. according to best but in the future it must available information. Of this number be recognized as a health hazard and approximately 22,000 are adults, care- probably least of all as a question of ful checks indicate. morals. It is reasonable to judge that the From now on syphilis must not only infection rate for Wayne is as high as be talked about but be fought actively the national average and probably because it is arising as the great Amer- higher, according to an opinion ex- ican disease and if all conditions due pressed by Dr. S. B. McPheeters, direc- to syphilis were reported as such, it tor of the Wayne County Health De- would probably be found the leading partment. cause of death in the United States today. Such a situation can not be al- The Wayne infection rate is prob- lowed to be obscured any ably greater than the national average longer by the fog of ignorance. because of the larger per cent of colored people in the County as compared with We can be justly proud of our record the nation as a whole. Checks show in the United States in fighting tuber- syphilis is six times more prevalent culosis and reducing its occurrence to among colored people than among the point where we can talk about white persons. eradicating it entirely. It is shameful, however, that pitifully little The startling facts for Wayne Coun- so has been done in fighting syphilis, cases of ty—equally true for every section of which are more numerous than the nation—were pointed to as word from Washington came of plans for measles, twice as numerous as tuberculosis and a hundred an intensive nation-wide attack on times more numerous than infantile paralysis, syphilis public health enemy number to — which so much public attention has 1 —to be launched in the near future In en directed in through a net work of federal and recent years. state health authorities, public and There is an even greater opportunity private institutions and practicing phy- for the eradication of syphilis against sicians. which we have made no progress than : ; —

14 The Health Bulletin October, 1936

for the eradication of tuberculosis. The 2. Examination of all persons hav- fact that the end results of the disease ing contact with a patient found to crowd our jails, our poor houses, and have the disease. our insane asylums is not due to a lack 3. Preventing the birth of syphilitic children by requiring blood of scientific knowledge, because we tests before marriage and early in each preg- have at hand specific methods of con- nancy. trolling it which are better authenti- 4. Teaching the facts about syphilis cated by science than the means of con- to all people. trolling tuberculosis. We know in general where syphilis Then, since the methods of treatment is—half of the cases are found in per- and eradication are known the steps sons between 20 and 30 years of age to be taken are these with six men having it for every four women infected. It is four times as 1. Finding cases of syphilis promptly prevalent in cities as in rural areas through widespread use of the Wasser- and six times as prevalent among niann test and treating them immedi- negroes as among white persons. ately. Goldsboro Neivs-Argus.

The Challenge

THIS afternoon's meeting of service North Carolina law says that any club heads and others interested person suffering from a venereal disease, and who fails to in the problem of venereal dis- take treatment from either the public clinics or a ease control in Wilmington and New private physician shall have his home Hanover County, is of vital importance placarded as a warning to the public. to the entire community. This law is absolutely ignored. There is no mistaking the gravity of Charlotte once tried it, but the red the problem. It is tbe most serious con- signs soon disappeared. Why? fronting health officials today. It is ag- False modesty that preferred the gravated by several reasons. Among sacrifice of human lives and human them is the over-modesty of the public welfare to satisfy a smug and hypo- the reticence of those afflicted, and ut- critical convention. ter failure to observe the law. Can the innocent and the virtuous These diseases can be curbed by edu- have a venereal disease and not know cation and law observance. That has it? been demonstrated by Sweden. They can. Let us recite the case of Sweden, a teeming kingdom on the four doctors. They were men educated Scandinavian peninsula once had one to the nth degree. With seven com- of the highest venereal rates in the panions, fellow practitioners of the world. The government grew interested ancient art of healing, they submitted and began a series of educational ven- to tests. tures plus a law that required compulsory treatment. Four of them showed positive. Bear in mind these were gentlemen, Last year, Sweden had less new cases reported than New Hanover not only versed in medicine, but whose moral lives County, and New Hanover's reported were above reproach. total was by no means a genuine index. Of the four, one survives with his North Carolina does not enforce the usual health. laic regarding venereal diseases. One is dead. A cerebral hemorrhage The statutes require that every case due to venereal disease took his life. treated be reported to health authori- Another is retired from practice, be- ties, not by name but merely as a new cause a heart weakened by venereal case. disease prevents his active engagement This is not done. in his profession. North Carolina law specifies that A third is in an institution for the every handler of food, whether em- hopelessly insane. ployed by public caterers or in private If a disease so insidious as to waylay families submit to tests for venereal practitioners of the healing profession diseases. without their knowledge, what can it Only those in public service comply do for the mere layman, unversed in with this law. the science of medicine? — — —

October, 1936 The Health Bulletin 15

The situation in Wilmington and because typhoid is born of the vilest New Hanover is no worse than in other filth. sections of the State, and of the coun- Scarlet fever was eradicated by the try, but same procedure. Venereal diseases lead every com- Shall venereal diseases endure, mere- municable disease, including typhoid, ly because we have a mistaken idea smallpox, diphtheria and scarlet fever. that it is a term not used in polite Venereal diseases cause indirectly society ; that it is spawned of im- themselves, but (they seldom kill of morality? confine the victim to a lingering death) that seventy-five more deaths than cancer, most dreaded Let us remember per cent of those who suffer are inno- scourge of the age. Smallpox was stamped out by edu- cent of the slightest immorality. cation. The challenge should be answered. So was typhoid, and we overlooked The time is now, today. Wilmington our conscientious scruples in so doing Star.

A Health Menace That Is Multiplying

N polite and refined circles certain esty in the handling of this problem. doctors themselves are largely to diseases classified non-technically The I blame, for they have unquestionably diseases" are taboo and as "social refrained from endangering the hap- as a consequence certain of these in- piness of married couples by not diag- fectious maladies are growing by leaps nosing troubles of various and multi- and bounds. fidious kinds that have originated in The surgeon-general of the United this infection. States is authority for the statement Discussion is frequently heard of the that syphilis now outranks all other advisability of requiring domestic serv- menaces to the health of the race. ants, conceded to be a source of infec- Statistics given out by the surgeon- tion, to be examined and to present a general indicate that there are more health certificate. Handlers of foods are than a half million new cases from this required to pass such examination in insiduous and destructive disease in places of public sale and public eating this country every year. By way of houses—why not require the private comparison, there are about 150,000 domestic servant to undergo such ex- cases of scarlet fever. 125,000 cases of amination? The saving of one baby tuberculosis, and 50.000 cases of diph- from infection from a diseased nurse- theria. maid would justify a rigid law and The surgeon-general points out that provision for proper examination and the next great crusade of health and certification. medical men in this country must be In this connection, of course, it can against this dread disease. No longer be argued that employers of domestic must it be considered a product of servants can act on their own initiative organized and commercial vice. More and require such certificate. The than 50 per cent of the victims, says trouble is they do not do so, and only a the surgeon-general, are innocent of comparatively small percentage can be any immoral conduct. The germ, which counted on to take the precaution un- does not live out of the human body, less supported by a general public law. except for a very brief time, is easily The State Health Department of transmitted—even by a handshake or North Carolina would do well to spon- a kiss is it spread. Nursemaids and sor a state-wide law—one with no loop- cooks are a prolific source of contagion. holes and with teeth in it. One instance is cited by the surgeon- Why not tear the mask from this general where seventeen active cases in monster? Kinston Free Press. a group of young people were traced to one infected carrier at a party We are much encouraged over the where a "kissing game" was in prog- fine response to our efforts to establish cen- ress. some maternal and child health The Free Press has been of the opin- ters. To date some sixty have been ion for many years that there was en- organized—about all that can be tirely too much secrecy and false mod- financed this year. — — —

16 The Health Bulletin October. 1936

DO WE BELIEVE IN SHOULD BE NO LET UP THE LAW? It is gratifying to learn that the Federal Government has released over IIIATT last night warned DR. $94,000 in funds ear-marked for child members of the Brigade Senior welfare, maternal and child health fraternity of the dangers of ve- services, to North Carolina during the past few months. nereal diseases. He cited figures that should be arresting to any normal No service being performed by local, mind. State and Federal Government units, save that of maintaining law and North Carolina law is very definite order, is more important than that on the subject of venereal diseases. If which pertains to the welfare of the the statutes were enforced, the mala- mother and child. dies would be eliminated, but the The appalling tragedy that is writ- wholesale disregard for these laws is ten into needless infant and more flagrant than the contempt in mother deaths in maternity, and the life which the late prohibition law was handicaps thrust children held. upon through the lack of proper pre-natal and post-natal It is unlawful in North Carolina for care are vital concerns of the public, a person suffering from venereal a dis- and government as the legal represen- ease to expose another to infection in tative of the public will, acts wisely any manner or form whatever. and well when it moves to remedy the A fine or imprisonment or both are conditions that cause these evils. provided for the offender. Community, State and Nation should It is unlawful for a physician to stay behind this mother and child treat a venereal case and not import health and welfare program. On this it to the health authorities. It is simi- front there should be no let up. Wins- larly unlawful for the manager or ton-Salem Journal. superintendent of any institution where a venereal patient is treated to fail to make a similar report. It is unlawful PREVENTIVE for any person who makes a diagnosis MEDICINE of a venereal disease whether physi- DREAMS cian or otherwise, to keep it secret. "Preventive medicine dreams of a Health authorities of North Caro- time when there shall be no unneces- lina, may at their discretion examine sary suffering and no premature against their will persons reasonably deaths ; when the welfare of the people suspected of having a venereal disease, shall be our highest concern ; when and to detain in custody such suspects, humanity and mercy shall replace until the result of such examinations greed and selfishness ; and it dreams are known. that all these things will be accomp- The law of North Carolina says also lished through the wisdom of man. that persons refusing to take treat- By Dr. M. P. Rosenau, Head of the ment, when their disease is known, if New Department of Preventive Medi- venereal, may be subject to quarantine cine at University of North Carolina. (or imprisonment). The law of North Carolina says further that domestic servants must be TAKE A TIP FROM YOUR DOG examined periodically, if their duties include the handling of foodstuffs, or Speed! Speed! Si>eed ! Speed is the otherwise cause the hazards of trans- spirit of today ! We must all learn to mission. relax. Have you ever noticed your dog? In brief North Carolina law will pro- After he is through running and play- tect the public if the law is enforced. ing, have you noticed how he com- North Carolina law however is not pletely relaxes and falls asleep on the enforced. It is treated with contempt. rug at your feet? He lets down, rests And in the meantime, venereal dis- every nerve and muscle, and builds up eases have taken rank as the greatest his strength for the next run. menace to health in the world today You. too. need to relax. Take a tip and are gaining steadily. from your dog and let down. In these Do we believe in the law? Wilming- high-tension days if is vitally impor- ton News. tant to relax- -Ohio Health Bulletin. |

Publis\edbq TFVLN°fLmQ*FSUMlK STATE. D^ARDs^rtmUn

This Bulletin will be ser\t free to ar\\j citizen of the State upor\ request

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

Vol. 51 NOVEMBER, 1936 No. 11

CHRISTMAS SEALS FIGHT TUBERCULOSIS Please Buy and Use Them MEMBERS OP 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. Lee 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, 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. Stimson, M.D., Director Division of Vital Statistics. R. E. Fox, M.D., Director Division of County Health Work. H. F. Easom, M.D., Director Division Industrial Hygiene.

