The Health Bulletin [Serial]

HEALTH SCIENCES LIBRARY OF THE UNIVERSITY OF NORTH CAROLINA This book must not be token from the Library building.

Form No. 471

NOTICE TO READER.— When you finish reading this magazine place a one-cent stamp on this notice, hand same to »ny postal employee and it will be placed in the hands of our soldiers or sailors atihe front. NO WRAPPING— NO ADDRESS.

Thl5 BulkliAwillbe 5er\t free to qimj citizen of the State uporxreguest j

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

Vol..XXXIII APRIL, 1918 No. 1

HOGS OR FOLKS, WHICH? seepages ONLY THE PEOPLE CAN LOOSE THE BONDS TABLE OF CONTENTS

Hogs or Folks, Which ? 3 Physician Found Guilty 13 Sentekced to Prison oe Steriliza- More Intelligent Excitement tion 3 Needed 13 Soldiers and Tobacco 4 Paste This on Your Mirror 14 Popular Mistakes 4 What Vaccination Will Do 14 State Death Rate 5 Low Know How to Live 15 Three Things to Do 5 Spring Fever and Bran ... 16 Tanlac—The Master Medicine .... 5 Wheat Large Scars and Sore Arms Unneces- First Aid Instructions 17 sary 6 How to Stop Worrying 18 Cancer Not Inherited 7 Gasoline as an Emergency Medicine 19 School Epidemics 8 Don't Stand so Much 19

Where Ignorance is Crimin.a.l 9 Safe Guide to Healthful Eating. . 19 Play is the Thing 10 Saving Mothers 20 How an Epidemic Developed 11 Why Register a Baby? 21 Sex Hygiene 12 Avoid Early Handicaps 21 Typhoid Bacillus Carries foe Over Why Nurse Your Baby ? 21 Forty Years 12 Have Early Diagnosis 22 Open-Air Schools 12 Symptoms of Tuberculosis 24 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

J. Howell Way, M.D., Pres.,. .Waynesville Chas. O'H. Laughinghouse, M.D., Richard H. Lewis, M.D., LL.D.,. .Raleigh Greenville J. L. Ludlow, C.E Winston-Salem Edward J. Wood, M.D., Wilmington Thomas E. Anderson, M.D Statesville Cyrus Thompson, M.D Jacksonville E. C. Register, M.D Charlotte F. R. Harris, M.D Henderson Official Staff W. S. Rankin, M.D., Secretary of the State Board of Health and State Health Officer. C. A. Shore, M.D., Director of the State Laboratory of Hygiene. Warren H. Booker, C.E., Chief of the Bureau of Engineering and Education. L. B. McBrayer, M.D., Superintendent of the State Sanatorium. J. R. Gordon, M.D., Deputy State Registrar. G. M. Cooper, M.D., Chief of the Bureau of Medical Inspection of Schools. A. McR. Crouch, M.D., Epidemiologist. B. E. Washburn, M.D., Director of County Health Work. FREE PUBLIC HEALTH LITERATURE The State Board of Health has a limited quantity of health literature on the subjects listed below, which will be sent out, free of charge, to any citizen of the State as long as the supply lasts. If you care for any of this literature, or want some sent to a friend, just write to the State Board of Health, at Raleigh. A postcard will bring it by return mail.

No. 12. 107. Life Saving Facts About Diph- theria. 116. Scarlet Fever. 117. Tuberculosis. 118. Measles. 119. Whoo])ing Cough. 120. Hookworm Disease. 121. Sanitary Management of Hotels. 122. Poliomyelitis or Infantile Paraly- sis. 123. Tjphoid Fever. 126. Indigestion. Teeth, Tonsils, and Adenoids.* How to live long.* A War on Consumption.* Milk.* Periodic Medical Examina- tion. Typhoid Fever and How to Prevent It.* Concrete Septic Tankst Anti-Spitting Placards (5 inches by 7 inches). Anti-Fly Placards (14 inches by 22 inches). Anti-Typhoid Placards (14 inches by 22 inches). Anti-Tuberculosis Placards (14 inches by 22 inches). Clean Up Placards (14 inches by 23 inches.)

*Furnished by courtesy of the Metropolitan Life Insurance Company. JFurnished by courtesy of Portland Cement Association. 'M(Bm Q)»

Ell PUBU5AELD BY TME- nPRTA CAgOUhA 5TATL. BcyMgp q/^mEALTM \\{°]

Vol. XXXIII APRIL, 1918 No. 1

EDITORIAL HOGS OR FOLKS, WHICH? SENTENCED TO PRISON OR STERILIZATION On the front cover page is our car- toonist's conception of a little North One of the most respected and ex- Carolina incident which occurred a perienced judges in the criminal court few months ago Avhen the State De- at Chicago set a precedent, which is said to be the first of its kind, in giv- partment of Agriculture, acting under ing a prisoner the choice between go- the law which protects hogs, horses, ing to prison for a crime of which he cattle and chickens, revoked the license was convicted by a jury or of sub- of one or more companies to sell al- mitting to sterilization. In offering leged hog-cholera preventative com- this alternative from the bench. Judge pounds which authorities found did Marcus A. Kavanaugh said to the pris- not adequately protect. oner, sixty-five years of age and a We think this an excellent law. married man with children: Valuable live stock should be ade- "If I send you to the penitentiary it quately protected particularly at this means death to you in your present time when food products are such a health. At the same time I dare not factor in the winning of this war. turn you loose upon the public, for Feeding worthless medicines to hogs or fear this mania with which you seem live stock at a time when they are to be affected may cause you to at- with disease is akin to put- threatened tempt a similar crime, and then I in the hay and oats ting ground glass would be at fault. If you will submit horses and mules at our furnished the to an operation, with the choice of military camps. Robbing a farmer or the best surgeons by next Saturday, I stock raiser of money for such nos- will set aside your sentence. I cannot trums—well, consider the folks. There compel you to submit, and you will are scores of worthless nostrums cal- have a week to think the matter over. culated to filch hard earned money If you decide to do this, it will mean from the pockets of the sick and needy that you do not have to begin your for every stock food nostrum vended sentence of from one to twenty years and there are no laws giving the in the penitentiary." folks protection at all comparable to prisoner subsequently decided the hogs. The hogs should have such The a law. They need such protection from to be sterilized. the unscrupulous. All we are asking In commenting on the case the for at present is to promote the folks judge said he presumed he would be to the dignity and an equal standing criticised for his proposition to the with hogs in this particular. Hogs or prisoner, but he wished neither to Folks! Which? commit him to what really would be —

The Health Bulletin

a death sentence nor to expose the for it. Like the vodka, if they gave it public to a repetition of his heinous up long enough, they would cease to offenses against little girls. desire it. The excuses offered for the "One of my reasons for rendering use of tobacco are weak, same as all the decision," he added, "was to draw others that are made for the indulging public attention to a situation which of the various depravities of the age. has been disregarded too long. I be- Leigh Hunt Wallace, England. lieve all morons, the criminal insane and habitual criminals, both men and women, should be so treated. To my POPULAR MISTAKES mind it is a crime against society One of the most frequent mistakes that this class should permitted to be among the uneducated, with regard to propagate their kind. As for those medicine, is the belief that what has who commit outrages against women done good in one case of disease is and female children, I advocate even to be equally beneficial when similar more drastic measures, which would symptoms happen in another. When make repetition of the acts impossi- an eminent physician has been called ble. It is my hope that public interest in, and has prescribed a medicine may be aroused."—Survey. v/hich has answered the purpose in- te::ded, and to all appearance has cured the patient, nothing is more SOLDIERS AND TOBACCO common than for the precious recipe to be kept and lent to a long series The Institute of Hygiene reports of afflicted friends. Such benevolent that James the First declared that quack'ery proceeds on the supposition "No man can he thought able for ser- that a disease called by the same name vice in the wars who cannot endure has the same symptons in every case, the want of tobacco," for in those and that a drug produces its effects as days smoking was considered "alien infallibly as an operation in mechanics, to all military fitness." How does the or a process of chemistry. It reduces spending of millions in the consump- medicine to the simplicity so much tion of tobacco tally with recent calls boasted by the mathematical physi- to thrift by England? "Not only must cians of the seventeenth century, who the nation avoid the consumption of thought they had in many cases solved nonessentials, but must ever restrict the problem—a disease being given, to the consumption of essentials to the find the remedy. But there is a pre- limits of efficiency." liminary problem equally necessary Is tobacco an essential? Does it and difficult, that should . be first feed the body, purify the blood, or in- solved: a patient being given, to as- crease the mental or physical effi- certain his disease.—Dr. Macaulay's ciency? There are such things as to- Dictionary of Medicine. bacco cancer, tobacco blindness, tobacco heart, the mention of which re- minds me that in the medical world If your county is one of the lucky there is, now, much professional dif- thirty-five to have medical school in- ference of opinion as to the cause of spection this fall and winter, see that heart troubles among soldiers, the key your child gets what is due him under to which may be the use of tobacco. the medical inspection law. If his ex- Before our smokers used tobacco amination shows that he needs treat- they never craved it, or felt any need ment, see that he gets it. The Health Bulletin

LOW STATE DEATH RATE TANLAC—THE MASTER MEDICINE The most unsentimental of all busi- The following facts with regard to a nesses, that of life insurance, has just much advertised medicine are supplied awakened to the work that the Board by the Michigan State Board of Health: of Health has been doing in North A new panacea for the cure of "all Carolina for several years, through ailments of the stomach, kidneys, and the discovery that the death rate of liver, catarrhal affections of the mu- the Tar Heel State is the lowest of any cous membranes, rheumatism, nervous of the Atlantic commonwealths. Com- disorders and the like," is offered to piled census figures show: the public under the name of Tanlac. Death rates per 1,000 in 1914: The label on the bottle neatly avoids Maine, 15.6; New Hampshire, 16.3; the pure drugs act by claiming to be Vermont, 15.0; Massachusetts, only a "tonic and system purifier." 14.7; Rhode Island, 14.7; Connec- An analysis of Tanlac in the labora- ticutt, 15.1; New York, 14.7; New tory of the State Dairy and Food De- Jersey, 14.2; Pennsylvania, 13.9; partment shows the following: Maryland, 15.9; Virginia, 14.0; Alcohol 16.4 per cent North Carolina, 13.2. Glycerine 2.0 per cent these figures directly reflect That Licorice Present of the health authorities in the work Aloes or cascara Present in im- calling attention to sanitation, Gentian Present preach- munizing against disease, in Alkaloids (Berberine) Trace ing the care of the body cannot be The presence of a trace of tartaric doubted. When it is considered that acid shows that wine is the base of the population from which the show- this medicine. The 16 per cent alcohol ing is made is one that contains a gives it the "kick" that makes a fellow large element of negroes among feel good and ought to fill a long-felt whom the death rate, especially the want in "dry counties." Aloes is a infant rate, is abnormally high, the laxative. Gentian is a bitter drug, a result is akin to the marvelous.—Ral- so-called tonic. If the reader wants eigh Evening Times. to be cured by the Tanlac route at THREE THINGS TO DO one-fourth the expense, let him get S quart bottle of good cherry wine. Then The three most important health go to the local druggish and get I14 matters for every householder to at- drachms of glycerine and two drachms tend to this spring is first, to thor- each of aloes, oughly screen every door and window gentian, licorice, and cascara. Mix (if you wish) and in the house, upstairs and down stairs. you will have Tanlac so near that neither Also to screen the back porch if there you nor the manufacturer can tell the is one. The second thing to do is to difference. build a good first-class sanitary privy, This formula will give four preferably of the pit type or the septic times the quantity found in an ordi- tank type. The pit privy should be nary $1 bottle of Tanlac. We say, "mix sheathed to a depth of one or two feet, if you wish." For our part we dislike made fly-tight and well ventilated. TTie to spoil a good bottle of wine by mix- tank type should hold at least 200 gal- ing it with bitter drugs like aloes and lons of sewage and be well ventilated. gentian. Our personal advice to all The third important thing to do is to desiring to try this panacea would be have the entire family vaccinated to drink the bottle of wine and give against typhoid. the drugs to the hired girl. —

6 The Health Bulletin

LARGE SCARS AND SORE of pressure necessary for insertion and ARMS UNNECESSARY i n order t o demonstrate a possible early immune reaction in previously vaccinated individuals. Complications Following' Smallpox Vaccination Avoided bj' Careful Preparation Technique The skin of the upper arm, in the region of the depression formed by the HE big scar and the painfully I insertion of the deltoid muscle, should sore arm that follows vaccina- be thoroughly cleansed with soap and ™ tion against smallpox in many water if not seen to be clean, and in cases are now known to be to a large any case with alcohol or ether on extent preventable by observing certain sterile gauze. rules and methods in administering After evaporation of the alcohol or the vaccine. Scientists say now that ether, a drop of the virus should be a "successful take" does not neces- placed upon the cleansed skin. To ex- sarily require either a very big scar or pel the virus from a capillary tube, the a very sore arm. On the other hand tube should be pushed through the they say that these extreme results small rubber bulb which accompanies are often due to two or three things it, wiped with alcohol, and one end the vaccination wound is often made broken off with sterile gauze; the too large, it often becomes infected at other end may be broken inside the the time of vaccination or soon after, rubber bulb. The hole in the latter and it does not receive the proper treat- should be closed with the finger as the ment during the reaction. bulb is compressed to expel the virus. The United States Public Health Ser- The under surface of the arm is vice advises the following procedure in grasped with the vaccinator's left hand order to secure the best results from so as to stretch the skin where the vaccination and to prevent possible virus has been placed. The skin is complications. kept thus stretched throughout the

I, The Vaccine process. Methods The freshest possible vaccine should be obtained. All vaccine packages, (a) The method of incision, or lin- pending use, should be kept in a metal ear abrasion.—By means of a sterilized box in actual contact with ice. needle or other suitable instrument, held in the right hand, a scratch, not deep enough to draw blood, is made II. The Vaccination through the drop of virus, one-quarter Vaccination should never b e per- of an inch long and parallel with the formed by cross-scratching or scarifi- humerus. The virus is then gently cation, but by one of the methods de- rubbed in with the side of the needle or If a prompt "take" is scribed below. other smooth, sterile instrument. Some very necessary, as in case of direct ex- blood-tinged serum may ooze through posure to smallpox, or if the first at- the abrasion as the virus is rubbed in, tempt has been unsuccessful, three or but this should not be suflicient to wash four applications of the virus should the virus out of the wound. be made, but the insertions should be (b) The drill method.— A sterile at least an inch apart. Which ever drill, such as is used for the von Pir- method is used a control area may be quet cutaneous tuberculin test, shaped first treated similarly, but without the like a very small screw driver with a virus, in order to estimate the amount moderately sharp end not more than 2 The Health Bulletin

millimeters wide, is held between the thus become open, daily moist dress- thumb and middle finger, and with a ings with some active antiseptic, such twisting motion and moderately firm as mercuric chloride or dilute iodine pressure, a small circular abrasion, the (one part tincture of iodine in nine diameter of the drill, is made through parts of water) should be applied. the drop of virus; this should draw no Under n o circumstances should any blood. dressing be allowed to remain on a (c) The multiple puncture method.— vaccination wound longer than 2 4 A sterile needle is held nearly parallel hours, and no dressing should be ap- with the skin and the point pressed plied so long as the natural protec- through the drop of virus so as to tion is intact. make about six oblique pricks or shal- On account of possible fouling by low punctures, through the epidermis perspiration and to lessen the chance to the cutis, but not deep enough to of exposure to street dust, primary draw blood. The punctures should be vaccination should be performed pre- confined to an area not more than one- ferably in cool weather. eighth of an inch in diameter. In order to encourage proper surgi- With methods (a) and (b) it is ad- cal treatment, no charge should be visable to expose the arm after vacci- made for the aftercare of a vaccina- nation to the open air, but not to direct tion nor for revaccination in case the sunlight, for 15 minutes before the first attempts should prove unsuccess- clothing is allowed to touch it. With ful. method (c) the virus may be wiped off Although apparently trival, vaccina- immediately. tion is an operation which demands skill in performance and care in after- III. The Vaccination Wonnd treatment in order to avoid the rare,