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 request to the State Board of Health, Raleigh. N. C. 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 to Infant Care. The Prevention of months : 15 to 24 months ; 2 3

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

CONTENTS PAGE Notes and Comment - 3 On the Prevention and Modern Treatment of Tuberculosis 4 A Few Tuberculosis Aphorisms 7 Eyeglass Fakers Still Active 7 Reporting of Tuberculosis Cases 8 Club Women's Part in Preventing Tuberculosis 9 Backache 10 "Where Houses Thick and Sewers Annoy the Air" _ 13 How to Die From Tuberculosis 14 Tuberculosis Among Young People Decreasing Only Slowly 15 Deaths from Tuberculosis of the Respiratory System—By County and Race : 1935 16 Vol. 51 NOVEMBER, 1936 No. 11

Notes and Comment

By The Editoe ACCORDING to our custom for ventive medicine made such headway many years, we are again pub- as has been made in the efforts to con- lishing in the November issue of trol and eliminate tuberculosis. When The Health Bulletin on the outside the new State Sanatorium at Black Mountain is completed to its full back cover a list of the deaths from capacity, and with the addition of a tuberculosis of the respiratory system, few county sanatoria now underway by county and race, for 1935. If the or contemplated, it should be much reader is interested, as every citizen easier than ever before to reduce the of this State should be, it will be in- principal cause of the spread of this teresting to compare this column this disease, that is, the infection by con- year with those which have been pub- tact with healthy people, principally lished annually for the past several children, of patients seriously ill with years. tuberculosis. In 1915, there was a total number of Our front cover again this year was deaths from all forms of tuberculosis supplied by Dr. L. B. McBrayer. Man- that year of 3.710. Compare that with aging Director of the North Carolina the figures in this issue. It will be noted Tuberculosis Association. It is a pic- that in 1935, just twenty years later, ture of the 1936 tuberculosis seals, the there was a total of 1,938, just slightly emblem of the National Tuberculosis more than half the total number of Association. The sale of these seals deaths which occurred twenty years which are later affixed to Christmas earlier. In this year, however, the letters during the past few years has population of North Carolina had in- reached large proportions. Seventy-five creased considerably more than one per cent of the proceeds of the seals are million over the total population in retained in the community selling 1915. Had the same rate prevailed last them. It is always spent for a worthy year that obtained in 1915 with the cause in an effort to prevent further increase in population, there would spread of tuberculosis through edu- have been between five and six thous- cational efforts and through care to and deaths. susceptible children, and in many Tuberculosis is not eliminated. It other ways. For example, the past sum- has not been eradicated from this mer, a large group of children from State. It is still a public health prob- Raleigh and Wake County, all of whom lem of large proportions, but in no had shown susceptibility to the infec- otber disease, with the exception of tion, were sent to the State Sanatorium typhoid fever, have the forces of pre- in the children's department for a stay The Health Bulletin November, 1936 of several weeks. This was of great it distributed a full month before benefit to these children, and this aid statewide efforts are launched for their could not have been provided in any sale. This serves to call attention to other way. the various groups interested in pro- Our purpose in publishing the em- moting this work in time to organize blem in our November issue is to have their forces for a successful effort.

On the Prevention and Modern Treatment of Tuberculosis*

By C. H. Cocke, M.D., F.A.C.P., Asheville, N. C. ONE of the most hopeful and out- ease in this country and the wonderful standing phenomena of the mod- reduction in the death rate as a result ern efforts at disease control is thereof, still a fairly similar reduction the rapidly decreasing death rate from in the death rate from this disease has tuberculosis of the lungs. Twenty-five been found in other countries where years ago approximately 186 people no such concentrated efforts as ours out of every 100,000 population in the have been put forth. Just what these United States died of this disease every factors are which seem to be univer- year. During 1936 this figure will be sally applicable is not at all known cut approximately to a third, with definitely. But whatever is responsible some states showing less than sixty for the encouraging decrease in tuber- deaths for every 100,000, while the gen- culosis mortality, our conception today eral average will hardly be more than of the best possible method of prevent- 70. ing the spread of this disease is by as While it would be comforting to early recognition as possible of the in- think that this great improvement was dividual case, and then institution of due entirely to the sanitary, hygienic, the proper measures to prevent its and other preventive measures which spread by contact with others. This have been used during this period of means the proper care of the open case, time, still a review of the facts as (the one with germs in the sputum), known shows that the reason for this in a sanatorium, with careful studies decline is due to other factors in addi- of all members of the family and im- tion to these great efforts. One of the mediate associates of the patient. This peculiar features of this disease is that proper study would include, certainly one cannot predicate with any certainty in children, the use of the intracutan- the effect which the germ will have eous tuberculin test and the X-ray film upon any given host. In other words, in all instances. The increasing num- the question of the activity and viru- bers of available sanatoria, city, lence of the disease—and as a corollary county, state, and federal, has units commnnicability—are not subject to doubtedly been one of the prime fac- completely known laws. The reason for tors in bringing about the encouraging this statement is that while as I stated reduction in the death rate mentioned earlier, all tubei'culosis workers are en- earlier. This increased number of couraged over the results of the cam- beds offers still further hope of con- paigns to lessen and eradicate the dis- tinuing this satisfactory state of af-

* Being an abridgement of an address delivered August 20, 1936, at the Postgraduate Assembly, Banner Elk, N. C. held under the auspices of the North Carolina State Medical Society. November, 1936 The Health Bulletin fairs. The ideal, of course, is to have thought that exercise was the prime available in any given community or valuable agent in helping cure the dis- State a sufficient number of beds to ease. His most famous pupil, Dett- take care of all open cases. A good weiler, realizing from his own con- many communities predicate the num- dition the harmful effects of fatigue, ber of beds necessary upon the theory modified this open air treatment by that two beds are needed for each means of "rest halls", where the death during the year from tubercu- patients rested in the open. Neither of losis. An even larger number of beds these men actually appreciated the available might well be the goal. fundamental principle largely respons- With regard to the proper control of ible for their results upon which mod- the individual given case, this paper ern treatment is based, namely rest, has no concern. It is by no means to though they achieved results superior be inferred, however, that this is not to those obtained before. enormously important in the aggregate Then soon followed the first of the as well as for the individual as for his modern eras of treatment in which community. Where isolation of such patients sought climates which were cases—or better still accommodation supposed to have beneficial effects upon in a sanatorium—is not feasible, the the disease. The fallacy of this belief utmost care and zeal must be used in that climate alone will cure the dis- instructing the entire household for ease has led many to conclude that cli- their own protection. The absolute ne- mate is of no value. While undoubtedly cessity for this is apparent if the ulti- it is more important for the patient to mate goal of eradicating the disease is have the proper care than perhaps the to be reached, for naturally every case best climate, still for those able to ob- is the result of contact with another tain it, taking the cure period in a one, whether previously recognized or favorable climate does offer definite not. adAr antages over attempting the cure at Other factors contributing largely to home. As summed up by the late great the decline in the death rate are the Dr. Osier, "Care without climate is vast improvement in the economic sta- better than climate without care." tus of the American public, with bet- Following the announcement by Dr. ter food, better clothing, better housing Koch some nine years after his dis- and protection from the ills of weather, covery of the tubercle bacillus that he better early care of children's disabili- had discovered tuberculin, (which we ties, markedly improved milk supplies, now use as a means of testing for the and a wide dissemination of standards presence of tuberculous infection), it of health and habits of living that was thought that the long sought cure have resulted from all kinds of health for tuberculosis had been found. programs. The teaching of hygiene in Though tuberculin has been made in the schools must have been a valuable hundreds of different kinds and ways, factor. The wide popularization of and there have been all sorts of bio- knowledge of medical subjects has been logical products and chemical agents of value ; but perhaps of even greater sought and believed to be helpful in importance than all of these has been specifically curing the disease, up to the development of our modern ideas the present moment none has unequi- of the proper treatment of the disease. vocally proven its worth. The first sanatorium for the treat- The really successful treatment of ment of tuberculosis was founded by tuberculosis began with the develop- Brehmer at Gorbersdorf in Silesia. He ment of sanatoria and an appreciation The Health Bulletin November, 19S6 upon the doctor's part that rest, and to the exclusion of other methods of that preferably in bed at the beginning, treatment will bring great disappoint- was the prime essential in the cure. ment. That mere residence in an institution Other less commonly used methods and twenty to twenty-four hours in bed of compression, such as apicolysis, do not constitute the sum total of sana- paraffin packs, scaleniotomies, intercos- torium treatment is a truism, though tal neurectomies, and various combi- likewise the sanatorium is infinitely the nations of all of these are used by men safer and better place for a patient to skilled in compression therapy. Lately, acquire the details which are necessary the operation known as thorocoplasty, for his cure. However, after several or removal of certain portions of the years of success in this manner of ribs, allowing the chest wall to shrink treatment, aided by careful nursing, and compress the lung, has become in good nourishing diet in a wholesome the hands of skillful, well trained climate, it was found that a certain thoracic surgeons, a most valuable ad- number of cases still needed additional junct to our present means of attack- help. Then, within the last quarter of ing advanced tuberculosis. This I feel a century, we entered our present com- should not be used until pneumothorax pression or collapse era of treatment, or some of the less serious procedures which today is offering the best results have been tried and proven wanting. yet obtained in the treatment of the Of all the measures mentioned, disease. pneumothorax stands out in my opinion Compression treatment attempts to as the one most brilliant, single ad- put the diseased lung at rest so that its vance in the treatment of tuberculosis constant functioning eighteen or thirty within the past twenty-five years. times a minute, in addition to the ef- Certainly some things have been fort of coughing, may be still, and the learned well in the last few years lesion allowed to heal. It had its great about the surgical treatment of tuber- in Forlanini, impetus the work of who culosis ; and of these, three seem to first successfully did artificial pneumo- me fundamental : First, there must be thorax. Since certain cavities could not the fullest cooperation between the be closed by this method owing to competent internist caring for the case adhesions holding them to the chest and the equally competent thoracic wall, attempts were made and a tech- surgeon, who have decided that sur- nique has been evolved of severing gery is indicated in the given case; these. To Jacobaeus goes the most another factor is that having once de- credit for first popularizing this cided that surgery is indicated, it is method, though Unverricht and the most important to determine as care- Matson brothers of Portland, Oregon, fully as is possible what form and how in this country did pioneer and valu- much surgery should be done in any able work following his lead. Within given case ; 3rd and last, but by no the past fifteen years, either crushing means least, the choice of the optimum or severing or extirpation of the time for the operative procedure ; and phrenic nerve, which controls dia- then, again, by way of emphasis, the phragmatic motion, has received wide patient should be very carefully warned acclaim and in some places quite ex- that surgery is not a substitute for the tensive use. This is not the place to cure, but only a means to an end, and discuss its applicability, indications for it by no means absolves the patient it, and contra-indications, as well as from the necessity of proper care of the results, though dependence upon it himself after the surgery is done. :

November, 19S6 The Health Bulletin

A Few Tuberculosis Aphorisms

By C. H. Cocke, M.D.

few years ago Dr. Lawrason culosis are treated successfully by the A Brown enunciated certain valu- thousand. able theses on the subject of What the patient does is more im- tuberculosis, which crystallized his portant than where he does it. thought at the moment on various mat- In tuberculosis there is no greater ters of interest in the disease. By way fallacy than that the patient is as well of supplement to such. I would like to as he feels. add aphorisms of my own What is above the eyes is as impor- Tuberculosis is acquired usually by tant or more so than what is below the intimate, prolonged contact, rarely by collar bone. chance, massive infection. Rest is the only proven specific in Every open case of tuberculosis is a the cure. Compression or surgery are potential source of danger to his house- only aids in achieving this. hold, his associates, and his com- All consumption is tuberculosis, but munity. all tuberculosis does not have to be- Proper control of such a patient come consumption. makes him no menace whatever to any- The time to call the fire department one. In the proper disposal of all tuber- is when you smell smoke ; the way to culous excreta and above all of his diagnose tuberculosis early, and hence sputum lies the only safety. treat it successfully, is always to think The essence of the cure is freedom of tuberculosis. from stress, strain, and fatigue of All things else being equal, the ear- mind, body, and soul. lier you discover tuberculosis, the more The most essential element is Time, likely and certain the cure. for this there is no substitute. Never assume your patient knows

Tuberculosis itself is not often suc- the way of the cure ; he must be

taught it. cessfully treated ; patients with tuber-

Eyeglass Fakers Still Active AT frequent intervals for the past We had hoped that by this time they ten years, we have been publish- would be safely in prison at hard labor. ing information about the activi- We find that we are too optimistic. In ties of a bunch of fakers traveling over a recent issue of the Reidsville Review the State posing as "specialists" in eye we find the editorial quoted below. diseases. They have robbed many old That indicates that these light-fingered people of a good deal of money. No crooks are still reaping a harvest from one knows how many, because some of that rather large portion of our popu- the victims have been ashamed to make lation who always insist on trusting public their loss in fear of ridicule strangers with their health and their from their friends. Only once has an money in preference to their family arrest been made and they forfeited a $2,000 cash bond at Winston-Salem two physician. Read what the Reidsville or three years ago, thus slipping out editor says and if you see one of these of the hands of an alert officer. "specialists" hold him and call the :

8 The Health Bulletin November, 1936

nearest policeman and get him into jail the prospect's eyes, and a little later, for a court trial if possible. by the aid of tweezers extracts what The article follows he explains was 'an invisible cataract'. In truth it is but the fine skin from the "A CRUEL RACKET inside of an egg which the dupe had "Citizens of Reidsville and surround- concealed in his hand. Then he asks a ing territory will do well to be on fee, mentioned occasionally that the guard for what is reported to be the same operation at the Mayo Clinic costs most cruel racket ever practiced in this a huge sum. He usually departs with country. It is known as the "eyeglass from $25 to $300 of the unsuspecting racket", and is being operated in var- victim's hard-earned money. ious parts of the country now. A man, "It is a cruel hoax^ so cruel in fact pretending to be an eyeglass specialist that Uncle Sam has stepped in and is call on an elderly man or woman, assisting in rounding up the racketeers. usually after finding they have a small bank account, and interests them in Several have been arrested in the past eyeglasses at extremely low prices, but few weeks, but there are others still refuses to make a sale since he says the working the 'racket' in various parts glasses he carries are only samples. But of the country. They may strike your he agrees to send along another special- section next. So be on your guard and ist to first examine the eyes. This sec- report the presence of such a scoundrel ond man, arriving a few days later, ap- the moment his operations reach your plies a white salve-like substance to attention."

Reporting of Tuberculosis Cases

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

September 1, 1934, tuberculosis community treating a large number of ONwas made reportable to the State tuberculosis patients will not be penal- Board of Health. The procedure ized by having these cases charged in reporting is the same as that used against that community when they in the reporting of other communicable should be credited to some other com- diseases ; that is, the report of the munity or state. physician goes to the local health or This, of course, increases the work quarantine officer who in turn reports of this office, but it is felt that it is to the State Board of Health. The card essential to have this information. The is a specially designed one which prompt reporting by giving home and should be mailed in a penalty privilege present address with age of patient envelope insuring the privacy that most will facilitate our finding duplicate physicians and patients desire. report cards when they exist. The State Board of Health is at- In reporting cases of tuberculosis, if tempting to put the records into the patient happens to be a married usable shape by an index system that woman and it is known or suspected will facilitate finding the names of that her case has been reported at patients that have been previously re- some previous date, it will be apprec- ported. It is also desired to secure iated if the maiden name of the indi- enough information relative to the vidual is put on the report card as well home address of the patient so that any as her married name. ; —

November, 1936 The Health Bulletin

Club Women's Part In Preventing Tuberculosis

By Mrs. J. H. Highsmitii BEHIND the headlines that have maintaining nursery schools, supervis- announced from time to time that ing nutritional groups, and supplying the tuberculosis death rate of the milk to hungry children. State is declining is a beautiful story Plans are being made by the North of cooperation. I refer to the part that Carolina Tuberculosis Association and North Carolina club women have the State Board of Health to make the played for about thirty years and are Thirtieth Christmas Seal Sale the larg- still playing in the fight to bring tuber- est the State has ever known. There culosis under control. Particularly, I was a seven per cent gain in the coun- have in mind their faithfulness in or- try's 1935 Seal Sale over that of 1934, ganizing Tuberculosis Christmas Seal and an even greater increase is antici- campaigns each year and letting not pated for this year. Around seventy- even the festive holiday spirit inter- live of the largest women's clubs in the fere with this important mission State serve each year as agents for also, their care of the tubercular needy selling Tuberculosis Christmas Seals in their community ; their operation of in their communities. What they have fresh air camps and preventoria for accomplished in past years with the children predisposed to tuberculosis funds obtained from the sale of seals and their manifold efforts to feed the is a thrilling page in the history of under-nourished school child that he North Carolina health work. County may not fall a victim to this disease. sanatoria have been built ; fresh air To the unfailing interest and co- and nutritional camps have been operation of club women has been maintained for many summers. Under- credited a fair portion of the success nourished children have been fed and achieved not only in North Carolina needy tubercular cases have been given but throughout the country in reducing hospital treatment, all financed through the tuberculosis death rate. But tuber- the sale of the Christmas seals. culosis is not yet a conquered disease. The lean years have passed, and in of the fight is that to The best part departing have left in every community be made from now on—the part that depressed and dependent families children will enable men, women and homes in which children become easy to resist this disease or to cope- with prey to tuberculosis. The protection of it intelligently wherever it does exist. such families from the ravages of this Preventive this is the work of kind devastating disease is the opportunity most constructive phase of the tuber- that faces every woman's club in the culosis control program and is there- State today. fore the most valuable. It is the field of work in which club women have been most successful in the past and Twenty-six people died from pellagra in which they can continue to work in North Carolina in September. This with effective results. They should plan was four more than the number who now to sponsor the 1936 Tuberculosis succumbed in 1935. If this disease is Seal Sale and through it raise funds to be completely controlled in our State for such undertakings as constructing intelligent efforts will have to be made preventoria, operating summer camps, 365 days of the year. ;

10 The Health Bulletin November, 1936

Backache*

By D. W. Holt, M.D., Greensboro, N. C. WHILE a student in medical col- that simple uncomplicated retroversion lege and later a resident physi- was not a cause of backache, and in cian, under the teaching and lead- stressing this point he said "Any physi- ership of the noted physician, author cian who tells a woman that an oper- and loved teacher, the late Dr. Thomas ation for simple retroversion would McCrae, I was particularly impressed relieve her backache, certainly does with the way he emphasized the sub- not know the nerve supply of a wom-

ject of my paper today ; namely, "Back- an's pelvis." ache." Well do I remember how he With the advent of the knowledge of tried to impress upon us the import- focal infections, many other causes for ance of a careful and painstaking his- backache have been recognized. Many tory and examination in these cases. men of outstanding authority have The study of backache affords a most stressed the importance of teeth, ton- interesting problem in medicine. It is sils, sinuses of the head, the appendix, now definitely known that backache gall bladder, prostate, seminal vesicles, may arise from any number of condi- and the female pelvic organs as chief tions which may be coexistent in the sites of focal infections. The bacterio- same individual. Therefore, in an logic work of Rosenow and Dick has analysis from an etiologic standpoint, given this theory a reasonable amount it is necessary to proceed with the ut- of corroboration, and the fact has been most caution. It has taken a long time established that backache may well for medicine to arrive at this conclus- represent some evidence of infection, ion, and there have been many steps with or without disturbance of posture. in the development of the opinion. There are certain fundamental con- When gynecology developed as a ditions that attend any investigation specialty, it was believed that pelvic of backache. We realize the fact that conditions were the chief cause of bad posture is most common in women. backache. The view changed when it Women do not usually stand as well became known that relief did not often as men. They have a high proportion follow the procedures directed toward of flat feet due to improper style of the lesions, and that men were also shoes. liable to backache. At that time, prob- The importance of fatigue is not ably little was known as to the cause sufficiently emphasized. Fatigue alone of lumbago or sciatica or of the role may *be responsible for backache. Be- the prostate gland plays in causing cause nearly all gynecological patients backache. When the pendulum swung complain of backache, it seeems reason- to the other side, the gynecologists be- able to assume that fatigue must be came more conservative in their state- shared with static as well as with the ments about backache. Dr. Kelly, in pelvic conditions. the 90's, constantly cautioned his stu- Infection of the bladder usually dents not to promise relief from back- causes a definite backache. Backache ache in the presence of inflammatory has occurred in patients whose tubes conditions, or in marked retroversions have been removed or tied off, and this and Dr. P. Brook Bland, in Philadel- may be due sometimes to ovarian ad- phia, also tried to impress upon us, hesions or other pelvic pathology. How-