1. The original vaccination wound but serious complications. For the pre- should be made as small as possible, vention of these complications vacci- and all injury to the vaccinated arm nation (a) should be performed with should be guarded against. Any cover- strictly aseptic technique, (&) should ing which is tight, or more than tem- cover the smallest possible area for porary, tends to macerate the tissues each insertion, and (c) should be during the "take." This is to be treated without any covering which avoided. No shield or other dressing permits maceration. should be applied at the time of vacci- A child should be vaccinated by the nation. Customary bathing and daily time it has reached the age of 6 washing of the skin may be continued, months, and the operation should be so long as the crust does not break. repeated at about 6 years of age and The application of moisture to the vac- whenever an epidemic of smallpox is cinated area should not be enough to present. soften the crust. If an early reaction of immunity is CANCER NOT INHERITED to be watched for, the patient should who are in anxiety report on the first, second, fifth, and Men and women seventh days after vaccination. Other- of mind on account of the appearance wise, the patient should report on the of cancer in their ancestry or imme- ninth day, or sooner if the vesicle, diate family may dismiss such anxie- pustule, or crust breaks, Every effort ties, as there is no statistical evidence should be made to prevent such rup- at the present time that the disease of ture. However, should the vesicle, cancer is transmitted by inheritance pustule, or crust break, and the wound in mankind. PUBLIC HEALTH AND SANITATION

SCHOOL EPIDEMICS less unventilated school room, than it is when they are living and playing out of doors in oceans of fresh air. How to Control Them In our schools as soon as cold ONTAGIOUS diseases are largely weather begins to come on many teach- I school diseases. That is, they ers begin to close the windows to re- •^^ occur most frequently among main closed until the advent of warm children of school age, they are spread weather. This is all wrong. It is by school children and at the same wrong for two reasons. In the first time they can be most effectually place, it shuts in any possible infection handled through the agency of the that any of the pupils may have and schools. Here are some recent facts. instead of having it diluted by fresh Last August there were reported only air wafted away through open win- 638 cases of contagious diseases in the and dows it becomes necessary for other State. As the schools opened Septem- children to breathe over and over this ber showed 808 cases. In October this stale, vitiated air that should have been was increased to 1,092; in November quickly diluted and removed. In the to 1.109 cases; December, 1,567 cases; place, shutting off the sup- January, 3,158 cases; February, 3,134 second by ply of fresh air it reduces the vitality cases; and March, 3,600 cases. and resistance of all the children and Cold weather in itself is not respon- quicker easily than they sible for this alarming increase. In- and more otherwise would. fection or the germs of contagious diseases are spread with "'uch more diffi- The Solntion culty in cold than in v/irm air. Ordi- narily the germs of such diseases flour- The remedy for such a problem is for ish outside the human body much bet- the most part self-evident. Have good ter in summer weather than in winter, school sanitation. That is, have good weather. This is a matter of temper- ventilation in the school room at all ature. times. Keep at least some of the win- The real reasons why we have so dows partially open at all times. Do many more cases of contagious diseases not be afraid the children will catch during school season than at other cold. Colds are never caught from times is not hard to find. At schools fresh air. It is from stale, second we have assembled many children hand air into which some one else has from many families in many condi- been coughing, sneezing or spitting tions of health and sickness all in the that colds are caught. This is a very same room. The actual personal con- important fact for every teacher to tact is much closer and the danger of bear in mind and to endeavor to im- well children breathing in the tiny par- press upon her pupils. ticles of spray coughed, sneezed and Besides providing good ventilation spit out by carriers or sick children is the teacher should use every means at far greater when they are housed up her command to induce her pupils to close together, frequently in a more or shield the mouth and nose with a hand- — The Health Bulletin kerchief when coughing or sneezing force them is punishable by a fine or when in a room or near anyone else. imprisonment. Teachers should also forbid the use If our teachers will follow these sim- of the common drinking cup, dipper, ple precautions contagious diseases or roller towel, or exchanging bites will affect our schools but very little or eating from the same piece of food in the future as compared with the or the putting of pencils in the mouth ravages they have wrought in the past. or exchanging pencils at all times, particularly when there is a possibility that a contagious disease may exist WHERE IGNORANCE IS CRIMOAL in the community. Fifty years ago it was a common be- Since measles and some of the other lief that every child must have measles contagions are ushered in by symptoms and mumps, scarlet fever and whoop- very similar to an oncoming cold and ing-cough before he "grew up," and the since the infectious material in the earlier in life each one took his turn case of measles and some of the other the better it would be for him. Not in- contagions are transmitted through the frequently mothers took their little secretion of the nose and throat teach- ones to visit a sick neighbor in order ers and principals should watch care- to expose them to the disorder because fully every case of possible onsetting it happened the epidemic was light in cold, sore throat or coughing, particu- form and the season favorable. Now it larly if a contagious disease is known is known that children grow up or suspected of being present in the stronger and in better health if these community. Furthermore, upon find- diseases are altogether avoided, and ing a pupil who has not had measles, that if it should happen that any are or a particular contagious disease, ex- so unfortunate as to "catch" them, the hibiting symptons of that disease or older and stronger they are at the Indications of an oncoming cold it be- time, the greater probability of going comes the duty of the teacher or prin- through the disease unscathed. We cipal to immediately exclude such a now know that whooping-cough alone pupil from school until the symptoms kills ten thousand children in the have disappeared or at least for a United States every year, and that period of one week. others who do not die from it have Likewise the teacher or principal their bodies so weakened as to be un- should exclude from school all children able to resist other serious maladies. who have never had measles (or any Measles and scarlet fever take equal of the contagions) who live in families or greater toll, besides leaving their in which the disease exists. victims with maimed ears and eyes The teacher can do much to check and throats. the spread of an epedimic by distributing literature on the particular disease in question which can be obtained from "You will agree with me that it is the County Quarantine Officer and by easier for us to keep men healthy than

explaining the nature of the disease it is for a physician to cure them." and how to avoid it to the pupils. Lord Nelson's Dispatch to the Ad- The above suggestions and the au- miralty. thority for enforcing them are em- bodied in the rules governing teachers and principals upon the appsarance of There are constantly about 1,500,000 a case of a contagious disease in the Americans ill with preventable dis- school community and failure to en- eases. — 10 The Health Bulletin

PLAY IS THE THING obey orders. He can never be a leader who cannot himself follow. Play is a factor so important in the Children Must Haye More Play for health and educational life of a child Proper Deyelopment of Health, that Dr. Woods Hutchison says: Character and Morals "Rather a play-ground without a school LAY is as essential to a child as than a school without a play-ground." fi work is to a man. He needs it Regardless of whether one wholly sm for growth. He needs it not only agrees with Dr. Hutchison's views or for his proper physical development, not, the playground is what is needed but for his mental and moral develop- to counteract the stress and strain that ment as well. Someone has said that children are likely to suffer not only the boy without play today is the man from reports and conditions dealing without a job tomorrow. Play is no with the war but also from the in-

longer looked upon as a useless luxury creased efforts that are being required for children, as a time-killer for youth, of children to make for themselves a but parents, teachers, and even law- more thorough mental and physical makers, are now beginning to look equipment for the future. Tomorrow upon children's play as a necessity will need men and women with sound something they 77iust have if they grow minds in sound bodies, with highly up into strong healthy, happy men and trained intellects supported by strong, women. healthy sinews and nerves. The chil- Play teaches children team work. dren of today will be the men and Boys that can play together today can women of tomorrow and whether they work together tomorrow. It teaches be prepared to meet the more trying them fairness. Honesty is nowhere put problems of the war that will fall to to the test that it meets on the play- their lot depends largely upon the ground. Play on the square is the training that is given them today. first rule of the game. It teaches re- A playground for every school, play spect for authority. The first marks space for every child, and every child of a good soldier is his willingness to playing at playtime, is the program The Health Bulletin 11 that should be carried out at every of all children who die of measles are schoolhouse in North Carolina this less than 6 years of age. But because spring. The little sum of money- a large majority of deaths occur before needed to provide sand-boxes, swings six years of age is no reason why moth- and teeter-boards for the little chil- ers should carelessly or intentionally dren as shown in the accompanying expose a child of more than 6 to such cut, and ball fields, tennis courts and a harmful disease. Every child who horizonal bars for the older chil- has measles suffers and runs the risk dren, will be small indeed compared to of losing its life. the vigor of mind and body that will But the killing off of a few helpless be readily noted in the children who innocent children each year in prac- play. No school that stands for serv- tically every county in North Carolina ice to the child can afford to neglect from measles and other needless con- this part of its necessary equipment tagious diseases represents by no and no teacher can afford not to have means all the havoc wrought by these her pupils recreate their minds and diseases in cooperation with ignorant their bodies every day. parents who criminally thrust their helpless children into the jaws of such diseases in order 'hat they may "ketch

it and have it ovei with." Such need- AN EPIDEMIC DETELOPED HOW lessly wanton sacrifice of child life is comparable only to the ancient crim- It Shonld Not Derelop And Why inal sacrifice of child life to idols and Two children were unavoidably ex- the gods by the heathen. But a very posed to measles a few weeks ago, be- large number of the children who sur- came infected and in due time devel- vive the disease itself, or its complica- oped a cold. The mother, knowing tions, are permanently injured in one that her children had been exposed, or more ways which do not manifest said "They may have measles, I don't themselves until years later in the know, but they haven't broke out yet." form of heart troubles, weak eyes, The children were allowed to attend deafness, weak lungs and a great many school until they did "Break out." Sev- other ills and physical defects. Why eral families repeated the same proce- should any parent think of needlessly dure and an epidemic of measles de- handicapping a child for life in such a veloped. No intelligent effort was manner? made in the beginning when the dis- A further very important considera- ease was most contagious to prevent tion in connection with spreading epi- other children being infected. As in demics from schools is the fact that most cases it was in the initial, doubt- there are about as many babies and ful stage of the disease, the stage of very young children at home as there the oncoming cold, cough, reddened are older children in school, and these eyes, the earliest symptoms, while the older children all too frequently bring mother was pending a confirmation of home contagious diseases to their the diagnosis by the "Breaking Out" younger brothers and sisters which fre- when so many children become exposed quently prove much more serious with and contracted the disease. the younger children than the older Some ignorant parents still believe ones. that every child must have measles Since contagious diseases of child- sooner or later and the sooner the bet- hood are not nearly so fatal or so seri- ter. This is a grave mistake. These ous with older as with younger chil- parents do not knqw that 90 per cent dren, everything possible should b e —

12 The Health BuLLETI^"

done to postpone the evil day and if worthy feature of the case was the perchance they can be prevented from fact that this carrier had had his having these diseases altogether, so typhoid infection forty-six years pre- much the better. viously when a young man. He was kept under observation both by the City Health Department the SEX HYGIENE and local health officer for four or five years, Don't marry your cousin. when he died of heart disease. But Family intermarriages have a ten- bacteriological stool examinations dency to produce blind, the deaf, im- made from time to time during this becile and crippled children. period of observation showed that he There are 50,000 blind children in remained a carrier. the United States. It is claimed that As the result of an investigation of gonorrhea is responsible for 12,000 of a recently reported case of typhoid them. fever occurring in this same city, The father or mother who does not there has been discovered another believe in sex hygiene education may typhoid bacillus carrier in the person invite the destruction of son or daugh- of the mother of the patient, a woman ter. aged 76 years, who had typhoid fever Women and children are the inno- forty-nine years ago. No other cent victims of venereal diseases. members of the patient's family, friends, There is no more reason why the average healthy young woman should or relatives, gave a history of typhoid be hauled to a hospital a few weeks fever, and it is very probable that this after marriage than there is a neces- carrier constituted a source of infec- sity of a dispensary for cats. tion in this case. The bacteriological Every man and woman should make stool examinations were made by the a confidant of some reputable physician Research Laboratory of the New York and seek advice on questions that can City Health Department. best be answered by such physicians. These two cases indicate how "Syphilis" was the name of a shep- searching must be the investigation of herd in an old Latin play. He was a suspected carrier's history and how cursed with an ugly disease for offend- long a time the carrier state may per- ing the gods. The word means "dear sist. hog." This disease has proved a "dear hog" to an unfortunate humanity. Buffalo Sanitary Education. OPEN-AIR SCHOOLS

It has been computed that more than two hundred open-air schools and TYPHOID BACILLUS CARRIERS classes for tuberculous and anemic FOR OVER FORTY YEARS children were in operation at the opening of the school term last year. Some years ago, as the result of an Massachusetts led the list with eighty- epidemiological investigation of an ex- six, eighty of them in Boston; New tensive outbreak of milk-borne typhoid York had twenty-nine and Ohio 21. fever in New York City, an outbreak North Carolina had but two or three. embracing more than three hundred It is estimated that there should be in cases of the disease, a typhoid bacillus the cities one open-air school for every carrier was discovered in the person of 15,000 population. According to this a dairyman operating in a small vil- statement North Carolina should have lage in Central New York. The note- a dozen or more. The Health Bulletust 13

PHYSICIAN FOUND GUILTY active agitation over this disease, but the only reason that there is this unus-

physician of Buffalo, New York, ' A ual stir is that infantile paralysis is was convicted in city court for failing uncommon, and that its epidemics are, to report a case of scarlet fever. The for this country, comparatively new. father of the patient conducted a store We have had diphtheria and measles on the premises, and apparently did and scarlet fever with us for a long not want his business injured or his time, and yet, we believe, no large family inconvenienced, so no physician prizes have been offered for their cure, was called until the patient was dying no specialists have been hurried to from acute nephritis. From the his- the scene of the epidemic to see what tory and condition of the child the could be done to check its spread, and readily made a diagnosis of •doctor the National Government has never scarlet fever. The child died soon had a hand in its suppression. Even after the doctor saw it. When an in- local authorities have seldom taken spection was made by the Department the trouble to clean up on a large another child was found to of Health scale in order to check an epidemic of from scarlet fever. be desquamating these diseases. Yet the death toll from court the doctor justified his ac- In diphtheria is still approximately 25,000 the case on the tion in not reporting for the United States each year, the treat the pa- grounds that he did not mortality from scarlet fever is six tient for scarlet fever, but for one of times that from anterior poliomyelitis, court promptly the sequellae, but the while its annual incidence in all our the law found him guilty of violating cities usually far surpasses that of the which requires every physician to re- w^orst outbreaks of the more unusual port to the local health officers all malady. Even tuberculosis, about cases of communicable diseases with- which there was a wave of excitement in twenty-four hours from the time some time ago, is fairly holding its when the case is first seen by him. own with a death-rate reduced only As a result of the failure to report from 201 to 147. Infantile paralysis is this case the house was filled with always present in the community, but

people who had come to see the dead it leaves a large percentage of crip- child and who did not know the cause ples in its wake, and so seems the of death. more dreadful. Doubtless this has something to do with our fear of it, but the crippling from scarlet fever MORE INTELLIGENT alone, the impaired hearing, damaged EXCITEMENT NEEDED kidneys, and heart defects, if not so evident, is more serious than an abbre- viated and weakened limb, and the Tor 3Ieasles, Whooping Cough, Diph- army of scarlet fever cripples is larger theria and Scarlet Fever than we realize. The same is true of HERE has been much ado, there measles, diphtheria, whooping cough, G has been much running to and typhoid, and malaria. SDfl fro, much offering of prizes for We become attached to old acquaint- miraculous cures developed on short ances, especially those that Avere once notice, and much newspaper and other believed to have been sent for our talk over the alleged presence of an chastisement and the correction of our epidemic of anterior poliomyelitis. It evil ways, and perhaps, after all, we is quite right that there should be like to have the plagues (no one calls 14 The Health Bulletin^

them such) of the good old infections WHAT VACCINATION WILL DO with us. At any rate, no one is mak- One part of the land ing any great fuss about them com- surface of the globe under the care of the United mensurate with that which is being States has no anti-vaccination society. made over this less common and less The reason is destructive disease. that they have had a chance to see what a Our dollars and cents seem very vast change for the good has been precious and we use them for other effected by universal vaccination. purposes than health protection. We In the Philippines cannot, or at any rate do not, afford under Spanish rule there even a national department of health, were about 40,000 small- though we do have a department much pox deaths yearly, and 6,000 in Ma- devoted to the health of plants and nila every year. Although the people animals. We often have no local were at first bitterly opposed to it, health departments, and where we measures for vaccination have been have them they are usually badly ham- carried out in a most successful man- pered for lack of both funds and moral ner. So rapid were the results that support. If popular agitation over since 1906 there has not been a single the presence of anterior poliomyelitis death from smallpox in Manila, and the mortality could only help to open the eyes of in all the islands has the public to the more disastrous but dropped from 40,000 to 700 per year. Over 10.000,000 more familiar sources of untimely in- of Filipinos have jury and death—to our other annual been vaccinated without a single disease plagues—we might even be death, and where originally they thankful for it. fought the measure viciously, they have now learned to attribute the results to it, and seek vaccination with PASTE THIS ON TOUR MIRROR avidity.