* Being a modification of a paper read August 20, 1936, at the Postgraduate Assembly, Banner Elk, held under the auspices of the North Carolina Medical Society. November, 19S6 The Health Bulletin 11

ever, we must remember that back- any length of time. One is struck by ache can be caused by many other in- the frequency with which these women flammatory pelvic conditions. patients date their disability back to Consider some of these variations child-birth. from the normal : firstly, retrodisplace- Patients who describe a backache ment. To the lay mind, a "tipped womb" after exertion also complain of discom- always means a backache, but there fort in the lower abdomen, sometimes are a large number of backward dis- sharp and fleeting, sometime dull and placements without any symptoms persistent. These pains have usually whatever. It becomes necessary to ex- been present for a long time and they plain why backache is present in only usually disappear when the patient certain cases of retrodisplacement. lies down. "Gas" is a common accom- Something beyond the theory has been panying complaint. They have rarely advanced that circulatory disturbances been confined to bed with abdominal in the broad ligaments, or in the uterus, pain or backache. They have "hollow accompany the abnormal position, and backs" and there is usually definite

that it is this circulatory disturbance relaxation of the abdominal walls ; they that causes the backache. However, often are "round-shouldered", apt to be backache is not always present in pel- under-nourished, and they generally vic inflammations, where circulatory convey the impression that the business disturbance is marked. Secondly, pres- of living is almost beyond their cap- patients sure : the adherent retroversion with ability. On the other hand, the pathology in the appendages might whose backaches are worse only at seem to be one abnormality which night present an entirely different pic- would most likely produce this pres- ture. They are apt to be over-weight, sure. One must remember, that the short and thick, they have no lumbar uterus or womb can "come outside" curves (normally the lumbar spine is without the slightest complaint of pain convex anteriorally), and they have a by the patient. One surgeon states that flat, square back with markedly re- in backache cases, an accompanying stricted motions in all directions, a retrodisplacement was disclosed in only restriction obviously due to the "build." eleven per cent of the total number. The largest group has no hesitancy in With the realization, then, that back- saying that in bed it has complete re- ache may be present in one patient lief from this symptom. Certain mo- with certain pelvic abnormalities, and tions such as bending, lifting, sweeping, absent in another with more or less and other household duties aggravate identical pathology or identical lesions, the pain. we see that the part the pelvic organs We also note that a great majority play in the production of this symptom of these backache cases in women do of these backache is uncertain. Many housework, not perhaps in itself con- cases are of long duration, measuring clusive, for the majority of women still over months and years. In the greater do housework. We share the common number of cases, the symptom is worse knowledge also that factory efficiency after exertion, especially towards night, has not yet been introduced into the with relief after lying down. A much kitchen, where one hears nothing of smaller but very definite group has "fatigue" and "faulty position", of backache when first getting up in the morning. Another small group has "muscle strain" or "wasted motion", backache only when in bed, and there though we have seen the faint begin- is a group which embraces patients nings of attention to this in the "yard- who are uncomfortable when sitting high sink" advertisements. 12 The Health Bulletin November, 1936

The gross defects in the structure of long drawn out course of treatment. It the back, the backs with definite becomes necessary to short-cut in a lesions, do not often appear in this search for relief, and oftentimes a cor- group. They have long since come un- set, in the case of a woman's backache, der the care of the orthopedists. The is more or less a permanent part of her gynecologist rarely sees an acute back, wearing apparel. Proper corseting will but he finds cases with chronic back take care of a very considerable num- pain, dated from some accident or in- ber of these cases, enough to warrant jury supposedly causing uterine dis- it a standard first procedure for the placement (displacement of the backache which comes to us. It takes womb). In a general way also, these care of the whole group which has its patients with only slight deviation symptoms with exertion and its relief from normal, posturely, have a maxi- on lying down. A reasonable propor- mum of discomfort and minimum tion of these cases which have back- lesion. ache only in bed are relieved by a The physician also sees patients who proper corset worn in the daytime; can be said to have real back strain, others of this group are benefited by sometimes associated with sciatica. procedures which tend to minimize the The terms sacro-iliac strain or dislo- extreme flexion these rigid backs are cation and lumbo-sacral strain are iu subjected to when sleeping in beds with most common use. The usual complaint soft mattresses and relaxed springs. is "pain in the lower part of my back." When a case seemingly belonging to Men are usually affected, and trauma the postural group does not get relief or lifting is the usual history. In a at once from proper corset or support- large number of these cases, no lesion ers, before accepting demonstrable pel- is demonstrable, the X-rays are nega- vic trouble as a probable cause, we tive, and no evident joint lesion can be must not forget to consider the pos- found. An over-taut ilio-tibial band (a sibility of a true arthritic condition, band of fascia on the outer side of the including the sacro-iliac joints. I have thigh) has been blamed by some. Sup- found that the knee-chest position over port of the bony pelvis by strapping, a period of several weeks is a valuable or a corset or belt is the best mode of addition to the treatment of the abdom- treatment. inal aspects of these cases. With the correction of the postural fault, and If the adult patient could only be excluding arthritis, tumors, and in- taught to walk and stand correctly, if flammations of the vertebral column by regulated exercises their muscle and spinal cord, acute and chronic, by tone could be brought to normal, if with a thorough history and examination, a gesture the improper and fatiguing including X-rays and a neurological apparatus of housework and other examination, one is reasonably justified kinds of work could be removed, if the to proceed on the theory that some height of all patients could be stand- definite pelvic pathology or pelvic lesion ardized, as well as sinks and tables, a is its cause. cure for this housewife backache would doubtless ensue. This ideal, of course, is impossible of attainment. There were 441 infant deaths under Even it question learning were a of one year of age reported to the State correct posture by systematic exercis- Board of Health in September. This ing, it would be impractical. The ma- was an increase of 62 deaths over the jority of these patients do not have the high mark for the same month in 1935. time nor the patience to devote to a It is a discouraging report. :

November, 1936 The Health Bulletin 13

"Where Houses Thick and Sewers Annoy the Air"

Portions of an address on Health Problems of the Negro by E. F. Tyson, M.D.

the city of Charlotte, the chief actually become stagnant or polluted INcauses of deaths among negroes are, several times within the course of a single year, constituting a health men- according to frequency : heart dis- ace of gigantic proportions, increasing ease, pneumonia, apoplexy, external not only infant mortality, but the inci- causes (including homicides and auto dence of social diseases, tuberculosis, casualties), cancer and tuberculosis. malarial and typhoid fevers? Negro According to the last available statis- mothers, domiciled in such localities, tics, the average age at death for in hovels, which, for want of more whites was 44 ; colored, 36 ; and in- repulsive names are styled "shot-gun fant mortality per 1,000 live births was houses", thrown together by landlords for whites, 53; for colored, 121. As for whose initial thought is a quick re- for the prevalence of social disease, turn from a financial outlay—Negro every one white there were four col- mothers, I say, forced by economic ored, and of tuberculosis, one white and stress to go out in service often within seven colored. one week of their accouchement, leav- Now these are disquieting statistics. ing their babies, pardon the expression, Grievously do we accept them and to "root hog or die" in the care of ir- grievously do we answer them. We are responsibles, in insanitary homes and ashamed of them, yet there is some- premises, where sometimes four fami- thing we can say about them. lies are forced to use a single toilet Our health department can be as- and where the only available drinking sured that the Negro medical profes- water supply is confined to the same sion stands behind it 100 per cent. We inclosure—leaving their babies, I re- take this opportunity to congratulate peat, in dens, unprotected from flies, every member of its personnpl as well mosquitoes, and vermin, to be brought as its subsidiary group, our city, school up undernourished, pale, anemic, un- and welfare nursing services, upon the der-privileged, diseased and without a very creditable work they have put chance in life—these mothers, with over this year. Our health department, tear-stained faces, with cruel furrows in particular, has worked indefa tig- across their brows, their steps robbed ably, has made infinite importunings of elasticity, and the buoyancy taken and has used countless moral suasions out of their lives, invariably turn to with the powers that be but in unavail- the family physician with the question ing efforts to remove the greatest cause "Is it true, Doctor, that my baby died of our public health dilemma—the city because it's blood was bad?" The slums. answer, of course, is an emphatic no. Is there great wonder about these Social disease is but the smoke screen figures of infant mortality when we that hides the insanitary, squalid, stop to consider that the Negro is loathsome abomination called the city shunted off upon the mud-sill of slum. society, upon the murky banks of the As to social disease and tuberculosis, several streams of water which nor- I shall simply offer a quotation and a mally traverse our city but which quasi paraphrase from the classic — —

14 The Health Bulletin November, 1936

Cicero : "How long, oh Catiline, will pearance of our city and a blot upon you continue to abuse our patience?" our public health escutcheon.

Paraphrased : How long ; how long will Finally, we need a hospital for tuber- we allow those Catilines who live in cular Negro children. Speaking of hos- the slum sections of our city to con- pitals, it would be ingratitude more tinue to abuse the female patients of strong than traitor's arms that would an honorable, struggling, outraged and quite vanquish the spirit of Mrs. Jane indignant medical profession? I say Renwick Wilkes were we at this hour to that our health department has left no fail to pay her a deep debt of gratitude stone unturned in a genuine effort to and a lasting tribute to her memory. It wipe out our slums—abominations, was Mrs. Wilkes who, in 1881, estab- where five, six, and eight, male and lished, single-handed, our own Good female, are huddled together in a Samaritan hospital, the very first insti- single room, living night and day in a tution of its kind in the entire South, veritable "glory-hole" of iniquity, offering sanctuary to indigent Negro squalor and disease, where ignorance, sick. That institution stands today as though it doth corrupt, is bliss, and a lasting memorial to her spirit of sac- where thieves break through and steal rifice, magnanimity, Christianity and our pride and progress. And yet there inter-racial good will. More than are those who would stand by and try any other single instrumentality, that to decide whether they should chide or hospital has been the most potent in- deride either the health department or fluence in improving our mortality sta- the medical profession for the fact tistics, our public health record and that these abominations still persist inter-racial relationships. The Char- both as a blight upon the physical ap- lotte News.

How To Die From Tuberculosis

By John P. Koehlee, M.D., Commissioner of Health

1. Don't go near a doctor, no matter tried them all, you will have reached how much you may cough, or how poor the incurable stage. your appetite or how great your loss 5. If you should go to a sanatorium in weight may be, because an early for treatment, leave as soon as you feel diagnosis and treatment of tuberculo- a little better, because by staying too long you might be permanently cured. sis prevents deaths. 6. If in spite of your efforts to the 2. If you should consult a reliable contrary, you received early diagnosis physician and be told that you have and treatment for tuberculosis which tuberculosis, continue to visit other kept you from dying, you still have a physicians until you find one who tells chance to re-open your case by paying you that you have only a cold or a no attention to medical advice and per- touch of bronchitis. sonal health and hygiene.

3. If you know that you have tuber- 7. Don't ever believe that tubercu- culosis don't go to a sanatorium too losis is curable if diagnosed and treated early, because early cases are always early, because if you do, you might be cured. tempted to see a reliable doctor before 4. When your friends advise you to your case is hopeless and in that way see a doctor, buy patent medicines in- escape death. Milwaukee Health Bul- stead, because by the time you have letin. :

November, 1936 The Health Bulletin 15

Tuberculosis Among Young People Decreasing Only Slowly

CONTRARY to general opinion, that these girls had not gone in for tuberculosis among young people, dieting or inadequate clothing, nor especially young girls, has not were they the "jazz mad" type. decreased to the same extent that it The conclusion of those who made the has among other age groups. During study was that the physiologic develop- the period between fifteen and nineteen ment of the young victims must be ac- years of age, the tuberculosis rate has countable. The strain during the grow- declined more slowly than for any other ing, adjustment-making years seems to period. This finding is according to a be greater on girls than on boys. They study made by Elizabeth Cole and re- experience more exhausting physical ported in Hygeia. She says changes. Many girls are so constituted "When this situation was brought that they find it difficult to adapt them- out several years ago, many educators selves to any sort of change, and life's and health workers immediately sought complications appear onerous. The to place the blame on diet faddists, too transitional period, when the girl be- thin clothing, too much "jazz" and too comes a woman, in certain cases affects little sleep. Gravely shaking their heads the general health to such an extent they lamented over the "younger gen- that resistance to sickness is lowered. eration" and their "bad ways that The National Tuberculosis Associa- would lead them to no good end." tion, having in mind the need of pro- Then, in an attempt to secure a more tecting the health of young people, that convincing explanation for the preva- of young girl's especially, has taken the lence of deaths among young women, slogan "On Your Guard," as this year's the National Tuberculosis Association anti-tuberculosis campaign motto, and made an investigation in two large as a special warning to parents to pro- cities, Detroit and New York City, to tect the health of their sons and daugh- find out about the living habits of the ters in passing through their early girls between 15 and 25 who had died adult years. from tuberculosis during a period of

one year. In Detroit, 180 girls had died ; RADIO FORUM in New York City, 678. Their life his- Beginning Wednesday, October 21, tories, their families and the con- and ending Wednesday May 19, 1937, tributing factors of their environment there will be a series of radio programs were studied to ascertain whether this put on every Wednesday afternoon be- high death rate had been due to any tween 4:00 and 4:30. The talks will one of these causes. Only a few were be over NBC - WJZ Blue Network. The found to have been living in crowded subject of the talks which will be ac- quarters. The majority had lived in companied by suitable music, will be their own homes, either with their the "Growth and Development of the parents or with their husbands, on Child." This interesting series is put close to or above the average family on under the joint auspices of the

income ; in Detroit, $1,500 a year ; in National Congress of Parents and New York City, $2,000 a year. When Teachers, the American Academy of working they had received a normal Pediatrics and the National Broad- wage and did not work long hours. In- casting Company. We would advise all dustrialization, therefore, had not been of our readers to listen in on every responsible. It was found, moreover, one of these programs. 16 The Health Bulletin November, 1936

DEATHS FROM TUBERCULOSIS OF THE RESPIRATORY SYSTEM—BY COUNTY AND RACE: 1935

TOTAL DEATHS (TUBERCULOSIS, ALL FORMS), 1,938

By Place By Place By Place of Usual By Place of Death of Usual Residence of Death Residence County County

o o o H H o

Total, State 1,761 783 978 1,612 697 915 Johnston 20 21 13 Alamance ... 12 8 4 13 9 4 Jones 7 7 7 Alexander . 3 3 3 3 Lee 4 Alleghany 4 4 ... 3 2 3 2 1 Lenoir 27 10 26 18 Anson 16 4 17 4 13 Lincoln Ashe 3 3 3 7 6 8 7 1 McDowell* 6 3 Avery 6 2 7 7 6 6 Macfn 10 8 10 2 Beaufort 9 3 6 11 3 8 Madii '>n 13 13 13 Bertie 23 2 21 23 2 21 Martin 14 2 12 15 12 Bladen 9 2 7 11 2 9 Meckit.iburg . 70 27 43 74 47 Brunswick .. 6 4 2 6 4 2 Mitchell 3 3 3 Buncombe .. 288 187 101 112 82 30 Montgomery . 6 4 Burke 8 2 22 20 2 22 20 2 Moore 18 11 15 7 Cabarrus .... 14 13 1 17 13 4 Nash 21 5 21 16 Caldwell 8 7 1 8 7 1 New Hanover 28 8 31 23 Camden 3 3 3 3 Northampton 11 4 14 9 Carteret 8 1 7 Onslow 4 2 4 2 Caswell 7 5 7 Orange 4 4 4 Catawba 10 6 12 Pamlico 1 1 1 1 Chatham 7 5 9 Pasquotank .... 16 3 15 3 12 Cherokee .... 6 1 6 Pender 5 2 5 2 3 Chowan 1 2 Perquimans .... 4 2 4 2 2 Clay Person 11 3 12 4 8 Cleveland .... 16 5 18 5 13 Pitt 38 8 44 11 33 Columbus .... 10 1 10 1 9 Polk 1 1 1 1 Craven 23 7 26 9 17 Randolph 13 13 15 14 1 Cumberland 13 5 16 7 8 Richmond 15 6 16 7 9 Currituck .... 3 1 3 1 2 Robeson* 22 2 17 2 15 Dare 2 2 2 2 Rockingham .... 18 10 19 11 8 Davidson 15 9 6 15 9 6 Rowan 22 14 22 14 8 Davie 5 2 3 6 3 3 Rutherford 14 9 14 9 5 Duplin 16 5 11 16 5 11 Sampson 12 6 Durham 13 6 7 74 28 46 67 23 44 Scotland 17 4 19 4 15 Edgecombe ... 44 16 28 43 15 28 Stanly 14 11 15 12 3 Forsyth 62 15 47 68 17 51 Stokes 8 7 8 7 1 Franklin 13 2 11 13 2 11 Surry 17 12 18 13 5 Gaston 17 6 11 17 6 11 Swain* 8 7 7 7 Gates 12 4 8 12 4 8 Transylvania Graham 3 3 3 3 Tyrrell 4 1 4 1 3 Granville 13 15 13 Union 6 4 6 4 2 Greene 7 8 8 Vance 7 3 8 4 4 Guilford 64 67 33 Wake 54 21 53 24 29 Halifax 32 34 26 Warren 10 1 11 1 10 Harnett 13 15 8 Washington ..... Haywood 7 1 7 1 6 13 14 2 Watauga 4 4 4 4 Henderson ... 6 8 1 Wayne 53 4 47 5 42 Hertford 22 22 21 Wilkes 12 8 11 7 4 Hoke 39 11 8 Wilson 29 4 29 Hyde 4 25 2 2 Yadkin 7 7 7 7 Iredell 23 17 23 18 Yancey 5 5 6 6 Jackson 7 8

Sept. 18, 1936. * McDowell— 1 Indian death, * Robeson—6 Indian deaths. * Swain— 1 Indian death. Thi5 BiJtetirvwillbe seryt 1 free to arwj citizen of the 5taleupoi\ request !

Entered as «eco«d-cJass matter at Postoffice at Raleigh, N. C, under Act of July 16, I89i. Published monthly at the office of the Secretary of the Board, Raleigh, N. C.'

Vol. 51 DECEMBER, 1936 No. 12

TRANSFORMATION

These before and after pictures of a child treated through one of the State Orthopedic Clinics illustrate the type of result the State Board of Health is achieving in the extension of its plan of services to the crippled child in North Carolina. Social Security funds coming through the United States Children's Bureau make possible the expanded program. The pictures illustrate, also, the importance of early diagnosis, treatment, care and oversight of children affected with crippling conditions or conditions which lead to crippling. This child will have continuous oversight and observation through the clinics and by the field workers of the State Board of Health until the age of 21 years. The purpose of frequent observation and follow up is to conserve and protect the corrective results of treatment and to prevent any tendency toward relapse or recurrence. 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. Lee 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, Ph.G _ Charlotte J. LaBruce Ward, M.D _ _ _ _ Asheville

Executive Staff

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 8

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

CONTENTS PAGE Notes and Comment 3 The Public's Responsibility in the Community Health Program 6 "Rats and Our Health" 8 The Teacher and a Health Certificate - 10 Notes on Maternal Mortality 12 Why Mothers and Babies Die Needlessly in North Carolina _ 13 The Initial of a Friend 16 Vol. 51 DECEMBER, 1936 No. 12

Notes and Comment

By The Editor

SEVEN years ago, we devoted our thrift methods of living, with the ex- December issue almost entirely to pectation that in old age, the govern- a discussion of the problems of old ment will provide for all necessities. age. In that issue, we made as strong The opponents of this system say it is editorial plea as we could for the es- better to trust to the old true and tablishment of a system of old age pen- tried methods of encouraging thrift sions or benefits. Since that issue a and savings and to depend on efforts great deal of water has gone under in young and middle life to provide for the wheel in these United States. When the needs of old age. On the other we prepared the material for that hand, the friends of the system defend issue, the stock market had just begun it by arguing that frequently as in the to waver and wobble, but the only talk past few years unfortunate invest- of hard times heard was the high cost ments which cannot be forseen are

of living. Stocks and bonds and real wiped away, unemployment, ill health, estate were all going at top prices. and other misfortunes during early and Since that issue was published, the middle life and a little later very fre- country has come nearer disaster than quently wipe out one's savings too late it probably ever has before, with the in life to be recouped. The opponents exception of the period of the War Be- of old age benefits also argue that de- tween the North and the South, erron- pendent old people should look to their eously called the Civil War. families and children particularly, The Federal Government has in ef- when they have children, to care for fect, as everyone knows, at this time them during old age. Again the de- a provision for State cooperation in the fenders of the system point out that payment of old age benefits to people this does not always work out and sixty-five or over, who establish the claim that frequently the children are need for such benefits. For reasons not overburdened with their own families necessary to discuss here, North Caro- and own obligations, and that they are lina has not been and is not now, par- therefore financially unable to care for ticipating in these benefits. The em- their parents in declining years as they ployers in the State, however, are hav- should be cared for. There can be no ing to pay their proportionate part of doubt that a practical system of gov- the tax to support the system of old ernment benefit for old people in want age benefits. Some people argue that would do a great deal to make for a the system of old age benefits is a mis- feeling of security and for tranquility take, that it will conduce to shiftless sorely needed by large numbers of very habits, encourage reckless and spend- old people. The Health Bulletin December, 1936