The soldier has twenty-nine chances of coming home to one chance of being Sixty Thousand Dollars has been ap- killed. propriated by Governor Stevens of Cali- He has ninety-eight chances of re- fornia from the State War Emergency covering from a wound to two chances Fund, for the suppression of venereal of dying. diseases. The State Health Officer. Dr.

He has only one chance in 500 of los- Sawyer, has directed county sup9rvi- ing a limb. sors of health to provide in their an- He will live five years longer because nual budget for hospital facilities for of physical training. the care and isolation of persons suffer- He is freer from diseases in the ing from venereal diseases. This is army than in civil life. certainly an advanced step and Cali- He has better medical care at the fornia deserves high commendation. front than at home. We especially commend Governor Stev- In other wars from ten to fifteen ens for the beneficent forward step he men died from disease to one from bul- has taken. lets.

In this war one man dies from disease to every ten from bullets. People who will not get vaccinated This war is less wasteful of life are welcome to their smallpox and than any other in history. their quarantine. —

KNOW HOW TO LIVE holism, etc., are now overlooked by ninety-nine persons out of a hundred. Bad Personal Habits Responsible for Wear-and-Tear Disease. Four Rules for Hygienic Living The wear and tear diseases are the The first step toward the hygienic by-product of civilization. For in- life for the individual is the under- stance, one of the boasts of civilization going of a thorough physical exami- is the abundance and variety of the nation. The next step is to learn the foods it provides, and yet it is to this lesson of that examination, to find out very abundance and variety that we the slightest impairment and correct must attribute a large number of the it. The third step is to learn the rules degenerative diseases which afflict the of hygienic living and apply them so human organism. For instance, it is faithfully that no further impairments through soft foods that our teeth be- will develop. The Life Extension In- come diseased and invite disease stitute, through its Hygienic Reference throughout the body, because the teeth Board of ninety specialists, has form- lack exercise. ulated such a set of rules for the di- Again, civilization boasts of the ad- rection of the individual who wishes vantages of houses. But as an offset to live a hygienic life. If lived up to to these advantages we have the dread- conscientiously, one may feel satisfied ful scourge of tuberculosis, a house that he is following the best knowl- disease, especially frequent where edge of the day. These rules are: overcrowding and dark-roomed tene- I. Air: Ventilate every room you ments abound. occupy; wear light, loose and porous And so the invention of the chair clothes; seek out-of-door occupations which affords great comfort is, at and recreations; sleep out, if you can; least, partly responsible for nervous breathe deeply. prostration and other breakdowns, be- II. Food: Avoid overeating and cause the chair is not made to fit the overweight; eat sparingly of meats curve of the back; and even when it and eggs; eat some hard, some bulky, does, the person sitting in it does not some raw foods; eat slowly. take the trouble to place himself prop- III. Poisons: Evacuate tho"oughly, erly. regularly and frequently; stand, sit, The possibilities of self-improve- and walk erect; do not allow poisons ment through learning how to live are and infections to enter the body; keep far beyond what any one who has not the teeth, gums, and tongue clean. gone over the evidence realizes. The IV. Activity: Work, play, rest and evils of bad air, bad food, imperfect sleep in moderation; keep serene. teeth, wrong posture, improper cloth- Prof. Irving Fisher of Yale Univer- ing, constipation, self-drugging, alco- sity. —

16 The Health Bulletin"

SPRING FEVER AND WHEAT BRAN marily brought about by poor digestion, and especially by constipation. The cause of about two-thirds of all "Wheat bran is the king of laxatives. this so-called "Spring Fever" is that There are stronger laxatives that the victim has been gorging himself should be used in various emergencies, all winter long with heavy, concen- but for a laxative that can never harm trated, constipating foods, or "throw- you in the least, nothing compares with ing in too much brickbats and mor- wheat bran. There are other ailments, tar," as a busy physician remarked re- all allied with the stomach, that wheat cently, and when spring comes along bran will cure; and It is now admitted these sluggish physical machines are that this simple laxative will actually all clogged and gummed up with last improve anemia. winter's debris and are not geared up "There are a good many ways to at all for spring and summer condi- take wheat bran. The simplest way is tions. to stir two tablespoonfuls in a glass of cool water and drink it every morn- To relieve this tired, sluggish, lazy ing. Another method is to mix it half feeling there is probably nothing so and half with your cereal and eat it generally effective as good, free, healthy in that manner; or, better still, pour bowel action at least once a day a rich cream over the dry wheat bran many prefer twice a day. Pills, castor in a saucer, sprinkle with a bit of salt oil, salts, and the whole line of pur- and eat it without sugar. There is gatives are just so much dope. They nothing unpleasant about it, and peo- stimulate and excite action for the ple get so that they are really fond time being, but they leave the source of it, although at first it seems insipid, of the trouble worse than before. A dry and tasteless. real cure will be effected only when the "If children do not care for it in individual corrects his habits of living, this form, make it into a gruel for particularly his habits of diet and ex- them, and also serve it in a soup. ercise. Let him drink eight or ten You may also mix it thoroughly with glasses of water daily, or even more marmalade, honey, maple syrup, or in hot weather; let him get plenty of other suitable table syrups, and spread exercise, particularly the kind that ex- it on bread for children. ercises the muscles of the abdomen, "For constipation, one may take as and above all, let his diet consist of much as a cupful daily until relieved; fruits, vegetables, and bulky material. but for a general clearing of the skin In regard to a very valuable bulky four heaping tablespoonfuls daily will diet, we can do no better than quote suffice. Do not expect that after you a few paragraphs from an article by have taken this three or four days you Dr. A. M. Hughes, of New York City: are going to look into the mirror and "Every woman should know that if find that you have the complexion of wheat bran is taken daily it will clear Lillian Russell. Wheat bran is a laxa- up the so-called 'liver-spotted' skin. tive and a beautifier, but not a miracle

It is, in reality, a better beautifier than worker. Take your wheat bran every any cosmetic, face powder, or other ex- day without fail for six months. Then ternal compound on the market. Bran look in the glass and you will notice beautifies the skin by correcting the a difference. You will also notice a trouble that has brought about the difference in your health, and this dif- poor condition of the skin. A poor ference will be to your advantage, for complexion is caused by stomach trou- nothing serves as well as wheat bran ble or by some trouble that is pri- to keep the bowels in order. The Health Bulletin 17

"Pure wneat bran makes such a per- FIRST AID INSTRUCTIONS fect laxative because it is made up for Dr. C. W. Hopkins, chief surgeon of the most part of indigestible cellulose, the Chicago and Northwestern Rail- which is non-absorbable. For this rea- way, gives the following instructions son the bran takes up a large amount in regard to first aid to the injured: of water and swells, which adds to the Open Wounds.—Don't touch open bulk in the stomach and intestines, and wounds with bare hajids. thus quickly and easily removes all Don't disturb blood clots or wash the deadly toxins or poisons that them away. gather in the stomach and intestines. Don't try to cleanse and wash In brief, this wheat bran overcomes wounds. and prevents putrefaction and absorbs Don't use a quid of tobacco or spider the poison. webs to stop bleeding. "Expectant mothers are, in almost Heiuorrliage.—To control hemor- every instance, constantly in need of rhage place the compress on the bleed- a proper laxative. To keep their bow- ing part and make firm pressure with els in a proper condition is one of the the cambric bandage. Elevate the most important things they can accom- limb. If this fails, place a bandage the plish, and only in very recent years around the limb, above bleeding have physicians taken advantage of the point, and twist with a stick until the stops. the stick in perfect qualtities of wheat bran and bleeding Secure position. ordered its use. "Eruptions of the skin with the ado- Don't use a tight bandage around lescent is the rule rather than the the limb unless hemorrhage is active. exception. This is frequently caused Burns and Scalds.—-Burns and scalds as a result of too rapid growth, which should be treated in the same manner gives them a body out of proportion to as open wounds. Cut the clothing their natural blood supply, and the away if necessary. blood, working to supply the over- Don't attempt to remove pitch, var- grown body, becomes poor. There is nish, or wax from a burn. nothing better than wheat bran to Don't use oils on burns. overcome this. For such young peo- Shock.—A person in shock has pale, to tsaie ple one of the very best ways clammy skin, weak pulse, sighing res- is stir four tablespoon- wheat bran to piration. fuls in a large glass of milk and drink Place patient on his back. Cover it before the bran has an opportunity him up. Move him to the best place to settle. By doing this the young of shelter at once. If possible, apply person couples the advantages of the external heat by means of blankets or laxative with the health-giving prop- hot water bottles or hot bricks. Be erties of the milk, and milk, it should careful not to burn the patient. be known, contains every element of a Hot Avater, hot tea, or hot coffee, beef perfect food. stimulants. "Do not make the mistake so many tea or broth are the best Don't give him whiskey or other alco- people are making today, that is, of disregarding a remedy merely because holic stimulants.

it is so simple. 'Good Old Doctor Fractures.— If an arm or leg is bro- Wheat Bran' may be simple, but there ken, use splints composed of folded is nothing more effective for putting newspapers, pieces of board, or heavy the bowels and stomach, and even the pasteboard and secure in position with blood, into a healthful condition. bandages or handkerchiefs. If the —

18 The Health Bulletin"

arm is broken, place it in a sling. If Don't apply a sling or splint until the leg is broken, tie the legs together the wound has been dressed. If no splint is available. Don't soil dressings. Don't try to set broken bones. The two welfare movements, "Safety Straighten to relieve pain, then apply First" and "First Aid," on the part of splints. organized combinations of industrial Don't allow fractured limb to dangle workers, must have their influence on in handling the p*atient. less vrell organized industries and on Fits.—A person suffering from a fit legislation affecting workmen's com- should be kept quiet on the back. pensation and on the organization of Loosen the clothing about the neck hospitals provided with facilities for and abdomen, and be careful he does the economic and efficient care of in- not injure himself. dustrial workers. A wedged handkerchief or piece of wood or cork should be placed between HOW TO STOP WOERYING the teeth to prevent injury to the Not all worry is preventable, but tongue. for the most part it can be avoided. Heat Exhaustion and Sunstroke. Most of our fears are never realized, In heat exhaustion the skin will be and, as a rule, if we meet our troubles cold and clammy and the condition day by day as they come without will be the same as shock; the same worrying about them before they ar- treatment will be required. rive or fretting over them after they In case of sunstroke the body feels have passed, we will find that we have hot to the touch; is dry. Cloths wet the strength to rise above them. in ice water, or in the coldest water Worry undermines the health to a at hand, should be at once applied to certain extent. It really weakens the the head and body, and along the spine mental forces by tiring them out by from the head downward, and fre- doing nothing. Usually the relief quently renewed. For the head, the from worry rests with the victim of application of cracked ice in a towel this unhappy habit himself, but some- is recommended. times the real causes are not the ones Foreign Body in Eye.—Foreign bod- which seem to explain the condition ies should be removed from the lids and we must go deep into our lives or only. have the assistance of those who are Don't touch the eye with dirty fin- skilled in unravelling mental pro- gers or unclean cloths. cesses. Don't try to remove a foreign body The best antidote for worry is a from the eyeball. Dirty toothpicks or change of mental occupation, a get- dirty instruments are dangerous, and ting away from the scenes which pro- may cause serious results. voke worry, exercise in the open air, a good book, a pleasant recreation, or In General a temporary change of occupation. As Don't try to do too much. a matter of mental health every suf- Don't apply bandages too tightly. ferer from this unfortunate condition

Don't tell an injured person his con- owes it to himself to discover some dition is dangerous. simple means of getting away from Don't uncover a wound after it has this habit which is destructive to been bandaged. If it bleeds apply health and peace of mind alike.—U. S. more bandages. Public Health Service. The Health Bulleti:^? 19

GASOLIXE AS A]V EMERGENCY DON'T STAND SO MUCH MEDICDiE To many women it never occurs that much of the work they Gasoline is a good disinfectant for do can be done seated. In fact, the treatment of wounds in emergency many women feel that they are lazy unless they are standing cases. In fact, gasoline is such an up at their work. effective disinfectant that Dr. Dorothy How many women sit in a chair at a Childs, in her lectures to classes in table with a pan of water in front of hygiene in the University of Kansas, them when they have potatoes to wash strongly urges that an eight-ounce bot- and peel? tle of gasoline be kept in the family How many women sit down to wAsh medicine closet for use in treating cuts or wipe dishes, even though a high and scratches. chair must be made for this purpose? The value of gasoline in cleansing How many women arrange so that wounds has been demonstrated on the they may be seated when they are iron- European battlefields, Doctor Childs ing little things like handkerchiefs, said, and it is especially good if the that require no hard pressing? wound is lacerated or if the skin was Think it over, and learn to sit down. dirty when the wound was made. After washing the wound with gaso- SAFE GUIDE TO HEALTHFUL line, paint with a tinctui^ of iodine, EATING suggests Doctor Childs. Use a small Is it necessary to know how many wad of absorbent cotton for the iodine calories you are getting each day, or "paint brush." how many ounces of protein? Every family should have a supply By no means. of emergency remedies at hand, and The following rules will make it Doctor Childs suggests this list for possible for you to feed yourself and the home medicine shelf: your family without weighing your Two-ounce bottle aromatic spirits food or counting your calories: of ammonia. This is a stimulant and Weigh yourself twice a month. If good to use in case of fainting. Use you are above the average weight, you as an inhalation, or put one-half tea- need less fuel. If you are very light spoonful in one-quarter glass of water in weight, and losing weight, you need and give internally. Eight ounces of more fuel. gasoline, to be used freely to cleanse Try to have some bulky food, some wounds. Two ounces tincture iodine raw food, some whole cereal, some to paint wounds and kill germs. One fruit and some milk in your diet each yard sterile gauze. One yard zinc ox- day. ide adhesive plaster, two inches wide. Eat ^ high protein foods (meat, fish, One yard zinc oxide adhesive plaster, fowl, eggs) only once a day in mod- one inch wide. One-fourth pound ster- erate amount. Have at least one or ile absorbent cotton. One-half dozen two meatless days a week. Cold gauze bandages, assorted sizes. Eight- weather and active physical labor calls ounce bottle saturated boric-acid so- for more heat and energy producing lution to use as an antiseptic wet foods, while warm weather and seden- dressing for wounds and as an eye tary habits usually call for more bulky wash. Eight-ounce bottle peroxide of fruits and vegetables containing less hydrogen, not to be relied on for se- heat and energy and more bulk for the rious wounds. One hot-water bag. One bowels to act upon. fountain syringe. One ice bag. SAVING MOTHERS The expectant mother should at once consult a physician. She should remain under supervision so that any More 3Iothers Die From Incidents of dangerous symptom may be discov- Maternity Than From Any Disease— ered as soon as it appears. She >eglect at C'liildbirtii the Cause should learn how to take care of her-