Just the other day, we observed an out complaint, although it is unfair article which is not at all uncommon, and unjust, but even in such cases, the although generally there is no pub- aged victim suffers in many instances. licity about such cases. The story com- It would, therefore, seem that the most ing our way was about an old woman practical plan would be a system of old having six children all married and age pensions as now provided for in the liviug in different places in North Caro- Federal Law. Rigidly applied to the lina and Virginia, all maintaining needy ones, even though a government homes and families of their own. The assessment of the able-to-work mem- mother is an invalid and it seems that bers of the family, might be better in one of her daughters and her husband the form of an amendment to the pres- has been doing more for the care of ent law, reducing the burden on the the old woman than all the rest of the Government, but assuring each needy, family put together, even going so far aged person proper care and attention, as to contribute financially every is the best method and one we hope month for her upkeep when living with may be applied in our State within a one of the other children in Virginia. very few months. The Virginia part of the family, however, tired of the exacting demands made on them to care for the invalid COME days ago, Science News Service mother and she was unceremoniously sent out a story from Boston that brought down to North Carolina and Western Europe alone has thirty to deposited on the porch of the residence forty million people living below the of the daughter who had at least been standard of nutrition. The item in- doing more for her. This showed up terested the Editor of the Health Bul- the daughter and her husband in a letin because the nurses in the employ very bad way when they insisted that of the State Board of Health this fall the mother be taken back to another have been reporting a greater percent- member of the family or cared for in age of undernourished children in the the county home in that particular first two or three grades of the schools county. Imagine the heartbreak on the this year than they have ever en- part of the mother and the shame on countered before. According to the the part of at least some of the family Science Service article, the European over this state of affairs. Human situation is not confined to children nature being what it is, even in the alone. The Health Committee of the best bred families, there are instances League of Nations is making stren- which probably do not go so far as uous efforts to reach other standards this case, but in which the feeling is beyond the eat-to-live level. These facts often just as high on the part of mem- were discussed at the meeting of the bers of the family against other mem- American Dietetic Association in Bos- bers and the suffering on the part of ton. They further stated at this asso- the victim is just as acute. Care for ciation meeting that in no country of any aged member of the family gen- Western Europe does the whole popu- erally devolves on the one member of lation come up to the desired standard the family who is most sympathetic of nutrition. and most responsive to the needs of Just why there should be an increase the old person. The rest of the family in the number of children suffering have a way of letting the particular from lack of proper food in North member of the family who will do it Carolina in the first two or three assume all the burden. In innumerable grades of the schools at present it is cases, this is done cheerfully and with- impossible to say. In the opinion of December, 1936 The Health Bulletin some of our health workers, particu- years that the live at home program larly among nurses who have been en- and utilization of the products we have gaged in school work in the same ter- from the soil in this State is adequate ritory at frequent intervals for the the year around for balanced health. last eighteen or twenty years, they feel It brings to mind again that in the that it is probably a result of the lack days of slavery and for a long time of food and the impairment of proper following, in the State of North Caro- living habits and proper habits of eat- lina, on the plantations and in the ing during the recent depression years. turpentine woods, the principal food Some of them feel that the effect is of the workers in the woods and fields just now being felt to the fullest extent was cornbread and meat, supplemented and is seen in the children who went in season by various game and fish, through this period during the years which the workers could manage to from one to six. Whatever the cause, get hold of themselves, and of course it is a problem for everyone to think vegetables from the plantation garden. about. It means for one thing that The staff of life, however, was the within a few years, there will be a cornbread, raised in the locality and recrudescence in tuberculosis, that is, ground at a water-turned mill in the an increase in tuberculosis cases, par- neighborhood. The late Dr. Edward J. ticularly in adolescents. It means also Wood claimed that there was no that there will be an increase in suf- authentic cases of pellagra in the State fering and deaths from numerous of North Carolina until after the com- nutritional disorders. Systematic ef- pany stores of the lumber companies forts cannot be inaugurated too early and other "time" mercantile establish- to combat this condition. In this connec- ments began the importation of the tion it is essential that we bear in degermized corn meal from the corn mind that there are many poor people belt in the middle west. Just as soon yet living in North Carolina. A better as that custom became established distribution of work opportunities and throughout the State, the neighborhood food should be somehow brought about. water ground mills went into decay, * * * or most of them. Along with this im- TN the discussion in the foregoing ported corn meal which was supplied paragraphs of nutritional problems, tenants by time store managers and we are reminded of another story go- to the workers in the lumber camps by ing the rounds in the newspapers some the company stores, along with the fat- time ago. We refer to the news dis- back from the west, resulted in the patches which described some of the diet which the United States Public routine followed by two great football Health Service through the famous Dr. teams, one in Louisiana and one in the Goldberger later laid down as the pri- State of Washington. It is stated that mary cause of the deficiency disease these two champion teams are using known as pellagra, in North Carolina. corn sugar, technically known as dex- In our opinion, Dr. Wood was right trose, during the present season as a in his conclusions and the facts all quick restorative for tired muscles and seem to justify his statement. the quickest and most effective way to Today the mothers can utilize fresh overcome fatigue. It is only fair to tomato juice in order to secure the state that the story originated at the proper vitamins for her baby with the headquarters of the Corn Industrial same satisfactory results that she can Research Foundation. get by using oranges from the tropics We call attention to this story here and the corn products of this State, if because we have insisted for many properly utilized as food, along with December, 6 The Health Bulletin 19S6 the fresh vegetable and native meats pellagra in 1915 and 1916, in that and poultry, fresh water fish and sea- county, and all over the State, for food will more than compensate for the that matter, of a cow, garden, and loss of the wild game available to our flock of poultry for every home is still early ancestors in this country. applicable, for people living in the In conclusion, our old Bladen County country and their products for the peo- slogan, when we were fighting against ple in the towns.

The Public's Responsibility In the Community Health Program

By Roy Norton, M.D., Acting Director Division of County Health Work MUCH has been said and written a passive acceptance. The public must about the responsibilities of var- be served but the public itself must ious groups in the promotion of also become ready to serve in its own public health. What should be done by behalf. the private medical practitioners, by Greater progress has been made in hospitals, by nurses and by State and curative medicine in the last fifty years local health departments has been con- than in all the previous centuries. sidered at length. Long and heated dis- From the time that Moses handed down cussions have been held as to whether his sanitary regulations to the ancient curative medical practice should con- Hebrews until a quarter century ago, tinue individualized or become social- less progress was made in preventive ized. Various schemes have been de- medicine than in the period since then. vised to dispense medical care to var- And there has always been a consider- ious groups in many communities. able lag between the acquisition and The central thought which I wish to the application of scientific knowledge. emphasize is that the attainment of Private physicians and public health health by an individual or a community officers have promoted the utilization of is a project in which that individual or medical learning for the benefit of the community must actively participate. public health. Only recently, however, The promotion of health is not a has the part the public must play in spoon-feeding process. Preachers have working out its own physical salvation learned that an effective sermon re- been fully appreciated. Prescriptions quires a receptive and cooperative were written in Latin and the patient audience. Any farmer knows that good was discouraged from asking questions seed may be rendered unproductive by but told to follow directions. Super- poor soil and weather conditions. For stitions, taboos, and a semblance of a community to attain, maintain and magic and mystery tended to persist. grow in health a large percentage of Too much criticism should not be di- the citizens must appreciate and rected against the medical profession, actively participate in the public health however, for only recently have we program. Whether instinctive or con- seemed to realize that even the fire scious and whether singly or as a com- department and the police department munity the process of acquiring health, must do preventive work for greatest re- like "getting religion," is an active, effectiveness, and that prevention progressive, cooperative step and never quires intelligent and sympathetic pub- December, 1936 The Health Bulletin lie cooperation. The promotion of safety Definite protection may be secured or law observance like the teaching of from certain diseases by artificial im- individual, family and community hy- munization. Get advice from your giene involves active cooperation of physician about when and how you the great majority of people in a com- can secure increased resistance to ty- munity. The public must develop a phoid fever, smallpox and diphtheria. health-consciousness. In certain instances protection against What are some of the ways in which measles, whooping cough, scarlet the public must cooperate in the com- fever, rabies and tetanus may be ob- munity health program? Only a few tained. The amateur gardener gets ad- examples can be considered. Consider- vice on when, where, and what to able tax money is spent in inspection plant. Isn't your health, or that of your of cafes, dairies and markets and sani- child, just as worthy of intelligent tary regulations are enforced for the planning? protection of the public health. These Only by public cooperation can com- foodhandling establishments are graded municable and contagious diseases be and their employed personnel are given controlled. Report suspected cases to medical examinations. Do you eat at your physician or local health depart- grade A cafes, restaurants and hotels? ment and remember that a quarantine Do you buy grade A milk, preferably sign is intended as a protection to the pasteurized as an added protection? Do infected individual, to the family and you buy meats from the markets show- to the community. ing the highest grades from the stand- Go to your physician for examina- point of proper equipment and cleanli- tion, advice, and treatment at the ear- ness? To provide you with the best liest indication of trouble. Only in may, and does, require a great outlay this way can we make much headway of money by the grade A producers of in controlling cancer, tuberculosis and our foodstuffs. Do you express ap- many other diseases. Avoid quacks and preciation in patronage or do you show cultists and don't embarrass your drug- miserly shortsightedness and endanger gist by insisting that he prescribe over the health of yourself or your family the counter. The promiscuous use of by patronizing the dealer who through patent medicines is one of the most shortcut, bootleg, insanitary methods dangerous and costly procedures pos- is able to sell for a penny or two less? sible. This is particularly true of laxa- Any except the best and cleanest milk tives and cathartics, which are event- or other foodstuff may be costly in ually always constipating in their ef- sickness, disability or funeral bills even fect. Proper diet, the avoidance of fads, if given away. I have known city- moderate exercise with plenty of fresh dwellers who demanded the best in air and sunshine do more good and motor oil and paid the highest prices prevent all the dangers inherent in too and yet drove out and bought for their much dosing with patent medicines or children milk that had been banned other unnecessary drugs. from delivery into the city. Knowing Parents can cooperate by getting the insanitary conditions in those so- their children's remediable defects, called dairies I wouldn't have allowed such as those of teeth, tonsils, or eyes my children to drink the milk if it had corrected at the earliest possible time. been free. Go out and inspect the dairy Landlords are promoting the com- you patronize. Look for the grade A munity health when they keep their Health Department Card when you go rented houses in good repair with to a cafe or restaurant. Do you refuse proper screening, pure water and safe to eat in the lower grade cafes? disposal of human wastes. 8 The Health Bulletin December, 1936

Every man, woman and child can be- tional misconceptions about disease come better informed on health mat- and better evaluate the siren calls of ters relating to the individual, family, faddists, cultists and commercial ad- school and community. Free literature vertisers. One will then also be better on subjects of current interest may be able to join in that necessary coopera- secured from your physician or from tive public response to public health your local or State Health Department. leadership and bring about the promo- By this knowledge one can avoid tradition of community health.

a Rats and Our Health"

By George B. Lay, Junior Biologist, U. S. Biological Survey, With Headquarters at N. C. State College for Rodent Control in North Carolina, South Carolina, Virginia, Georgia and Florida

two previous articles, about rats Buildings and Premises ;" and is Farm- INand their threat to the health of ers' Bulletin No. 1638, of the U. S. man, I have gone into the discus- Department of Agriculture. This bulle- sion of the diseases carried and the tin may be obtained from the Super- necessity of man's making continual intendent of Documents at Washington war against this, the most destructive or from my office in Raleigh. animal in the world. In this article, The Government strongly urges the I will try to point out means of arti- permanent program of rat-proofing, im- ficial control and add to the informa- proving sanitary regulations, installing tion already given on permanent con- of incinerators, etc., rather than bait- trol. ing, gasing, shooting, etc. But, where In the first article, I stated that rat rats are plentiful and most buildings proofing, sanitation, removal of trash, are not rat proof and cannot be so disposal of garbage and other artificial made in short order, the use of baits means would permanently cut down and other artificial means of control is the shelter and food needed by rats, necessary and urged. within a given community. Where Among the poisons used—and there public opinion is behind strict sanitary are many—the Federal Government ordinances in a town or city, better ob- recommends baits with Red Squill servance of such regulations will auto- (flue- or oven-cured only) as the kill- matically be obtained, with a lowering ing agent. Red Squill is not expensive, in the rat population, and also better will keep in a tight can for a long health for the community. The build- time and does not kill animals other ing-out of rats from buildings costs than rodents, ordinarily. Red Squill money but such an investment is a comes from a bulb and is an emetic. long-term one and pays in dollars and Rats and other rodents cannot vomit cents in materials saved from destruc- and, hence when such animals eat bait tion and pollution. The Federal Govern- with sufficient Red Squill mixed with ment publishes a bulletin which gives foods, they die. Other animals (mam- facts, methods, data, diagrams on rat- mals) will vomit the bait up and re-

proofing. It is entitled : "Rat Proofing cover quickly. Fowls are not affected

* of Editor's Note : This is the third and final article by Mr. Lay on the subject "Rats and Our Health" prepared especially for The Health B; letin. We would suggest that our readers preserve this copy of the Bulletin for the excellent instructions on rodent control. ::

December. 1936 The Health Bulletin 9

strong concentrations by of Red Squill material ; and baits cost money. Never in feeds. In other words, Red Squill is place baits above the ground floor of safe. Further, Squill slowly Red acts an occupied building ; and do not use (in 4 hours to 5 days) and for that Red Squill baits in your home for reason has two very important assets mouse control, for cheap snap traps are rats usually leave the premises to die, surer and will handle the problem, if thereby removing the chances of odors kept baited and set. in or about a home ; and the animals Baiting is preferred by the Federal do not get sick before other comers to Government to other artificial means the bait at a later hour of night have of control such as gasing with poison- eaten their fill. ous gases, shooting, etc. However, in When a rat begins to feel the effects certain types of buildings, when not of Red Squill, he goes "home", and occupied by man, gasing with one of wharf rats live under floorings, under several different gases will completely trash, in runways in the ground ; but rid your premises of rats, for the time practically never in houses. In being. Many persons, especially men Raleigh's rat campaign in May, 1935, and boys, get fun out of shooting the there was one report of odors ; and in animals. Both gases and the use of that case the rats had died under a guns is a dangerous practice. Baiting coal pile in a basement—in other with Red Squill, if correctly carried words, they had gone "home." There out, is safer and just as effective. are several disinfectants on the market Trapping is very often useful, to kill such odors, quickly. especially as a follow-up of baiting. In using baits, care should be ob- Some rats seem endowed with almost served in mixing foods with Red Squill. human intelligence — especially the Several foods may be used as bases older animals. After baiting, a follow- oatmeal, hamburger meat, canned up with a few traps will often result mackerel, etc. In all instances, mix 1 in the capture of these super-intelli- part of Red Squill to 16 of the food. gent rats. Of course, trapping, when Often, it is best to put out some of two the traps are put in the proper places, or more kinds of bait—thus giving the is fairly safe. rats a choice and increasing your Baits, poisons, gases, guns, traps, etc., chances of killing most of your rats. are not sold by the Federal Govern- Farmers' Bulletin No. 1533, entitled ment. Such materials are to be ob- "Rat Control," is a general bulletin on tained from commercial companies and the subject of killing rats, etc. ; while firms in your home town. As there are Leaflet No. 65, entitled "Red Squill over one thousand different kinds of Powder in Rat Control," is the story baits on the market—many of them of squill in rat control. Both of these good and many of them of little or no publications may be obtained from the value—the Government urges that the Superintendent of Documents or from public do not buy a Red Squill so- my office. called bait or powder unless it is flue- Care should be observed in putting or oven-cured. Sun-dried squill, often, out baits. They should be placed in run- is of little or no value. There are other ways, in basements, in holes, where baits and poisons, using arsenic, strych- rats are known to run about and feed. nine, barium carbonate and so forth, as

Baits should not be placed where dogs, killing agents ; but these are dangerous cats, chickens or human beings can get and there is a greater risk in making to them easily. If such baits are eaten use of them. The Government bulletins by animals or fowls, other than rats listed give pertinent facts l-elative to and mice, you have wasted that much this situation. 10 The Health Bulletin December, 19S6

If your premises are not over-run and advisory work of all rodent con- with large numbers of rats, traps may trol problems in five Southern states, give you nearly perfect control. In such there may be some delay. For mater- an instance, you do not have a con- ials, see your druggist, hardware mer- tinual outlay of money ; bait would chant or other regular commercial cost you money and would have to be dealer. Wholesale druggists stock good put out periodically, not more often squill baits and powders, in case your than once a month. In the long run, local druggist does not have the needed rat-proofing will pay you as an invest- materials on hand. ment, for, once made, such repairs and Progress in rat control is being ob- improvements on your buildings, will tained. Here, in Raleigh, since March serve to keep out rats for years and 1, 1935, at least 40 structures (both in will eliminate the bait bill. the business section and in the resi- Tour county agent, vocational agri- dential areas) have been rat proofed. cultural teacher, city or county health That is permanent progress. I would officer, secretary of your Merchants As- like to see every town and city in my sociation or Chamber of Commerce, district adopt regulations fostering rat will be able to help you and give you proof structures ; and I would like to advice. If you cannot get the informa- see every rural family living in homes tion you wish in your local community, and on premises that were as nearly as write the author. Tour communication possible rat proof. I do not expect the will be handled as soon as possible. millenium but I do hope and look for However, as I am in the field much of slow but continued progress in this the time, and as I have the supervisory battle by man against the rat.

The Teacher and A Health Certificate OUR neighbor, The Sanatorium time ago an article pointing out that Sun, in its November issue has more than eighteen thousand tubercu- an excellent article under the lous teachers were in active service in title of "Tuberculosis, the Teacher and the schools of America at the time the the Pupil." article was prepared. Some of these A careful perusal of the Sun article, undoubtedly will have serious break- presumably written by the editor, Mr. downs eventually. Others may have suf- J. M. Gibson, reminds us that we have ficient physical resistance to keep on had in mind a discussion of this sub- working without developing the dis- ject for some time. The particular ease in a fatal form. Still others may phase we have meant to emphasize is never know they have, or have had, the present law on the subject in North tuberculosis. All, however, are a dis- Carolina. Mr. Gibson brings out one tinct menace to the millions of school point that has been literally a phobia children with whom they are in close with the Editor of the Health Bulle- physical association and, through their tin for a quarter of a century, and pupils, a menace to the pupils' parents that is the necessity for teaching and the general public. health to the teachers in the teacher "The Extension Department of the training schools before they go out to North Carolina Sanatorium has taken become teachers. Says the Sun: effective steps to correct this situation "The Bulletin of the National Tuber- insofar as it affects this State. It has culosis Association published some conducted clinics at the University of —

December, 1936 The Health Bulletin 11

North Carolina, at Dr. Mclver's Wom- of the Legislator who put it through an's College in Greensboro, in several without any amendment. of the Negro colleges here and there, The law very properly leaves the and in the other institutions where decision squarely up to the examining teaehers-in-the-making are getting the physician. This feature should be con- knowledge which it will be their task tinued ; but for his own protection as in the years to come to pass on to well as that of the pupils and the their pupils. The clinics that have been teacher it would be best for the physi- conducted in elementary and bigh cian to require, as the N. T. A. expert schools in all parts of North Carolina suggests, a supplemental X-ray exami- during the past several years have by nation, at least in every case in which no means confined themselves to the he could possibly be iu doubt. And that students. Members of the faculties is what we have been wanting to sug- have been encouraged to avail them- gest for two or three years. So far as selves of the knowledge of their physi- is known, the teachers and school cal condition which these clinics have authorities all over the State have made available, and many have done been complying with this law fully. so. A number of teachers have dis- The State Board of Health and the covered their true condition in this way State Department of Public Instruction and have thus been able to begin at both supply several thousand blanks the earliest possible moment their own every year for the physician to use in fight for recovery. Equally important, a brief statement following his exami- they have been removed from the nation. This certificate is then filed schoolrooms and eliminated as spread- with the employing school official. The ers of the deadly tubercle bacilli." physicians have always been urged to The Sun then goes on to say that take this required examination ser- there are possibly 500 teachers now en- iously and to make a careful and rigid gaged in teaching in North Carolina examination. Perhaps it would be best who have tuberculosis in an active to require that the examination be form. The Sun editor then quotes the made, and the certificate issued, by one National Tuberculosis Association ex- of the clinicians connected with the pert as saying that "The logical solu- Extension Service of the State Sana- tion will come when all states have torium. That is a matter, however, for laws requiring teachers to present evi- Drs. McCain, Reynolds, Erwin, and the dence that they are free of tuberculosis, officials of the State Medical Society to such evidence to be based upon physi- settle. cal examination supplemented in all cases by X-ray of the chest." TO PREVENT INFANTILE That statement leads to our intended PARALYSIS but delayed comment. North Carolina Experiments on animals have ap- has a law requiring a health certificate parently proven that infection by the from every teacher, declaring freedom virus or germ of infantile paralysis from tuberculosis or any other com- may be prevented by use of a nasal municable disease, to be signed by a spray three or four times a day on reputable physician, and to be filed alternate days during an epidemic. with the employing school official be- A good spray solution for the pur- fore being allowed to teach. The cer- pose is said by the National Institute tificate must be renewed annually. This of Health at Washington, D. C, to be law was enacted by the Legislature of one half per cent each of picric acid 1919. It was written by the Editor of and sodium alum in physiologic salt the Health Bulletin at the request solution (.85 per cent). Good Health. —

12 The Health Bulletin December, 1936

Notes On Maternal Mortality

the United States, as throughout birth-registration area expanded from INthe civilized world today, maternal 10 states and the District of Columbia mortality is a matter of serious in 1915 to include the entire continen- concern. Twelve thousand, eight hun- tal United States in 1934. The rates for dred and fifty-nine women died during the group of states included in the 1934 in the United States of diseases birth-registration area every year from of pregnancy and childbirth. More 1921 to 1934 show a reduction of 12 women in the reproductive period of points during that period. In other life (ages 15 to 44) died from diseases words, for every 10,000 mothers whose of pregnancy and childbirth than from infants were born alive, 67 mothers any other cause except tuberculosis. died in 1921 in these states, as com- Sixteen per cent of the women who pared with 55 in 1934—a saving of 12 died at the peak of the childbearing mothers. The rates from puerperal period (ages 20 to 29) were reported sepsis dropped from 27 to 22—a reduc- to have died from puerperal causes. tion of only 5 points. The most frequent cause of these The United States today has a high maternal deaths is puerperal septi- maternal mortality rate as compared cemia, which was responsible for 40 with the foreign countries that have per cent of the maternal deaths in comparable registration procedure. 1934. Next in importance were the tox- Among the countries with rates much emias of pregnancy, which accounted lower than the United States in which for 23 per cent of the maternal deaths. the variations in procedure do not ac- These two types of causes re- were count for the wide variations in rate, sponsible for 63 per cent of our mater- are Norway, Italy, and the Nether- nal deaths in 1934. lands, with rates of 28, 29, and 32, There is wide variation in the ma- respectively, in 1933. ternal mortality rates of the several A comparison of maternal mortality states. In 1934, ten states had rates of rates for white and for Negro women 65 deaths or more per 10,000 live shows how much less chance the Negro births ; 21 had rates from 55 to 64 ; and has than the white for 18 had rates less than 55. The lowest woman woman rates were for the District of Colum- survival of pregnancy and childbirth. The mortality rate for Negro bia (38), Vermont, (39), California women for and Wisconsin (43). 1934 was 93, as compared with 54 for white women. Child, U. S. In this country there has been little The reduction in either the total maternal Children's Bureau. mortality rate or the rate from puerperal sepsis during the period for In 1934 North Carolina lost 605 which statistics are available. In 1915, mothers from causes incident to child when the birth-registration area was birth. This gave the State a high ma- established, the maternal mortality ternal death rate of 7.6 deaths per rate was 61 deaths per 10,000 live 1,000 live births. By reducing this rate births. In 1934 it stood at 59 per 10,000. to 7.0 in 1935 the State was able to For both years the rate from sepsis save 51 mothers. Had the rate been as was 24 per 10.000 live births. low as the national average of 5.9, it The rates for 1915 and 1934 are, of would have saved the lives of 83 more course, not entirely comparable, as the mothers. December, 1936 The Health Bulletin 13