ORE women from 15 to 45 years self, and she should have proper food of age die from conditions con- and rest and freedom •from anxiety. from nected with childbirth than Yv'hen the baby is born the mother About any disease except tuberculosis. needs trained attendance. A difficult deaths from maternal causes 15,000 maternity case is one of the gravest annually in the United States, occur surgical emergencies. Many people available figures for this coun- and the do not seemrto understand that in any try show no decrease in the maternal case complications may arise which since 1900. Maternal deaths death rate can be met safely by prompt and largely preventable by proper care are skillful scientific care, but which at skilled attendance. and the hands of an unskilled attendant These 15,000 deaths do not measure may cost the life of mother or child extent of the waste. They are the full or both. Even after confinement the index of unmeasured merely a rough mother needs continued supervision preventable illness and suffering and rest until her strength has re- mothers. Furthermore, cer- among turned. diseases of early infancy are tain Thousands of mothers, both in city connected with the health of closely and country, do not have the essen- mother and the maternity the baby's tials of safety, partly, perhaps chiefly, received, and these dis- care she has because they do not realize the dan- about one-third of all the eases cause gers involved in lack of care, or else among babies under deaths occurring accept the dangers as unavoidable. age. More than 75,000 one year of Many women are at present unable each year from this group babies die to obtain proper care, but when all because they do not have of diseases women and their husbands under-

start in life. « a fair stand its importance and demand it health of the mother The life and for every mother, physicians will fur- in every way important to the are nish it, medical colleges will provide children. Breast well-being of her better obstetrical training for physi- part of feeding through the greater cians, and communities will see to it the baby's first year is his chief pro- that mothers are properly protected. tection from all diseases, and mothers Little has been done as yet to show are much more likely to be able to women that much of the waste of nurse their babies successfully if they mothers' lives and health is unneces- receive proper care before, at, and sary. Even less has been undertaken communities to provide protection after childbirth. by —

The Health Bulletin 21

for them. Many communities which ing boys and girls? It Is a sad com- have studied their typhoid and tuber- mentary that many fond parents are culosis death rates and have under- unconscious that their little boys and taken costly measures to reduce them girls are laboring under the handicap have been heedless of the death rates of defective hearing, bad teeth, poor among mothers. It is not strange, vision, hookworm disease, malaria, therefore, that since 1900 the typhoid anemia, etc., which is not only making rate for the country as a whole has mediocre or backward children out of been cut in half, and the rate from them now, but which is permanently tuberculosis has been markedly re- handicapping them in the long, hard duced, while the death rate from ma- race of life. Give your children a fair ternal causes has shown no demon- chance by encouraging medical inspec- strable decrease. tion of schools and prompt treatment of defects found. WHY REGISTEE A BABY? The registration of a child's birth WHY NURSE YOUR BABY? forms a legal record that is frequently Because useful and may be of the greatest im- Breast milk is always ready and is portance. It establishes the date of never sour. birth and the child's parentage. It Breast milk does not have to be pre- be may required to establish the child's pared or measured. age for attendance at public schools It is nature's method and was in- or for a working certificate in States tended for your baby. where restrictions are placed upon It will make your baby strong and child labor; to show in courts of law healthy. whether a girl has reached the age of It is absolutely free from germs and consent, or whether individuals have dirt. attained the age when they may marry It protects your baby from many in- without the parents' permission; to f-nt diseases. establish age in connection with the It is safer for the baby. Ten bottle- granting of pensions, military and jury fed babies die to one fed on the breast. duty, or voting. It may be important It is the only perfect food for the in connection with the bequeathing baby. and inheritance of property, or to fur- It contains the proper elements of nish acceptable evidence of genealogy. food in the right proportion for the growing child. Breast-fed babies seldom have bowel ATOID EARLY HANDICAPS trouble, which is so fatal in bottle-fed babies, especially during hot weather. Farmers dread having their grow- Your baby will have the best chance ing crops dwarfed, stunted, or "set of living if breast fed. back" during the early growing sea-

son, and stock raisers avoid, if possible, any interference with the very "Maternity is woman's exclusive pro- best and fullest growth of their young fession. Like genius in any art or livestock during the growing period. profession, successful motherhood is Why, then, should we not give our founded on efficiency and joy in the very best attention to the most perfect chosen work, and the greater of these and unobstructed growth of our grow- is joy." Anna Steese Richardson. — — ^^ TUBERCULOSIS

HAVE EARLY DIAGNOSIS the sand and believe that the disease cannot see them. The chief difference

Don't Wait Until You Are Sick to be between knowing that you have tuber- Examined—"Delays Hare culosis and not knowing that you have Dangerous Ends" tuberculosis is that, in the first case, you have a good chance of getting v^ UBERCULOSIS—the most com- well; in the second, you have little mon disease and the one which ^Jl^ ^"^ causes more deaths than any chance of getting well. If Ton Tire Easily and are "all other— is rarely recognized until it is yourself moderately advanced. If it is diag- played out," don't dope with nosed early, it is curable. If not diag- so-called "tonics" and stimulants. See nosed early, it is terribly fatal. your doctor and insist upon having a

''There should be no uncared-for tuberculous patient in any civilized community. The untrained and uncared-for tuberculous individual, whether he lives in a palace or in a tenement house, in a first-class hotel or a lodging house, will constitute a center of infection/' S. Adolphus Knopf, M.D.

Early tuberculosis or beginning tu- thorough examination. Weariness is berculosis is curable. The time to usually the first sign of tuberculosis. if cure it, however, is in the earliest If Ton "Catch Cold" easily, your stage. The symptoms at that time voice gets "husky," if you have "ca- may not cause one to suspect that tarrh," or there is anything the matter with the If Ton Congh frequently, or have to lungs. Without careful examination, "clear your throat"—don't take "cold the disease is not detected. When cures" or "cough medicines." See your the patient waits until he believes he doctor and be examined. Consump- has "lung trouble," it is often too tion usually gains its foothold while late for cure. The man with the ear- the victim is doctoring himself and liest diagnosis is the one with the best deceiving himself. chance of getting well. If Tonr Appetite is poor or "finicky" Some people delay seeing the doc- —good one meal and poor another tor because they do not want to be don't take "appetizers," "stomach told that they have tuberculosis. Like medicines," or "tonics"; but see your the ostrich, they stick their heads in doctor and find out why. —

The Health Bulletin 23

If Ton Haye Indigestion, don't de- to strip to the waist before examining lude yourself with "dyspepsia tablets" your chest. Do this cheerfully. He or any other medicines. Even if they may want to make tuberculin tests. give relief, they do not remove the These can do no harm and may give cause of your trouble. valuable information about your case. If You are a Little FeTcrish in the The best physician in your commun- afternoon, don't guess at the cause. ity is none too good to determine the Don't believe it is "just a little ma- condition of your health. If you want- laria." . See your doctor. ed a mechanic to repair a high-priced If Tou Spit Blood, don't assume automobile, you would select the best that it is from the gums or your mechanic you could find. A healthy throat. Probably it is not. Spitting body is worth more to you than the blood is too important a matter to best automobile ever built. guess about. See your doctor and find Any one of the symptoms named out the cause. above may be the first evidence of If Tou are Losing Weight or are be- tuberculosis. If, after careful exami- low your natural weight, there is some nation, your doctor tells you that you cause for it. Do not feed your stom- have tuberculosis, your chance of get- ach with oils and fats and other "fat- ting well is excellent, since the diag- tening foods." See your doctor. nosis is made early. If your doctor

That every person in North Carolina suffering with tuberculosis must he discovered and must he so supervised and cared for that he will have the hest possible opportunity for recovery, and so that he will not he a menace to his family and friends or the stranger that is within our gates. Bureau of Tuberculosis, State Board of Health.

If Tou are Neryous, or have had a tells you that you have not tubercu- nervous breakdown, be sure there is losis, that assurance will be worth not a physical cause—like tuberculo- much to you. sis—at the bottom of it. Nervousness Many of the wisest and most promi- is often the only sign of very early nent men in the country have their tuberculosis. doctors examine them at frequent in- If Tou Haye Any One or More of tervals. Through careful examination These Conditions, do not try to doctor when you are not sick, the first evi- yourself. See your doctor and be ex- dence of trouble may be detected and amined. See that you get a thorough much trouble prevented.—Illinois examination. Health Bulletin. A careless examination is worse than "Before any real progress will be no examination. A thorough examina- made in the battle against the Great tion will take your time and the doc- Plague, we must get the whole people tor's time. He will make a careful aroused to fight -this enemy which history of your case. Answer his ques- threatens the integrity of the race." tions accurately. He will require you Dr. J. H. Kellogg. 24 The Health Bulleti:n^

SYMPTOMS OF TUBERCULOSIS tions of the laws of hygiene reduce one's physical vitality and render him Many people die of tuberculosis be- much more susceptible to tuberculosis' cause they don't know they have it un- or other diseases. til it is in an advanced and practically Any one or more of the following • incurable stage. The earlier tubercu- symptoms are suggestive of tuberculosis is recognized and the cure begun losis and call for a thorough examina- the easier it is to cure. It has been tion by a careful physician. found that of the very early cases of 1. Loss of weight without any other tuberculosis found and promptly and apparent cause.

properly treated, 91 1/^ per cent recov- 2. Tiring easily after ordinary exer- ered. Of the moderately advanced tion. SYMPTOMS OF TUBERCULOSIS BE EXAMINED IF YOU NAVE ONE OR. MORE OF THESE

^ cough lasting longer man three weeks is ver^ suspicious

io55 of weighb or Tiring easily; suggests tuberculosis

-^ conlinued temperature of 98.° or less in the J? low blood pressure morning and an afternoon may mean tuberculosis, ir you have any one or more oF these temperature of 99.5 or symptoms be examined by a careful more are strong indi- physician at once. cations of tuberculosis. cases 661/^ per cent recover and of the 3. A cough that lasts more than advanced cases only 18 1/^ per cent re- three weeks. cover. 4. A temperature of 98.0 or less in One should be suspicious of tubercu- the morning, and an afternoon tem- losis if he has been living with, or in perature of 99.5 or more. close contact with, a tuberculous per- 5. A low blood pressure is suggestive. son who has been a careless cougher. 6. A hemorrhage from the lungs sneezer, and spitter. Frequent colds or means tuberculosis without exception. a "bad case of grippe" with a persist- Germs of tuberculosis in the sputum ent cough or sore or swollen lymph are a sure but a late sign of tubercu- glands or kernels in the neck, are losis. The diagnosis should have been causes for suspicion. Dissipation, over- made and treatment begun long before work, intemperance, or other viola- the case reaches this advanced stage. ) t APY TRIN I TY COLL fG I DURHA^

NOTICE TO READER—When you finish reading this magazine place a one-cent stamp on this notice, hand same to any postal employee and it will be placed in the hands of our soldiers or sailors ^ atthe front. NO WRAPPING— NO ADDRESS.

Publislyedb^ T/\E. ^9Km CARPLI^^A 5'IKm.B

Bulletin, will aeni: to This be free grxg citizen of the 5tate vipbn, 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. G.

Vol. XXXjf/ AUGUST, 1918 No. 2

ANNOUNCEMENT

A change has been made in the management of the Health Bulletin. Mr. Warren H. Booker, who has been Editor of the Bulletin and in charge of the educational work of the

Board for nearly five years, is leaving to undertake similar work in France. Arrangements have been made to have the Bulletin appear regularly. Hereafter Dr. B. E. Washburn, director of the Bureau of County Health Work, will be responsible for the section of the Bulletin on Personal Hygiene; Dr. George M. Cooper, director of Medical Inspec- tion of Schools, will be responsible for the section on Child Hygiene, which will include school sanitation and medical inspection of school children; Dr. L. B. McBrayer, superintendent of the State Sanatorium, will be responsible for the section on Tuberculosis; and Dr. W. S. Rankin, secretary of the State Board of Health, will be responsible for the section on Public Health and Sanitation. Editorials will be contrib-

uted by the Executive Staff of the State Board of Health and signed by their initials. TABLE OF CONTENTS Complete Mobilization 27 Monthly Variation Typhoid Deaths 39 The Spirit of the Times 29 Rules for Mothers 40 The County Health Officer is Right 29 Value of Life Extension Work. ... 41 Federal Government Assists State Danger in Ill-Fitting Shoes 42 42 IN Enforcing Quarantine Laws. . 31 Constipation Personal Hygiene and First^Aid Hygienic Value of Gardening 43 Medicine 32 A Confession 43 Prosecutions Brought by the State Preventive Dentistry 44 Board of Health During Month Necessity for Prevention 44 OF June, 1918 33 Frequency of Dental Decay 44 Why Publish the Names of the Proof That This State of Affairs Guilty? 33 Can Be Prevented 45 Prosecuting Doctors 34 Results op Neglect of Teeth 45 North Carolina's Typhoid Problem 36 Need for Dental Education 45 The Sanitary Index of North Caro- A Plan of Campaign 45 lina 36 Logic of This Procedure 46 North Carolina Winning in the Support op Leading Dentists an Ab- Fight Against Typhoid 37 solute Essential 47 Trade and Pro- Responsibility for Typhoid Fever. . 37 Difference Between Monthly Typhoid Deaths in North fession 47 Carolina for the Four Years 1914, Reward 47 -1915, 1916, AND 1917 38 How to Get Tuberculosis 48 FREE PUBLIC HEALTH LITERATURE

The State Board of Health has a limited quantity of liiterature on health subjects for free distribution. If j-ou are interested in one or more of the following subjects, or want same sent to a friend, write to the State Board of Health for free literature on that particular subject. Whooping-cough Clean-up Placards Smallpox Hookworm Disease Spitting Placards Adenoids Public Health Laws Sanitary Pr^'ies Measles Tuberculosis Laws Residentl\l Sewage German Measles Tuberculosis Disposal Plants Typhoid Fevee Scarlet Fever Eyes Diphtheria Infantile Paralysis Flies Pellagra Care of the Baby Colds Constipation Fly Placards Teeth Indigestion Typhoid Placards Cancer Tuberculosis Placards Malaria SEX HYGIENE BULLETINS Set a—For Young Men Set D—For Parents A Reasonable Sex Life for Men. When and How to Tell the Children. Hygiene for Men. Sexual Young Venereal Diseases—A Sociologic Study. Vigorous Manhood. The Need for Sex Education. Smash the Line. (The case against the re- List of Reliable Pamphlets. stricted district.) Pamphlets. List of Reliable Set E—Foe Girls and Young Women Set B—For Public Officials and Business Men Your Country Needs You. (Especially for girls 11 years of age and over.) Public Health Measures in Relation to Ve- nereal Diseases. Note.—For girls under 11, see "When Venereal Diseases—A Sociologic Study. and How to Tell the Children" (Set D) ; Smash the Line. (The case against the re- ])ortions of "Your Countrj' Needs You" stricted District.) also may be read to younger girls. Girls The Need for Sex Education. 15 and over may be given "The Nation's A State-Wide Program for Sex Education. Call to Young Women" at the discretion List of Reliable Pamphlets. of the parent. -For Set C- Boys The Nation's Call to Young Women. Vigorous Manhood. (Especially for boys 12 List of Reliable Pamphlets. years of age and over.) NoTE.^—For boys under 12, see "When Set F—For Teachers Tell "the Children" (Set D) and How to ; The School Teacher and Sex Education. portions of "Vigorous Manhood" also may Sex Education in the Home and High be read to younger boys. Boys 15 years and over may be given Bulletin "A Rea- School. sonable Sex Life for Men" (see Set A), Venereal Diseases—A Sociologic Study. at the discretion of the parent. Smash the Line. Sexual Hygiene for Young Men. The Need for Sex Education. List of Reliable Pamphlets. List of Reliable Pamphlets.

Any of the above will be sent without charge, Please send for only those bulletins for which vou have definite use.

C EDWARDS ft BROUGHTON PRINTING CO.. RALEIGH. N *TS7 Q)M B PUSUaAED BYTAE, nORJA CAROUMA 5TATL. BQMgP s^AEALJA

Vol. XXXIV AUGUST, 1918 No. 2

EDITORIAL

COMPLETE MOBILIZATION ice in some state institution, as an insane asylum or a tuberculosis sanatorium. Entire Medical Profession to be at the Under the plan of medical mobiliza- Call of the Country During tion as followed previous to the adop- the War tion of the proposed plan, the indi- In England and France, and in Ger- vidual physician, while directly ap- many, too, for that matter, physicians pealed to by the President through his of all ages, sexes, and physical condi- agency, the Council of National De- tions serve, wherever they are, at the fense, to offer his services to his coun- will of their country. So it is to be try, has been governed by the feeling here. So it should be. The medical that enough physicians without him- profession of America will not be self would yield to the call of the coun- found one whit less patriotic than try to supply its military needs. Like their brethren across the water. those in Luke 14:18-20, some did not The plan now in the making is the respond because they had bought a organization of a Volunteer Medical piece of ground; others because they Service Corps. The President Oi the had to prove a new automobile; and United States, through his agency, the others because they had married a Council of National Defense, will wife. Under the plan as heretofore shortly ask each and every physician carried out. only enough physicians in the United States to apply for mem- have responded to supply the military bership in the Volunteer Medical Serv- necessities of the country and, there- ice Corps. The membership of this fore, all of those who have volunteered Corps bind themselves to be subject to have had to be used regardless of the the direction of a Federal Board (rep- importance of the field which they va- resenting the Surgeons General of the cated. As a result, many communities Army. Navy, and Public Health Serv- are without physicians; medical col- ice, and the Council of National De- leges have become considerably disor- fense) with respect to serving their ganized through large numbers of their Government in the following capaci- faculties entering the military service; ties: (1) to remain in their present such governmental agencies as are post of civilian practice; or (2) to ap- manned by medical officers, as insane ply for and accept, in case it is granted, asylums, tuberculosis sanatoria, city a commission in the Medical Reserve and State health departments, have Corps of the Army or the Navy; or (3) been and are being seriously disorgan- to accept service with the Public ized through the medical officers of Health Service of the United States; these institutions leaving their civilian or (4) to accept service with a state duties at the call of their country and health agency; or (5) to accept serv- accepting commissions in the Army or 28 The Health Bulletin

Navy. The writer knows of a state medical profession recognizes the hu- board of health, in an adjoining state manitarian character of this war; that, that has lost three-fourths of its per- with the mass of the profession, hu- sonnel; and of another state board of manitarian ideals control. Of course, health in a neighboring state that has the country realizes that there is a lost even a greater per cent of its per- small percentage of tradesmen that sonnel; of another state employing in have secured license to practice medi- its engineering staff twelve engineers, cine, and that, like a small amount of and during the last year has lost four- fatty infiltration or degeneration o f teen engineers, the entire staff and two higher tissue, these inert, oily, slippery of the second crop; of another division globules will not respond; but even in a state board of health that for these, it is believed, will be squeezed eight months has been trying to find into their own places by the pressure six medical officers, and in the last of an irresistible public sentiment. three months obtained three medical There will be some physicians who officers only to lose two of these in the will hesitate to leave to an agency, last six weeks. Examples might even though that agency speak for be continued almost ad infinitum, but their country, the right to keep them these illustrations are sufficient. in their place or to assign them to The lesson to be drawn from all of some of the military or public duties this is: There must be discrimina- above mentioned. These men should tion in the distribution of the medical remember that our boys "in the army profession to meet both the military have not stood back on the possibility and civilian exigencies of the war. of their being placed under an incom- Discrimination is impossible so long petent commander. They know that as the number of doctors volunteering whoever their commander is, he is to is but slightly in excess of the mili- them the voice of their country. So tary needs. Discrimination becomes in the coming call for 100 per cent possible just in proportion as the call volunteers in the Volunteer Medical of the country meets with the whole- Reserve Corps, let the individual phy- hearted response of the profession. sician trust his country and submit Discrimination will not only become himself to its authorized agency for possible, but will force itself when the direction. By this faith lies the way profession offers the full measure of its of salvation, now and hereafter, but, service. The plan as outlined, which oh, ye of little faith! contemplates complete mobilization, And when this call comes, let every takes care of this important principle NORTH CAROLINA physician recog- of discrimination through which, and nize not only his opportunity for him- only through which, both the civilian self in a prompt response, but let him and military needs of our country can also recognize his individual part in be adequately cared for. grasping the opportunity of placing All will be called to volunteer; none his State FIRST in the completeness will be slighted. All will be asked to and the promptness of its mobilization. leave it to their country to determine How proud an achievement if North their place of service during the war. Carolina will lead all the states in The country, in making the proposed meeting intelligently and justly the appeal to the medical profession for medical demands of these great times! 100 per cent mobilization, takes the It will be up to you, doctor, to do your profession at its word: The country part in placing your profession and assumes that the soul of the profession your State in the right place. R. is the humanitarian ideal; that the W. S. —

The Health Bulletin 29

THE SPIRIT OF THE TIMES tion to duty. It means a lot to me the knowledge of work well done and an. inspiration to give of my best." A Letter from a Young Medical Officer who has been Attached to the British Army in France for THE COUNTY HEALTH OFFICER the Year Past IS RIGHT [An officer in the Surgeon General's "State Board of Health, office has received a letter from a "Raleigh, North Carolina, young medical officer who has been "Gentlemen: with the British Expeditionary Force "Permit me to say that it might not for one year and has been who be expected from one who, perhaps, wounded. The letter in part runs as has the largest number of vaccinations follows:] to his credit of any physician in North "At present I am very impatient and Carolina, to demur to anything said dissatisfied with my lot, for I have in favor of anti-typhoid vaccination, been forced to be out of tli'3 game, but the following paragraph in your owing to a wound received some twelve press article on Typhoid, released for weeks ago. My regiment had been in the papers on July 3, should be re- for a particularly heavy attack and written. The paragraph referred to barrage, and while making way my reads as follows: along a ridge to get to some of my " 'To combat the prevalence of Ty- wounded lads, about 300 yards from phoid, the State Board the boche. a machine gun opened on of Health urges anti-typhoid vaccination, the screening me. I was unfortunate enough to get of houses to protect from flies, and the a bullet through the back. It passed installation of sanitary between the spinous process. To make privies. The disease can be entirely prevented by a long story short, I have had a rotten the first measure, while the last two time of it, with blood poisoning and named would insure a very three operations. However, the wounds great reduction in the number of cases.' are now healed and I am going about "It London. My back is getting stronger should have read 'The disease and of more use daily. can be entirely prevented by sanitary privies, while "I am hoping to get back to France the other two would insure a very great soon. I am more than tired of being a reduction in the number of cases.' patient, and my only desire is to get Sanitary privies indeed, should back to my lads, to share everything have occupied first position in the paragraph with them in this time of crisis. How instead of last. I do love my boys of the Fifth Duke "Now it is time, and high time, that of Wellington Regiment! They are the truth about this whole business Yorkshire men, and to my mind the should be made clear to the lay people best boys, finest fighters, and the most of North Carolina, who must suffer cheerful men I have ever known. 1 until they learn the truth and conform their have no hesitation in saying I love habits thereto, and the them—the love of one strong man for truth about Typhoid is that it, with other strong, brave, and true men. I other intestinal diseases, will remain with will not be happy until I get back to us until doomsday unless human is them, and I love the game in spite of excrement safeguarded, and this truth should its dangers and discomforts, because it be so impressed upon people is a man's game and calls for the best until, like Banquo's ghost, it will that is in one. The experience is not down. worth everything. One has the chance "With human excrement carefully to have served at a time like this, to and properly safeguarded, the two have gven of one's best, to have lived other measures can be dispensed with, for an ideal. There is nothing better. and flies turned loose; but then, may True, there are many drawbacks and the Lord have mercy upon baldheaded dangers, but we can only live once, and men! if I 'go West' I will have solved the "It is now time to put over in North great mystery all the sooner. Carolina a compulsory sanitary privy "I am very proud of my military law and a state sanitary inspector in cross, which the British Government the field, and I am now announcing awarded to me for gallantry and devo- my candidacy for that position. 30 The Health Bulletin

"With best wishes for the Board in- The army has vaccinated all the men collectively, dividually and but more called to the colors. There is no ty- especially for the executive and heads phoid fever in the army. So follow the of bureaus, I am, "Very truly, example set for you. It is safe, sure, not painful; it requires three inocula- ••County Health Officer.'" tions, a week apart. Now is the time; don't delay! J. J. K. VACCINATE YOUB FAMILY AGAINST TYPHOID FEYER FEDERAL OFFICERS AFTER DOC- Typhoid fever is dangerous; it kills. TORS FAILING TO REPORT If it does not kill, it keeps you sick THEIR TYPHOID FEYER for a long time. It is therefore ex- CASES pensive. It takes at least two of your Invariably our attention is directed family to have the disease, one who is to epidemics of typhoid fever when the sick and the other to wait upon him. epidemic is not in its inception, but in It therefore means the loss of the serv- full blast, and frequently when the ices of two persons. height of the epidemic is passed. To Typhoid fever is a reflection on your illustrate: in the epidemic community, just as much so as a case at Canton of smallpox. Both can be surely pre- last year, where there was a total of vented by vaccination. A case of ty- over 150 cases, we know nothing of the phoid fever in your family at this time occurrence of the epidemic until some means the stopping or lessening of 60 or 70 persons had become infected. your earning capacity. You become an This was true again at Greensboro in expense rather than a producer, and, 1915, when a milk epidemic of 45 cases moreover, when the State and Nation occurred. And, again, it was true of need the full productive capacity of the epidemic in Wilmington in 1911. every one. Typhoid fever is an ally of It has always been true of epidemics the Hun. One sick with typhoid is in this State—we are called after the as much incapacitated as if shot by a horse is stolen. Hun bullet or poisoned with his gas. If doctors would report promptly So, don't have it! Swat the fly, keep their cases of typhoid fever (and all clean, keep well, be vaccinated against cases of recognizable typhoid are typhoid fever Do all you can for the treated by doctors), this office would men who "tote the gun" and use the be apprised of epidemics in their in- gun against the despised Hun. ception. We could immediately apply We can't do our full part when we the methods of control and prevent are sick or have any of our family many cases of typhoid and save many sick with typhoid fever. So keep well. lives. For example, if last year this Kuy Liberty Bonds, War Savings and office had known of the Canton epi- Thrift Stamps with what you would demic when only ten cases occurred, we lose in time, in doctor's bill, medicines, could have had a man on the job and and funeral expenses. Last year there prevented not less than 50 cases and were 6,000 cases of typhoid fever in at least 5 deaths. Just recently our North Carolina. Enough time lost by official attention has been directed to patients and those nursing them to the occurrence of 12 cases of typhoid have fully trained a regiment, not to fever in the small village of Landis, speak of over 600 of these who will North Carolina, a village of not over never hear the bugle call to the colors 200 people. If these cases had been —only Gabriel's trumpet of the Resur- promptly reported, the Board of Health rection morn. would have been able to act a week or The Health Bulletin 31 ten days earlier than it did with its effective state control of contagions is, delayed information, and in this way therefore, most reasonable. could have prevented a number of This interest of the Federal Govern- absolutely unnecessary cases and, per- ment in State control of contagions haps, some deaths. The doctor who has always existed, but in these criti- fails to report his typhoid fever cases cal times there are many additional promptly is guilty of the same kind of reasons to emphasize the interest of negligence as the citizen who sees the the Federal Government in the State's beginnings of a conflagration and neg- handling of contagion. There are in lects to call the fire department. At our State, and there are coming to present, doctors are not reporting our State in ever-increasing numbers, more than 80 per cent of their typhoid soldiers and workers in war indus- fever cases. tries, both equally important to the The Federal Government, by a well cause of civilization. These, our thought out system of correspondence guardians and visitors, are citizens of in which the franking privilege serves other states. We owe them protection, to great advantage, is getting in touch the protection that we ask of other with the households from which there states where our own soldier boys are are reported cases of typhoid fever, sojourning. and through these householders are Contagion must not be permitted. to ascertaining the existence of unre- pass from the civilian population into ported cases in the community. The the camps and industrial settlements. unreported cases are turned over to The sanitary officer of the camp must the State Health Officer with a request know, when men. apply for furloughs, from the Federal Grovernment that in what counties of North Carolina prosecutions be instituted. The prose- contagions exist, in order that men cutions will be instituted. "We hope may not be furloughed to counties in that with this notice the Federal offi- which there are epidemics and from cers will find very few unreported which epidemics may be transplanted cases. We shall have no option but to by the returning soldiers to the camps. enforce the law. W. S. R. The special interest of the Federal Government in state control of con-

tagion is, therefore, at this time, fully GOVERNMENT ASSISTS FEDERAL justified. QUAR- STATE I> ENFORCING Both the United States Public Health ANTINE LAWS Service and the Surgeon General of Infectious diseases must be handled the Army are now assisting our State under State laws, but this does not in running down and prosecuting vio mean that public and governmental in- lations of the quarantine law. Negli- terest in this class of diseases is re- gence on the part of physicians to stricted to the State in which the dis- report their cases of contagion, and eases are present. There is some- on the part of householders to report thing like 15.000 miles of North Caro- measles and whooping cough not un- lina in infectionable contact with der the care of physicians, and to re- neighboring states. There are 500,000 spect the quarantine laws, cannot and persons, potential conveyors of infec- will not be tolerated. The United tion, leaving this State by common car- States Public Health Service, through riers every year for other common- its officers and by a regular system wealths near and distant; and thus of correspondence with homes in been reported to our ills fly to fields we know not of. which contagion has The Federal Government's interest in exist, is securing reports from house- —

32 The Health Bulletin

holders of unreported cases of con- The individual citizens of North tagion in their communities. These Carolina have never been as interested unreported cases are referred to this in personal hygiene as they should office; this office is asked by the Fed- have been. There is a reason for this. eral Government to enforce the State Horace Greeley once said that people law (1) for the protection of our were interested only in the own people; (2) for the protection of unusual, and not in our own army, and (3) in considera- the usual. He gave an tion of at least $15,000 worth of assist- illustration of this. "Mr. Smith went ance on the part of the Federal Gov- down the street yesterday, met a dog, ernment in a praiseworthy and sincere and the dog bit him." This, he said, effort to make the quarantine law of is not news and does not interest, be- North Carolina effective. The Board cause it is the usual thing for dogs of Health will soon have from four to to bite. But, if "Mr. Smith went down five additional field men at work in- the street yesterday, met a dog, and vestigating violations of this quaran- bit the dog," it would be news and tine law, especially failure on the part of interest because it is unusual. of the physicians to report contagious It has always been the usual thing diseases. A 1 1 violations will be for promptly and fully prosecuted. An individuals to neglect their health embarrassing but unavoidable obliga- and become defectives, and nobody tion to bring these prosecutions rests not even one of the individuals—was upon the Board of Health. interested. But at present the per- W. S. R. sonal health of the individual has be-

come an important factor in the life of PERSONAL HYGIENE AND FIRST the Nation, and it has become more AID MEDICINE than ever the patriotic duty of every citizen to observe the rules of personal Personal Hygiene is a subject in hygiene and keep in good health. which every citizen of North Caro- Under the new plan lina should be vitally interested at the of editorship of the present time. Our Nation is taking Bulletin it is our aim to make an increasingly important part in the the Department of Personal Hygiene greatest war of all history. We are very practical. Each month there will called upon to defend the essential be items of interest regarding the things underlying our government, the more important phases of the sub- great principles of democracy. The ject, and instances of benefit secured health of the Nation is one of the through the practice of personal hy- most important phases of national de- giene will be cited, and attention will fense. While in ordinary times there be given to First-Aid Medicine. There is a responsibility resting upon every will also be news regarding the prog- citizen to maintain good health, in ress of health work in the State, time of war this responsibility is especially as it relates to measures by which enormously increased. The extent to individuals may acquire and preserve their health. In which we, as a Nation, live up to this a word, the object of the department will be the responsibility may even determine the same as that of all public health outcome of the war. President Wilson work—the prolongation of life and the has said: "It is not an army that improvement in the health and happi- we must shape and train for it war; ness of all the people. is nation." a B. E. W. The Health Bulletin 33