Why Mothers and Babies Die Needlessly In North Carolina

By Mrs. J. Henry Highsmith. Assistant Director, Health Education, State Board of Health THE message I am bringing to you babies in recent years has entailed this month is by request. It is the much study and many investigations. story of why so many mothers and Among those making studies of the babies die needlessly in North Caro- situation were a group of Duke Univer- lina, and what is being done by the sity students under the direction of State Board of Health and the Chil- Dr. W. C. Davison, members of the dren's Bureau in Washington to remedy State Medical Society, and the Division this situation. of Preventive Medicine of the State A few years ago North Carolina Board of Health. Interesting were the prided itself on being called the "Baby causes found by each investigation, and State," not because it was the young- strikingly similar. These were found est, or the smallest, or gave promise of for the most part to be the State's high rapid growth and development, but be- birth rate, ignorance and indifference, cause it produced the most babies per poverty, isolation, and the use of mid- 100,000 of its population of any State wives. in the Union. But North Carolina no Naturally, it is to be expected that longer takes pride in this appellation more deaths would follow a high birth for the reason that it has lost this dis- rate than a lower one, especially if tinction to New Mexico, and the fur- these babies were born to parents of ther significant fact that it has not small means, low incomes, amid been able to raise the babies that were crowded and poor living conditions and born to its mothers. Now, the trend is under circumstances which denied them upward again and we may be able to even the minimum care that babies recapture our boastful "first." How- must have to survive. ever, it is no distinction to have babies But ignorance and indifference were and not be able to raise them. It is a found to be large contributing factors, disgrace. North Carolina loses a shame- especially that hopeless ignorance that fully large number of babies every refuses to know better and still holds year. In 1934 we lost 6,169 under one to old notions and customs of a genera-

year of age, which was more than any tion ago ; that kind of ignorance that other state per population except fosters superstitions, old-fogy notions, South Carolina, Georgia, New Mexico, insanitary practices, and all the back- and Arizona. While times are better ward customs of thinking and living. and our death rate is beginning to de- It is a regrettable fact that supersti- cline we are still losing between three tions and old wives' tales are respons- and five hundred babies each month or ible for the neglect, and perhaps the about 5,000 a year, and between 40 and death, of many babies in this State to- 50 mothers a month, or about 500 a day. Even some husbands and fathers year. Physicians say that between 75 are hiding behind these old-fogy no- and 85 per cent of these deaths are tions, making them their excuse for needless. In other words, they could not providing adequate care for their have been prevented, since many of wives, when in that delicate period them were due mainly to neglect. preceding the birth of their babies. To determine the causes of the They will tell you that birth is a natu- State's high death rate of mothers and ral process and needs no interference, 14 The Health Bulletin December, 1936 not even from a doctor or a nurse, and sanitary midwives deliver one-third of that the services of a midwife, regard- the babies of the State, as a relic of less of how unskilled, insanitary, and the dark ages. As our civilization is ignorant she may be, are all that are constructed at present, perhaps there needed for the coming of the baby. Is is a place and service for the midwife, it any wonder that mothers and babies but the ideal of our public health die under such conditions as are found workers and all interested in the well- in nearly every section of this State? being of the race look forward to the Poverty, too, was found to be a con- time when every mother will have ade- tributing factor to the State's high quate care during the period of preg- death rate of babies and mothers. That nancy and at the birth of her baby. false economy that is brought on by Thus we see our problem, and it is poverty and was increased by the re- my privilege and pleasure to tell you cent depression, made having the serv- something of the program that has been ices of a physician to attend the preg- set up for the remedy of this situation nant mother and care for her baby at in our State. Last August there was birth considered unnecessary, and in passed by Congress what has been too many cases it was dispensed with called one of the greatest human docu- altogether. Thus the habit of doing ments ever enacted by a law-making without a physician's services was body—"The Social Security Act," a more fully established. False economy phase of which was to make more of failing to have a physician has been secure the lives and health of mothers responsible for not only a mother do- and babies throughout our great coun- ing without proper food and proper try. care before the arrival of her baby, but To the Children's Bureau was given also for paying for this neglect in pro- the responsibility of administering the longed illness and perhaps, invalidism, section of the Social Security Act, pro- if not with her life. viding Federal aid for maternal child Isolation, too, was found to be a health services, and to the North Caro- cause, especially isolation that made lina State Board of Health, under the accessibility to a doctor difficult and direction of Dr. G. M. Cooper, has been long delayed. Families back on the given the responsibility of putting into farm, down on the coast, and up in the operation this special health project in hills—those far removed from centers the State. By matching funds with the of educational, religious, and social Federal Government the State Board life—were found to have suffered of Health has been able to secure cer- greatly for the lack of general inform- tain health services for mothers and ation and free health service that is to children, particularly for those in rural be had today. To reach these mothers or neglected areas, or in places of never before served by the free economic distress. The program set up agencies of the State is our privilege by Dr. Cooper and his co-workers in- and task. cludes the organization of health cen- Another determining factor of great ters in conveniently located places, and importance is the general use of mid- these to be served by local physicians, wives. It is estimated that one-eighth pediatricians, obstetricians, dentists, of the white mothers, and two-thirds and one or more public health nurses. of the colored have only the services of So far, these have been placed mostly midwives at the birth of their babies. in sections of the State where the ma- Some day, it may be the millenium, I ternal and baby death rates are among predict that we will look back on this the highest. To these centers are in- period when ignorant, unskilled invited needy and indigent mothers of December, 1936 The Health Bulletin 15

the community who have been sought these counties are without any organ- out by the public health nurses and ized health department or public health urged to attend. At the centers, which nursing service, while the others have are held regularly each month, they are this maternity and infancy work as a given a physical examination and are supplement to their regular health pro- advised as to what constitutes proper gram. Already hundreds of mothers have care for themselves and their babies, been served at these clinics or centers both before and after birth. Valuable and the darkest spot in the State's public literature is put into their hands, with health work is beginning to clear up. the instruction as to its best use and But the baby problem in North Caro- helpful meaning. lina will not be met and settled by this The centers or clinics are under the one program alone. It is too large and supervision of local doctors, which too involved to be met and handled so means that mothers attending these easily. However, every little bit is a centers are brought face to face with decided help. Underlying it are all the their county or community physicians social, economic, moral and health probably for the first times in their problems that affect a people. Dr. lives. Here they are enabled, also prob- Cooper, who is familiar with the con- ably for the first time, to know and ditions that are largely responsible for appreciate the services of a doctor. the State's high death rate of mothers Furthermore, barriers of embarrass- and babies, has repeatedly stated these ment due to false modesty and inex- to be : Lack of pre-natal and competent perience are broken down and the way obstetrical service at child-birth ; lack is made easier for them to confer with of knowledge on the part of mothers a physician and have him administer concerning themselves before their to their personal needs. While a general baby's birth, and concerning the care physical examination is given, there and needs of the baby after birth ; lack are no provisions for treatment. Pa- of home comforts, and home and com- tients needing treatment are advised munity sanitation, and lack of fore- to go to their local or family doctor, sight or provision on the part of the and emergencies are handled through husband or father for the arrival of the county public welfare officer, or another member of the family. some other local agency. All of which is to say that poverty, Another phase of the center work is ignorance, and indifference are playing the instruction given to mothers re- too big a part in the background of garding the feeding and care of their the State's future citizens. And all of babies. They are advised to bring their which shows that the science of euge- babies regularly each month to the cen- nics must be made general and practi- ter and the child's growth and develop- cal, and the problem of improving the ment is carefully watched. While at the race be made the concern of the State. center, the babies are often given the Primarily it is an educational prob- immunizing treatment against diph- lem in which all agencies must help. theria and smallpox. Dental needs of Local groups like the mother and baby are also taken the woman's club, the note of, as well as other phases of parent-teacher association, home their general health. Thus the health demostration clubs, the schools, and the center in any community becomes both* church can cooperate with the health a health and educational institution. forces to educate the mothers of the To date, nearly 100 health centers community to realize the risks they run have been established in North Caro- when they fail to have the care of a lina in about 30 counties. Sixteen of physician. !

16 The Health Bulletin December, 1936

The Initial Of A Friend

What "Grade A" Means to You When You Eat Out

you ever think what that fami- ator to the screening of doors and win- DIDliar little "GRADE A" placard dows, from clean clothing and table means to you at your favorite linen to covered garbage cans. A hotel or cafe ? It means a lot "Grade A" placard in your hotel or It means a large measure of protection cafe means free life insurance and to your life and health and a large health insurance for you and yours. measure of assurance of cleanliness As might be expected, more and more and sanitation of everything connected people are patronizing hotels and cafes with food and food handling in the that are able to display "Grade A" hotel or cafe that displays such a placards, and that is as it should be. placard. Of course, there may still be a few A placard showing "Grade A" posted Grade B boarders, and for them there on the wall of are a few a North Caro- "Grade B" lina hotel or hotels and cafe indicates cafes — those that the sani- STATE grading from tary rating 80% to 90% of that hotel BOARD OF HEALTH on sanitation. or cafe was Finally, there found by a are a few sanitarian to "Grade C" be over 90% hotels and according GRADE IIHOTEL cafes or those to a rigid A that merit a standard of rating of only s a n i t a tion. December 5, 1936 70% to 80% And what on sanitation. Sanitary Rating 95 does that (Lsayz,™-&Zl Fortunately, rigid stand- public di s- Secretary State Board of Health ard of sani- By THE INSPECTOR ori nmnation, tation i n - plus this clude? It in- method of cludes, of s c orin g is course, the cleanliness and sanitation producing keen competition among the of the kitchen and dining room—that hotels, cafes, and their operators. The much is understood. But in addition to Grade A places are anxious to main- that, it also includes such details as tain their place, and the Grade B and the cleanliness of the wash room, its C places are anxious to improve their soap, towels, ventilation and lighting, rating. And you gentle readers can do as well as the state of repair of the more than almost anyone else to secure toilet fixtures. sood, clean eating places by looking But "Grade A" means much more for the "Initial of a Friend"—the than this. It means that a safe water "Grade A" placard—when you dine out. supply is used ; it means the sewerage It is your life insurance, your surety of facilities are safe and adequate ; it purity. Demand it of the cafe that means that a Grade A milk supply is receives your patronage, or go where used. Those three items are of vital a "Grade A" placard is displayed. importance. But "Grade A" does not stop there. It means that the servants and Beware of restaurants and public those handling food have been exam- eating places that have no reputation ined by a doctor and certified to be free to lose — restaurants with tinseled from syphilis, tuberculosis, and not a fronts, cheap music or mediocre enter- typhoid carrier. tainers. You may get quick service In fact. "Grade A" means that every- here and fill your stomach at little thing is checked periodically by a cost, but be assured it will be expen- competent sanitarian from the refriger- sive in the long run.