IN THE TOILS OF THE LAW

PEOSECUTIONS BROUGHT BY THE STATE BOARD OF HEALTH DURING THE MONTH OF JUNE, 1918

Cause 34 The Health Bulletin

against Dr. J. B. Smith, of Pilot Moun- Now, frankly. Doctor, do you not tain, North Carolina. Dr. Smith was think we ought to publish names? indicted for not reporting three cases Very truly yours, of measles and one case of typhoid W. S. Raxkin, M.D., fever. The public, having no official Secretary. knowledge of these four foci of infection, had taken no action to restrict PROSECUTING DOCTORS the spread of the diseases. It is impossible to know, and it would be very Reply to a Letter from a Physician interesting to investigate and find out, Convicted of Violating the Quar- just how many secondary cases, and antine Law possibly deaths, resulted from these Deau Doctor: — I have your letter of four uncontrolled foci of infection. July 10. and appreciate the fine spirit The justice of the peace before whom of the letter. the indictment was brought was a I regret very deeply to learn that man named R. E. Smith, of Pilot Town- one of the inspectors of the State ship, Surry County. His Honor's judg- Board of Health was enabled to secure ment was: "Judgment suspended upon evidence sufficiently convincing before payment of cost and during good be- the courts to prove that you had vio- havior." The cost was 95 cents; that lated the State quarantine law. is to say. 23->4 cents per violation. The The Board of Health (1) is required Board of Health in this case was rep- by the laws of the State to enforce resented by a young man who had not the quarantine law; (2) having ac- had much experience in bringing in- cepted about $15 000 worth of assist- dictments. "What should have been ance from the Surgeon General of the done in this case was to bring an in- United States Public Health Service dictment against the doctor on one and the Surgeon General of the Army count, and the representative of the for the enforcement of the quarantine Hoard of Health should have stated to law, the Board is obligated to these the justice that unless a fine of not Federal agencies to enforce this law; less than $5 or $10 and cost was im- (3) the Board is bound, by ordinary pocad, the Board would bring three moral considerations, to see that the more indictments and before some public is protected against the spread other justice of the peace or, perhaps, of contagion in so far as the State laws appeal to the Superior Court. How- can give this protection. ever, the least we can do under the The inspectors of this Board are circumstances is to hold up this jus- sent out instructed to investigate and tice of the peace by calling out his find violations, and NEVER to dis- name in public for whatever credit criminate in bringing indictments, but his acute sense of justice may bring to to indict every doctor found guilty him. of a violation of the quarantine law. Then there are two reasons. Doctor, We have indicted ex-presidents of the why the State. Board of Health insists State Medical Society, members of the on publishing the names of persons State Board of Medical Examiners, violating the State health laws: (1) some of our best friends in the profes- To warn and protect others disposed sion, physicians to whom we are ob- to be careless with respect to obeying ligated for both official assistance in the public health laws: (2) to let the building up the health work of the people see how some justices of the State and physicians to whom we are peace are assisting their State Board personally obligated. We make no dis- of Health in protecting them against criminations. Executive officers rarely contagion. ever get into trouble by enforcing The Health Bulletin 35

laws; the danger in the administra- sons why physicians do not report communicable diseases. One reason is tion of law is in discrimination, in } carelessness. Carelessness is the rea- treating one man differently from an- I son the high-class, law-respecting, ethi- other. long as we are able to say ] As cal physician fails to report his com- that we prosecute every KNOWN vio- municable diseases. Some of the finest { spirits of the profession fail to report lation of the quarantine law regardless because they are careless in this mat- the standing of the physician, we of ter of public duty. Carelessness is can keep our heads above water. But such an inherent part of the nature if we prosecute this man because he of all of us that we all sympathize its mistakes; however, should has no influence in the medical pro- with we not be blind to its effects. Carelessness fession and in the State, and avoid pro- is that which often robs tender in- secuting the man who has such infancy of its only support and closes fluence, we would soon become hope- the eyes of the young mother on a new world of bliss. Carelessness is the lessly submerged; moreover, you can thing that burned Chicago; that caused that the State cannot per- readily see the Baltimore conflagration; that burns mit the question of motive to deter- up millions of dollars worth of prop- mine recourse to the courts, for mo- erty every year. Carelessness causes practically all epidemics. Carelessness tive is a factor that can be accepted in the form of national indifference is what a man says, or rejected only by the only danger that confronts democ- and unscrupulous physicians, the type racy in this judgment day of govern- that should feel the hand of the law, ments. for the failure of would all escape. "The other reason physicians to report communicable dis- letter you say that you are In your eases which occur in their practice is "persuaded that hundreds of cases go a more sinister one. There are a few deliberately unrep'^''*^pd through ignorance or neg- mercenary physicians who attempt to capitalize the socially near- I think few. if any. through lect — sighted and ignorant by not reporting maliciousness—on the part of the phy- them for quarantine. In this way the sicians of North Carolina." It is not mercenary places the ethical physician ignorance. Doctor. Families may fail at a gross disadvantage, for it is grossly disadvantageous for law abid- to report their cases of contagion on ing doctors to have their patients account of ignorance, but physicians placed under quarantine restrictions are not ignorant. They are taught in while the patients of law-evading doc- accus- the medical colleges, they are taught tors are permitted their full and tomed liberties. Under such a lop- in the text-books that they read in sided administration of law the near- their offices daily that they must re- sighted and the ignorant family leaves port their contagious diseases to some the better for the worse class of phy- impedi- public official for quarantine; that sicians, and law becomes an ment to virtue instead of an obstruc- quarantine is a public function. Phy- tion to vice. sicians have been notified time and "In conclusion, it may be stated that again by letters, by newspaper articles, the rigid enforcement of quarantine and Sulletin statements from this of- laws has two objects in view: (1)

fice, of their duty with reference to protection of the people against un- reporting contagious diseases. They necessary contagion; (2) the protec- law-abiding physicians are not ignorant. In discussing the tion of ethical, against mercenary, law-evading physi- reasons why physicians do not report cians. The first object of quarantine their cases. I stated in my recent an- administration is the public health; nual report as follows: the second object of quarantine administration is justice within the medical "The failure of physicians to report profession." cannot be excused on this ground Very truly yours. [ignorance]. The medical profession W. S. R.\NKiN. M.D.. would resent it. There are two rea- Secretary. — 8

PUBLIC HEALTH i^ND SANITATION

JSORTH CAROLINA'S Average typhoid fever death rate by TYPHOID PROBLEM North Carolina counties for the years 1914, 1915, 1916, and 1917: North Carolina's Typhoid Rate Com- Rate for St.\te . . . 30.3 pared ^Vith That of Other Ashe States 7.8 Jones 8.3 The following table is compiled from Yadkin 12.2 the death rates of the states of the Polk 12.5 Union that are sufficiently advanced in Alleghany 12.9 Caswell intelligence and sanitation to appre- 13.4 Cherokee 14.3 ciate the importance o f properly Montgomery 14.5 drafted and enforced vital statistics Jackson 14.5 laws—in short, those states with vital Randolph 14.8 Northampton records that are accepted as correct by 15.2 Moore 15.5 the Bureau of the Census of the Fed- Alexander 18.8 eral Government. The rates quoted Alamance 18.9 are the average rates for the last Burke 19.1 Brunswick three years for which reports are avail- 19.6 Stanly 19.9 able, namely, the years 1913, 1914, and Graham 2^ 1915: Sampson 20.9 1. Wisconsin 6.7 Rutherford 21.3 2. Massachusetts 7.4 Wilkes 21.6 3. New Jersey 8.1 Anson 21.7 4. Rhode Island 8.8 Yancey 22. 5. New York 8.9 Madison 22.3 6. Minnesota 9.2 Surry 22.3 7. Washington 9.3 New Hanover 22.5 8. New Hampshire 9.4 Iredell 22.7 9. "Vermont 10.8 Transylvania 23.3 10. Connecticut 12.6 Carteret 23 i 11. California 13.0 Gates 2,'?. 12. Maine 13.8 Granville 23.8 13. Michigan 13.8 Union 23.9 14. Pennsylvania 14.4 Franklin 24.2 15. Kansas 14.5 Buncombe 24.4 16. Colorado 15.5 Craven 24.5 17. Montana 16.9 Davie 24.6 18. Virginia 18.1 Lincoln 24.8 Bertie 19. Ohio 18.7 [ 25^5 20. Indiana 20.4 Dare 25.5 21. Mississippi 21.2 Stokes 25.8 22. Maryland 27 1 Bladen 26. 23. NORTH CAROLINA. 31.9 Chatham 26.5 24. Kentucky 38.2 Nash 27. "Thank the Lord for Kentucky." Rockingham 27.3 Vance 27.4 Person 28. THE SANIT.4RY INDEX OF NORTH Tyrrell 28^ CAROLINA Macon 28.5 "Typhoid fever is everywhere an Harnett 28.6 INDEX of the sanitary INTELLIGENCE Henderson . . 28.6 Cleveland ... OF A COMMUNITY." Sanitary axiom. 28.7 Johnston 28.8 The Health Bulletin 37

Haywood 29.2 that casts the shadow is limited; that Hertford 29.6 the light of intelligence is shining Pender 29.9 upon this cloud and is gradually, Cumberland 30.1 Hoke 30.1 steadily dissipating its noxious vapors; Robeson 30.1 that the shadow is lifting. Onslow 31. Sanitary ignorance and carelessness Orange 31.1 (but carelessness is the child of ig- Watauga 31.1 Wake 31.8 norance) cause typhoid, and, con- Clay 31.9 versely, sanitary intelligence and the Mitchell 32. proper appreciation of human life (but Halifax 33.6 the latter goes with sanitary intelli- Davidson 33.6 Hyde 33.9 gence) will eliminate typhoid fever Mecklenburg 33.9 from the list of diseases. Gaston 34.1 Beaufort 34.3 Edgecombe 34.3 RESPONSIBILITY FOR TYPHOID Rowan 34.6 Warren 34.7 FEVER Camden 34.9 What Are Responsible Duplin 34.9 Catawba '. 35. The most important fact for any one Avery 35.5 to know about typhoid fever is that Cabarrus 36.1 the disease is caused by the swallow- Guilford 36.7 Washington 37.3 ing of human excreta, and is con- Forsyth 37.6 tracted in no other way. It is true Caldwell 38.6 that the excreta is usually in such McDowell 39.1 small amounts as not to be detectable. Columbus 39.2 Pitt 40.1 The excreta is taken in through the Pamlico 40.5 mouth in either water or food. Greene 41.9 Water may be contaminated with Pasquotank 42.4 human excreta (a) when well Swain 43. the or Richmond 43.1 spring is so placed and so imperfectly Durham 43.4 constructed and protected that surface Wilson 46. washings during a rain from a place of Currituck 47.8 deposit of human excreta flow Scotland 51.6 toward Lenoir 52.8 and enter the water supply; (b) by Wayne 54.3 percolation or infiltration through the Chowan 54.6 soil from an open privy toward a well Lee 59.2 or spring located dangerously near, Perquimans 60.2 Martin 61. that is, within 75 feet; (c) by the dropping of visible or invisible amounts of human excreta from soiled shoes or PfORTH CAROLINA WI>M>G IN feet through a n imperfectly n- THE FIGHT AGAINST TYPHOID c o structed well cover on which those us- In 1914. 839 deaths in the State ing the well may stand. from typhoid; rate 35.4 Food may be contaminated (a) with In 1915, 744 deaths in the State small amounts of excreta brought to from typhoid; rate 31.3 In 1916, 700 deaths in the State the food by the hands of some person from typhoid; rate 29.1 who has been nursing a case of ty- In 1917. 626 deaths in the State phoid fever; or (&) by the hands of from typhoid; rate 25.7 some person who has had typhoid fever The above table is the silver lining in recognizable or unrecognizable form to the typhoid shadow that rests upon years before and who still carries and our State. It means that the cloud discharges the typhoid germs from his 38 The Health Bulletix

intestines, that is, by a "typhoid car- number of open privies in proportion rier"; (c) by flies contaminated with to the population, that is, in the small, the human excreta from some open unsewered towns and cities of the privy within from 200 to 500 yards of State and in the suburban, unsewered the exposed food. sections of our larger cities, where, The next most important fact for 'instead of one privy being within fly any one to know about typhoid fever range of a home, there are from six is this: THE DANGER OF TYPHOID to a dozen privies so located. FEVER TO ANY UNVACCINATED The above statement with respect PERSON IS IN DIRECT PROPOR- to the variation in typhoid death TION TO THE NUMBER OF OPEN rates, in so far as the privy factor is PRIVIES AND THE NUMBER OF concerned, is in full accord with the FLIES WITHIN 500 YARDS OF evidence contained in the table show- THEIR EATING PLACE. This fact ing the typhoid death rates of differ- explains the variation in the typhoid ent counties, on page 36 of this BrL- death rate in (1) different communi- LF.Tix. One familiar with the distri- ties in North Carolina and (2) dur- bution of the population of this State ing the different months of the year. will recognize that the counties with Relation of Typhoid Fever to Priv- lowest death rates are counties with ies.—The lowest death rate in North the largest percentage of purely rural Carolina occurs where there are fewest residents. The counties with medium privies in proportion to the population, death rates are counties in which the that is, in the sewered section of our low rate of sewered communities off- larger cities. In these communities set the high rate of unsewered subur- there are no open privies. The next ban districts and small towns and lowest death rate from typhoid fever cities. The counties with highest in North Carolina occurs where there rates are those in which the highest are next fewest open privies in propor- percentage of unsewered village and tion to the population, that is, in the town populations live. purely rural sections of the State. Relation of Typhoid Fever to Flies.— Here there is but one privy within Typhoid fever in North Carolina comes fly range (within from 200 to 500 and goes with this messenger of death, yards) of the average home. The the typhoid fly. In support of this highest death rate from typhoid fever statement are the facts of the fol- occurs where there are the largest lowing table: MONTHLY TYPHOID DEATHS IN NORTH CAROLINA FOR THE FOUR YEARS 1914, 1915, 1916, AND 1917

1914 1915 1916 1917 Total

January 31 February.- March April May June July August. September. October November. December. _

Totals. —

The Health Bulletin 39

In this table we see the smallest ammunition from open, unsanitary number of typhoid deaths during the closets; thus we see that THE PRI- flyless months, November, December, MARY FACTOR IN NORTH CARO- January, February, March, and April LINA'S TYPHOID RATE IS THE typhoid deaths due to cases contracted OPEN-BACK PRIVY. The secondary from polluted water supplies, from factor is the ordinary house-fly. the hands of persons contaminated The time is ripe, overripe, when the from some case of typhoid fever that State, through its General Assembly, such a person has nursed, or from the should outlaw the open, unsanitary hands of a person who is a "carrier." privy. The next Legislature is likely During these flyless months the aver- to be asked to do this. age number of deaths from typhoid Who Are Responsible? fever in North Carolina is 29 deaths per month. Then come the flies, The county commissioners are the steadily increasing until toward the most responsible people in North Caro- latter part of August, when they de- lina for typhoid fever. That is a crease in number, and during these severe charge, and one that ought not six fly months the average number of to be made unless the facts will war- deaths from typhoid fever in North rant it. What are the facts? Carolina per month is 95 as against Well, first, the larger responsibility 29 during the flyless months. See of county commissioners: County illustration below. The case against commissioners are responsible for the fly is overwhelmingly conclusive. rural North Carolina, and rural North But the fly would be harmless if he Carolina is 90 per cent of the popula- were unarmed. He gets his deadly tion of the State. The responsibility

Monthly Variation in Typhoid Deaths (N. Coverage for 4 years)

High rate in summer and fall due largely +o flies cominq from open-back privies +o unscreened houses. 138 >4I

Jan. Feb. Mar Apr. May Jun. July Aug. Sep. Oct. Nov. Dec. —

40 The Health Bulletin

of county commissioners to the rural army is good protection for the civil-

people is for both property and life, ian. Then, if it is not money and it is but responsibility for human life takes not ignorance, why do the county com- precedence over responsibility for missioners, when they can reduce property, for is not life more than their typhoid death rate, not do it? meat, and the body more than raiment? Simply because they are not interested. County commissioners are responsi- But this absence of interest on their ble for typhoid fever because they part does not in any way modify the could prevent it, or prevent a large fact that they can greatly reduce their part of it, i/ they would. The method county's typhoid death rate, and that

of prevention is cheap; it is simple. if they do not reduce it, they are re- It is too cheap and too easy for any sponsible for its being unnecessarily board of county commissioners to be high. able to say that they could not do it. Mr. Citizen, if you agree with your Let us see if this is not so. State Hoard of Health, cut this out A board of county commissioners and mail it to one of your county com- can employ some doctor living in the missioners. It may do some good county, at $1.50 an hour for 4 hours a and it may not; however, the world in trying, and a week, that is, $6 a week, and this for do move; no harm chance only costs a 3-cent postage fifty-two weeks in the year is $312, to vaccinate citizens of .the county who stamp. apply for free typhoid vaccination. The State will furnish the vaccine RULES FOR 3I0THERS without charge. The county commissioners can arrange with the doctor Don't pin on baby's diaper or band doing the vaccinations for him to meet too tightly, as it may cause deformity the people in several places in the and is often the cause of vomiting. county instead of having all of the Don't handle the baby too much. people to come to the county seat. Don't let little children sit on the For a little additional cost for some floor on cold days, or in a draft be- newspaper notices and for some prop- tween open door and window. erly gotten up placards, the people of Don't walk the floor with your baby. the county can be told of their oppor- Don't let him lie in a wet napkin. tunity for free typhoid vaccination Don't give him solid foods before he and what this means in typhoid pre- is one year old and then only spar- vention. Certainly, for a total sum ingly. not exceeding $500 a year, the average Don't feed the baby too often or too county can carry out a very compre- much. hensive plan of typhoid vaccination. Don't pick him up every time he So we see that the reason county cries. commissioners do not protect their Don't put too many clothes on the people by anti typhoid vaccination is baby during warm weather or too few not money. It is not ignorance. No during the cold weather. county in North Carolina at this time Don't let baby's hands and feet get has a board of county commissioners cold. that do not know something about ty- Don't let a child put playthings or phoid vaccination. They know that other objects in his mouth. there is not an army in the world that Don't use milk unless you are sure is not protected, absolutely protected, that it is clean and pure. in this way, and they ought to know Don't give medicines or drugs with- (as a matter of fact, they do know) out the doctor's advice. that what is good protection for the Avoid soothing syrups. TALUE OF LIFE EXTENSION WORK The necessity of having every adult examined In the examinations of the first draft regularly in order that he may if about one-third of all the young men know there is any incipient disease called and examined were rejected be- or any defects which may impair cause of physical defects. The causes his health and decrease his working of rejection were many, chief among capacity is evident. And in order to them being eyes, teeth, underweight, meet this necessity the State Board of feet, heart, overweight, ears, tubercu- Health is preparing to inaugurate in losis, undersize, injured and amputated the counties cooperating with the Bu- limbs, syphilis, debility, hemorrhoids, reau of County Health Work a unit and rheumatism. A study of the known as Life Extension Work. causes shows that probably three- The Life Extension Unit is closely fourths of the conditions could have modeled after the work being done by been prevented by proper personal the Life Extension Institute. The hygiene or by medical or dental treat- health officer sets aside one or more ment if this could have been obtained days each week for the examination in time. It should be remembered of citizens that the above statistics are for young who may apply at the health men between the ages of 21 and 31 department. The purpose of the ex- years. If the higher age groups (31 up amination is to detect disease in its in- to 61 years) of both sexes should be cipiency, to find minor defects which examined, there is no doubt that the may impair the citizen and decrease number of those found defective would his working capacity, and urge medi- be much larger. cal attention before the condition may Among our many weaknesses that become serious or permanent. Where have been brought to our attention by medical o r surgical attention i s the war. none is more alarming and in thought necessary, the patient is re- need of correction than the fact that ferred and chooses his own physician. a large majority of our citizens in the Of course, no treatment is given by very prime of life are physical defec- the health officer, but each person ex- tives principally because of neglect of amined is given a report, with verbal personal hygiene. This is a more seri- and printed advice together with suit- ous problem than it appears to be. able literature on the health conditions The mental devolopment is largely de- in which he is interested. pendent upon the physical condition, At present the following nine coun- and the loss in efficiency which must ties are cooperating with the State result from such physical conditions Board of Health in the development is no doubt a serious handicap to our of county health departments: David- educational and industrial develop- son, Forsyth, Lenoir, Nash, Northamp- ment. ton, Pitt, Robeson, Rowan, and Wilson. 42 The Health Bulletin

take so much trouble to DANGER I> ILL-FITTING SHOES necessary to train the soldiers in the care of their and the correction of foot trouble. A recent publication of the Life Ex- feet Note that bad as the men's shoes are. Institute of New York (-How tension the women's are far worse and palpa- To Live" for May, 1918) has the fol- bly deforming. lowing to say about shoes: "It is a woman's duty to be a good angel, and most of our women are, God "Foot arches should never be worn. bless them! But crude as it may They bring no real benefit, but in- sound, it is a woman's duty to be a crease the weakness and disability and good animal as well as a good angel, are not permitted in the army. The and no woman is a good animal who exercise most highly regarded in the has deformed, unsightly, feeble, feet treatment of flat foot among soldiers that jangle her nerves. great is as follows: "Men and women who stand a '•Stand with feet parallel and some- deal should keep the feet well apart what apart with great toes firmly grip- and parallel, pointing straight for- ping the ground. Without bending the ward. Rest first on one foot and then knees or moving the feet, rotate the on the other; much fatigue wall thus thighs outward repeatedly. This is be avoided." chiefly done by strong contraction of the great muscles of the back of the thigh and seat. CONSTIPATION "Exercises that involve curving in- Very few people recognize the seri- ward of the feet and raising of the inner margin of the foot are particu- ousness of constipation, and a still larly valuable. Most foot arches found smaller number know that the lack of a exert a contrary effect. in the shops privy is one of the chief causes of con- The modern treatment is by proper stipation (especially among the wo- exercise, manipulation of the foot to overcome adhesion, stiffness, etc, and men) in the rural homes of North the practice of proper posture in daily Carolina. A privy—and a sanitary one walking, that will prevent typhoid and infant 'In measuring the feet for shoes the diarrhea, at that—would cost less, in soldier stands with his full weight on one foot on a flat board with a slid- many instances, than the money spent ing block. Measurement is also taken each year by the average family for on his back. with a forty-pound weight patent medicines and remedies for con- A shoe two sizes larger than the actual stipation. Osier, in his "Practice of measurements of the foot is chosen to allow proper foot play and for sock. Medicine," states that chronic consti- In the shops the sizes are deceptive. pation is the direct cause of many gen- are numbered To cater to vanity they eral symptoms, such as debility, lassi- somewhat smaller than the actual size, tude, mental depression, headache, and also the measurement is taken with the customer sitting, and does not al- loss of appetite; while in women it low for the expansion of the foot or may, and often does, cause painful The bearing the weight of the body. menstruation, congestion of the pelvic army shoe, Munson last, is a good shoe organs with leucorrhea, and neuralgia and can now be found in the shops. Its inner edge is not exactly straight, of the sacral nerves. Also, in women, but it is a decided improvement over it is one of the most frequent causes Other types of the conventional shoe. of digestive disturbances, with nausea shoes conforming to the normal foot and vomiting. The Life Extension In- can be had if you insist upon it. Those approved by the American Posture stitute's publication, "How to Live." Leiague can be procured by any shoe- says about constipation: maker. "Take a shoe census on the trolley "The injury which comes from the products car. Note how few people have shapely retention of the body's waste The feet free from large joints; note how is of the greatest importance. few wear proper shoes with straight intestinal contents become dangerous inner edge and no outward curve. by being too long retained, as putrefy- poisons You will then understand why it is ing fecal matter contains The Health Bulletin 43

which are harmful to the body. Ab- found out that gardening is a most conditions of the intestines are normal pleasurable and healthful means of largely responsible for the common recreation. headache malady, and for a generally lowered resistance, resulting in colds Those who merely eat food and do and even more serious ailments. Con- not create it are missing a lot. There stipation is extremely prevalent, partly is a peculiar mental as well as physi- because our diet usually lacks bulk or cal benefit to be obtained from other needed constituents, but partly garden- also because we fail to eliminate regu- ing. It is much like fishing—only larly, thoroughly, and often. more certain. The mind is rested and "Constipation, long continued, is by the muscles are brought into play. no means a trifling matter. It repre- While working his garden the tired sents a constant and cumulative tax which often ends in very serious con- business man or office assistant is sequences." made to forget the cares and duties of his routine life and, if he proper It is a well-known fact that chronic has imagination, will have aroused in him constipation is more common among an appreciation of the marvelous country women, and it has been proven workings of nature. For the fat and that the condition is more prevalent the lazy, gardening supplies in homes without privies. The reason a method of health regimen more easily fol- for this is due in a large measure to lowed than any system of the fact that (to quote again from gymnastic exercises ever devised. "How to Live") "the natural instinct with helping the to defecate, like many other natural Along Government, we should take advantage of the war instincts, is usually deadened by fail- and secure for ourselves and our fami- ure to exercise it. The impulse to lies an increased knowledge of per- defecate, if neglected even five minutes, may disappear." In homes without sonal hygiene and sound and healthful standards and ways of living. privies it is often difficult, or even impossible, for women to have regular times for the important call of nature, A CONFESSION especially in winter and in rainy I am a murderer! weather. Because of unsuitable condi- I play a safe game. I scatter dis- tions they neglect the impulse, and ease germs in halls, in the street cars, constant neglect brings chronic consti- wherever there is a crowd. pation and the evils with which it is attended. Few people suspect me. I am never No rural home can better conserve detected. its health and its money than by I kill babies, children, grownups, building a sanitary privy. Write to impartially. Hundreds of hospitals the State Board of Health for a bulle- are filled with those I do not succeed tin on the subject. in slaying. Thousands of graveyards are filled

with those with whom I have more suc- HYGIENIC VALUE OF GARDENING cess. I am ruthless and cruel. Yet I One of the greatest lessons taught could be restrained if people really un- by the war is that by complying with derstood how much harm there is in the food regulations we kill two birds me. Instead of that they think I am with one stone—conserve and help win funny and laugh at me. Some of them the war and at the same time benefit even cry the German word for "health" our digestion by the use of a more when they hear me. rational diet. And many of us have For I am a SNEEZE! learned more than this. We have —Arizona Health Bulletin. ' :

=^^^^^^0<^

PREVENTIYE DEMISTRY propaganda. I shall not touch the field of pathology. I am not a dentist, and George M. Cooper, M.D., By so would make myself ridiculous be- Director Bureau Medical InspectiorTof fore a body of experts. One thing, Schools, N. C. State Board of Health. however, I do want to emphasize as before the North Carolina Dental (Paper read strongly as possible, that nine-tenths Society at Wrightsville, June 20, 1918. of so-called indigestion is due to im- In the beginning, I want to express with the resulting teeth my appreciation for the honor con- perfect teeth diseases. The teeth compose the very ferred by the invitation to take a part gateway to the alimentary tract. The in your meeting, and to assure you at mouth is the beginning of trouble. the outset that I have not come for the purpose of preaching to you or at Frequency of Dental Decay you. But I come to frankly and honestly discuss with you a program Among the policyholders of the " which is of vital importance to every Metropolitan Life Insurance Company citizen of North Carolina present and in 1917 fifty-two deaths occurred from prospective, but of especial importance diseases of the teeth and gums. But to the children, who, after all, repre- the most significant part of this record sent our State's greatest resource. is that seventeen, or onethird, were of Some of you have probably wondered children under fifteen years of age. what I mean by the term "Preventive Working in accordance with the law Dentistry." I mean simply collective or requiring a medical inspection of community prophylaxis. I want to ask school children in North Carolina, the you to consider the matter exactly as teachers made the preliminary exami-

I would ask a body of health officers to nation for something like 175.000 school consider the prevention of typhoid children during the last school year. fever, for instance. Here are a few of the results taken at random Necessity for Prevention A school of 23 pupils in Lenoir County had 19 children reported with It is an inviolable law of Nature teeth, average age 12 years. that nothing ever stands still. A leaf decayed Only two had ever consulted a dentist. is either growing or rotting. A plant Forsyth County a school of 51 grows or dies. In pupils had 44 with decayed teeth; 23 I have been telling the mothers, and of them, or nearly half, were 12 years teachers, all over North Carolina that over; 27 per cent of them the age to begin taking a child to a old and were over 14 years of age. All per- good dentist is six months old. A dent- teeth affected. Only three of ist told me a few days ago I was manent wrong. He said that the time to be- them had been to a dentist. gin was with the child's grandmother In Guilford County the health officer every at six months of age. He is everlast- examined a school and found per ingly right. And so I hope every dent- child in it with decayed teeth 100 a perma- ist here will agree with me that it is cent bad. Every child had per time to start a systematic educational nent tooth involved. Less than 10 The Health Bulletin 45

cent had visited a dentist during their years and who now have perfectly lifetime. good teeth. I it In an examination which I had made know can be done. Persistence and patience is all the requisite. myself for one of the larger cities of the State we found 1.088 children out Results of Neglect of Teeth of 1,638 examined having remediable dental defects; 325 of them being over If this is not done, what? As said 14 years of age. above, most so-called indigestion is one These figures can be duplicated in result. Cancer, tuberculosis, appen- any city, town, or school district in dicitis, rheumatism, arthritis, diseased the State. tonsils, stomach ulcer, heart disease, constipation, deformed mouth, physical Proof That This State of Affairs discomfort, decreased productive capac- Can be Prevented ity and general unhappiness are some So much for the frequency of of the direct results to be expected. trouble. Now, can it be remedied and Need for prevented in the future? Dental Education A member of the Executive Staff of The first essential is to get the pub- the State Board of Health told me re- lic to realize these truths and get them cently that he took his 2-year-old child to take action. I mean the people, the to see a dentist, and the dentist refused folks, the 90 and 9 per cent that are to look in the baby's mouth, stating out on the farms and in the mills and that it was not necessary to treat a factories. But "How shall they hear child's teeth under 14 years of age. I without a preacher?" The facts must am a living example of the fact that be continually and persistently pre- if something is not done vigorously sented to them. But how can this be and persistently for about half of all done? Dr. Brady says that a "good children's teeth before 14, few of them dentist does not conduct a bargain will have a sound tooth of their own counter." If a patent medicine man at 30. sells his stuff he advertises—and lies. If a politician ofl5ce, Here is where the grandmother wants and he al- does, theory comes in. Numbers of people, ways he goes out and asks for votes, owing to generations of bad heredity and buys and steals what he or wrong living environment, have cannot otherwise get. But a physician blood and bone deficient in certain and dentist cannot go out and ask for patients. advertising al- chemical elements, such as lime salts. Their must To treat these people successfully ways consist of a job well done when every dentist must begin on the child the patient comes. But the rub is get- soon after birth. Must have a good ting the patient to come at the right knowledge of physiology, chemistry, time if at all. and of food values, or, what is better, Plan of Campaign must have a physician consultant upon A whom he can rely. At least two of the "We have already shown that at least best dentists in North Carolina have 95 out of every 100 persons In North informed me that they have the living Carolina over six months of age need proof that not only one isolated case, dental treatment. "We are equally sure but literally hundreds of them, from that in all matters of this kind the families of notoriously bad teeth on only strategy worth while is to begin both sides, have been coming to them on the children, especially the group from babyhood for the past twenty masses of school children. 46 The Health Bulletin

course. We will have difficul- We have worked out a plan by which there, of and obstacles to overcome. we propose to begin this year the offer ties past there have been many of free dental treatment of a limited In the in North Carolina to get at this class to school children regardless of efforts but every case so far as social or financial standing. We al- proposition, in failure. We ready have this work started in one I can find out resulted of course, profit by those mis- county, and it is taking the combined shall, efforts failed chiefly for efforts of the State and county health takes. Those departments and the dentists to get two reasons: First, the dentists of- services free, and, second, the people out to take advantage of fered their proposed to treat only the chil- free treatment. But that is exactly they Both propositions what we expected. If the present dren of the poor. In the first activities of the State Board of Health were radically wrong. had been put into effect suddenly ten place, dental work like any other pub- years ago we would have been mobbed lic health question is worth paying for in the by the profession and the public. as a public proposition, and, Now, with the assistance of the dental second place, whenever you start out card profession, we hope to begin just such to divide people into classes and an educational propaganda. I had the index a proportion of them as indigent, trouble. This privilege of helping direct the first you are out looking for less a public great campaign in 1915 against typhoid work is not one whit typhoid vaccina- fever. And the same methods that got health necessity than treat- 52.000 people vaccinated by our force tion or giving free hookworm typhoid that summer will get 5,000 children ment. Now, suppose in our sent out notice that treated by the dentists, if we have the campaigns we had same support from the dentists we had treatment would be given free to the from the physicians in that effort. poor, and the others could get it by their private physician's office We are proceeding on the principle going to paying $5 for it. Would we have that you gentlemen have failed to get and vaccinated 52,000 people the first sum- the mountain to Mahomet, and so would not have seen a Mahomet must go to the mountain, mer? No; we dozen. We made our effort then to get that is, the people. The plan is strictly the richest people in every dispensary ethical. We pay a young dentist a district to come first; they came, and small salary, send him out in the coun- so did the rest. This is exactly what try with the health officer with a fold- must be done if our dental compaign ing army chair and let him do dental succeeds. work among the people. No expensive gold or bridge work, etc., will be of- Logic of This Procedure fered, but the simpler forms of treat- Now, the logic of this method is as ment, which in the case of amalgam plain as daylight. Every big man in fillings will last a lifetime. This work profession was quick to In the summer is to be followed where the medical years possible by the installation of a per- see it when we began a few manent dental infirmary at the county- ago. We had a few physicians in al- seat town, to be open throughout the most every county to protest that we practice. year certain hours each week, free to would ruin . their private school children, especially those six to These same men look silly now when eight years old. This is bound to be asked about it. Why? Because the phy- a success, because it is founded on work was educational and the fundamentally correct principles. We sician is now called on oftener and at expect to make mistakes here and a time when he can accomplish some- The Health Bulletin 47

thing and when the patient is able One big reason why dental propaganda to pay him for the service, and not is hard to make popular is the morbid simply called in to sign the death fear of pain, and I am convinced that certificate. the dentists themselves are partly to "With living material in North Caro- blame for this attitude. I recall that lina sufficient to keep busy ten times several years ago I had a troublesome the number of dentists you now have tooth, as usual, and consulted my dent- for a lifetime, you cannot fail to see ist friend. He is a splendid dentist, the sound logic in any plan which good man and loyal friend, but pro- helps make a dental convert out of a fessionally cruel as a German. He. young school child, and therefore as- looked at my molar, and bluntly stated sures to some dentist a patient for that the nerve must come out, and, life which would otherwise go to the suiting the action to the word, he country physician for treatment or placed his instrument and with a extraction when suffering with tooth- mighty blow of the hammer nearly ache. killed me. Oh, yes, he got "the" nerve and "my" nerve, too. Trouble was, Support of Leading Dentists an it would have taken fifteen minutes of Absolute Essential his time to have obtunded the nerve Unless we have the sympathetic, un- terminals, and he was in a hurry to go selfish, enthusiastic support of all the home. Now, I hold that such an act is leading men in the dental profession criminal, because there was no neces- our work will be a failure. It is true sity for inflicting pain. Give me my you will be building the bridge for chance of going back into his chair those who are to come after you. again or going over to the big electric But— chair at the Capital, I would take the latter without a quibble, because death ''The icorks of God are -fair for naught would be mercifully inflicted. Unless otir eyes, in seeing, Patience and tenderness are the See hidden in the thing the thought prime essentials of success with school That animates its being." dispensaries. But it is well worth all the efforts. Difference Between Trade and Eeward Profiession If this plan of work succeeds, the I hope I may be pardoned for call- reward to the dental profession will ing to the attention of young graduates, especially, that every young dent- be great, materially and otherwise. ist, no less than every young medi- The practice of every man will in- cal graduate, cannot remember too crease just in proportion to his ability. often that there is a world of differ- You will have the satisfaction of know- ence between a trade and a profession. ing that you have placed your profes-

The tradesman asks. "How much can sion on a plane of great service to all I get?" The professional man, if he the people. You will see in the years be true to his heritage, must ask, to come a material decrease in the "What service can I render?" death rate from many easily prevent- If we would be successful in treating able diseases, due directly to your ef- school children and get the great mass forts. The sum total of human happi- of people to grow up to the "dental ness and prosperity will be greatly habit" early, every dentist must make augmented. But your greatest reward it an invariable rule not to infiict will be the conscious knowledge of a pain unless it is impossible to avoid. duty well done. 48 The Health Bulletin

HOW TO GET TUBEKCCLOSIS consumptive has been coughing, sneezing or spitting. By so doing, one is Tuberculosis is caused by tiny germs very likely to inhale the fresh viru- which live and multiply in the human lent germs of tuberculosis sprayed out body. When these germs are coughed into the air by the consumptive. In up, sneezed out and otherwise dis- a closed room such germs may float charged by those having the disease, around in the air for hours. they are frequently carried to others The same principle applies to con- in one or more of the ways shown in tracting colds, pneumonia. "Grippe," the accompanying cut. Study this cut diptheria and several other diseases. carefully. On the other hand, we should avoid

HOW THE GERMS OF TUBERCULOSIS ARE CARRIED FROM THj: SICK. TO THE WELL

Tuberculosis germs deposiled on common roller towels and drinking cups, spread frequenHjf The germs the disease. ent-erl-he bodies of Consumptive spilling Spit on the floor dries, and careless on Hoor. children ploying on Flies Feeding on it.carry sweeping. dusting or draughts cause fhe floor, ^hroLlgh sores the germs of the disease well people to breathe in these germs. or wounds, or are carried to food- by the hands bfhe mouth. ^ih

JS"d&&fr<^

Kissing Frequently spreads breathing Others may gel- bhe diseose by the germs of tuberculosis Putting food. money, pencils and other or swallowing the germs. From the lips of the sict<. objects into rhe mouth. offer a con- Spray given off in sneezing or coughing, to ttie well. sumptive has poisoned them with contain germs in a moisfand active stale. his spih spreads the disease.

Germs of tuberculosis are much exposing others to our diseases known more active and likely to cause the or unknown. Whenever indoors or near disease when they have just been any one else, one should always cough coughed, sneezed or spit out than they or sneeze into a handkerchief or spit, are after they have been outside the when necessary, where it will harm human body for a week or more. No no one. By living outdoors and in the one should ever needlessly expose him- fresh air as much as possible any self by breathing dust from dried tu- dangerous germs which have been bercular sputum. It is highly danger- coughed, sneezed or expectorated into ous also to breathe in an atmosphere the air will be rapidly carried away, or in a close unventilated room, and the danger of infection greatly church, store or shop, where a careless reduced. fOLLFGf ,

NOTICE TO READER.—When you finish reading this magazine place a one-cent stamp on this notice, hand same to any postal employee and it will be placed in the hands of our soldiers or sailors at the front. NO WRAPPER-NO ADDRESS.

Published bn T/YE>^9R.mCAK9LUÂ STATE. DÂRDsÂE^LTA

BulMin.will'be 5er\t free to arvj citizeA of ihe State upor\ request !

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

Vol. XXXffI SEPTEMBER, 1918 No. 3

THE BADGE OF PATRIOTISM

DOES YOUR DOCTOR WEAR IT ?

THE INSIGNIA OF THE VOLUNTEER MEDICAL SERVICE CORPS MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

J. Howell Way, M.D., Pres., Waynesville Chas. O'H. Laughinghouse, M.D., Richard H. Lewis, M.D., LL.D., Raleigh Greenville M.D., Wilmington J. L. Ludlow, C.E., . . Winston-Salem Edward J. Wood, Thomas E. Anderson, M.D., Statesville Ctrus Thompson, M.D., Jacksonville E. C. Register. M.D Charlotte F. R. Harris, M.D., . Henderson Official Statf

W. S. Rankin, M.D., Secretary of the State Board of Health and State Health Officer. C. A. Shore, M.D., Director of the State Laboratory of Hygiene. Warren H. Booker, C. E., Chief of the Bureau of Engineering and Education. L. B. McBrayer, M.D., Superintendent of the State Sanatorium. J. R. Gordon, M.D., Deputy State Registrar. G. M. Cooper, M.D., Chief of the Bureau of Medical Inspection of Schools. A. McR. Crouch, M.D., Epidemiologist. B. E. W^ashburn, M.D., Director of County Health Work.

FREE PUBLIC HEALTH LITERATURE

The State Board of Health has a limited quantity of literature on health subjects for free distribution. If you are interested in one or more of the following subjects, or want same sent to a friend, write to the State Board of Health for free literature on that particular subject.

Whooping- cough Clean-up Placards Malar :tA Hookworm Disease Spitting Placards Smallpox Public Health Laws Sanitary Prfvies Adenoids Tuberculosis Laws Residential Sewage Measles Tuberculosis Disposal Plants German Measles Scarlet Fever Eyes Typhoid Fever Infantile Par.a.lysis Flies Diphtheria Care of the Baby Colds Pellagra Fly Placards Teeth Constipation Typhoid Placards Cancer Indigestion tuberclt.osis placards SEX HYGIENE BULLETINS Set a—For Young Men Set D—For Parents Reasonable Sex Life for Men. A When and How to Tell the Children. Sexual Hygiene for Young Men. Vigorous Manhood. Venereal Diseases—A Sociologic Study. Smash the Line. (The case against the The Need for Sex Education. restricted district.) List of Reliable Pamphlets. List of Reliable Pamphlets. Set E— Girls and Young Women Set B—For Public Officials and For Business Men Your Country Needs You. (Especially Public Health Measures in Relation to for girls 11 years of age and over.) Venereal Diseases. Venereal Diseases—A Sociological Study. Note.—For girls under 11, see Smash the Line. The case against the "When and How to Tell the Children." restricted district.) of "Your Country (Set D) ; portions The Need for Sex Education. Needs You" also may be read to A State-wide Program for Sex Education. younger girls. Girls 15 and over may Li.st of Reliable Pamphlets. be given "The Nation's Call to Young Set C—For Boys Women," at the discretion of the parent. Vigorous Manhood. (Especially for boys 12 years of age and over.) The Nation's Call to Young Women. Note—For boys under 12, see List of Reliable Pamphlets. "W^hen and How to Tell the Children" portions of "Vigorous Man- Set F—For Teachers (Set D) ; hood" also may be read to younger boys. Boys 15 years and over may be The School Teacher and Sex Education. given Bulletin "A Reasonable Sex Life Sex Education in the Home and High for Men" (see Set A), at the discretion School. of the parent. Venereal Diseases—A Sociologic Study. Sexual Hygiene for Young Men. Smash the Line. List of Reliable Pamphlets. The Need for Sex Education.

Any of the above will be sent without charge, Please send for only those bulletins for which you have definite use. Vol. XXXIV SEPTEMBER, 1918 No. 3

EDITORIAL

BREAKING SILENCE ON THE SEX right age and in the right way. Teach- QUESTION ers should understand the subject of sex hygiene in order that they may The Coimcil of National Defense and check the failure of parents to prop- the War Department have asked the erly inform their children. To the North Carolina State Board of Health teacher who will carefully read the to break our long silence on the sex article referred to, we feel safe in lay- problem. This official request of the ing down the challenge that he or she country is sufficient ; we heed. cannot point out any branch of knowl- Ever since our first parents realized edge taught in our schools that is of their nakedness and modesty was born, greater importance than a knowledge of the sex problem has been wrapt in si- the laws of sex and their relation to lence. With both the spoken and writ- development. Ministers should under- ten word concerning this problem re- stand this subject on account of its fun- stricted to almost prohibition, ignorance damental bearing on character. It is has naturally abounded, and the off- God's law that the physical (we have a spring of ignorance, disease and death, right to assume the perfect physical), have had a gala time in this large field should condition inspiration and become of public health. But the world moves, the means of spiritual life. If mini- things and conditions change, and war sters would realize this close relation accentuates changes. And so conditions between physical development and arising out of the war or, more truly moral and spiritual values, they would speaking, revealed by the war, demand be in a position to use more of the that the long maintained silence on the ounce of prevention in dealing with sex problem be broken ; that the light of sin, and would need far fewer pounds knowledge, through plain and, let us of energy in dealing with its grosser hope and we believe, inoffensive words, effects. W. S. R. be permitted to dispel the miasma of ignorance. MEDICAL INSPECTION OF This Bulletin discusses on page 64 SCHOOLS to page 71 the first phase, and by far the most important phase, of the sex We are publishing on another page of problem. The subject is one that the Bulletin this month a review of should receive an attentive hearing what has been accomplished under the from parents, teachers, and ministers. law enacted by the General Assembly of Parents should understand the sub- 1917, requiring a state-wide inspection ject of sex hygiene in order that they of all public school children every three may see to it that the proper infor- years. mation reaches their children at the The work has been a failure in a few 52 The Health Bulletin

individual counties, because the physi- graded school building and the latter cians who accepted the office of Medical in the courthouse. Each outfit costs Inspector have made little effort to per- about five hundred dollars. form the duties conscientiously. But The local dentists are giving substan- considered as a whole, the move has tial aid in this move. Thus the plans been an undoubted success. for giving all the State's little ones The most gratifying feature of the an even chance in life are meeting with year's work has been the uniformly abundant success. satisfactory work of the teachers of We need the moral support and en- thirty-two counties in completing the couragement of all the public spirited preliminary examination of the chil- citizens of the State, regardless of creed for the children. In all except two or three coun- or party, in this great work ties their work was well done. As a dren. direct result of the teachers' examina- Reader, may we have your active as- G. M. C. tions, and before the medical inspector sistance? could make a more expert examina- numbers of children have been tion, HAS YOUR DOCTOR ENLISTED IN etc., and taken to specialists, dentists, THE VOLUNTEER MEDICAL ; and literally hundreds of par- treated SERVICE CORPS? ents have become interested in the personal hygiene of their children. The design shown on the cover page To be entirely successful, medical in- of this Bulletin, worn on the lapel of spection must accomplish two things: the coat, is the mark that distinguishes First, teach applied hygiene; second, the doctor who has placed himself find the defective children and get them under the orders of his Government treated. from the doctor who has declined to Judging success by the above stan- do so. dards, the following represent the coun- Neither age, sex, nor physical condi- ties which should be placed in the honor tion debar a doctor from enlistment in column for a job well done: Madison, the Volunteer Medical Service Corps. Franklin, Gaston, Mecklenburg, Cald- If the doctor is ethical, if he is a grad- well, Hertford, Transylvania, Wake, uate of a reputable medical college, Martin, Guilford, Edgecombe, Nash, and if he is patriotic, he is enlisted in Northampton, Lenoir, Davidson, Robe- the Volunteer Medical Service Corps. son, Rowan, Forsyth and Wilson. The doctor who is a member of the On July 15th five excellent young Volunteer Medical Service Corps is one dentists were employed jointly by the who not only approves the selective State and County Boards of Health and draft for others, but who has applied set to work in five of the above named it to himself. He has agreed, in writ- counties offering free dental treatment ing, to permit the Council of National to school children. At the end of the Defense to classify him and to decide first week's work they had treated the whether he shall serve his country in teeth of 686 children. a civilian or military role during the Supplies have been ordered, and will war. He has placed himself under probably be in place by the time this orders. To him the voice of his coun- is published, for the equipment of two try and the voice of duty are in per- first-class permanent dental infirmaries fect harmony.—W. S. R. in connection with the schools in the towns of Kinston and Salisbury. The first named will be installed in the :::::

The Health Bulletin 53 IN THE TOILS OF THE LAW PROSECUTIONS BROUGHT BY THE STATE BOARD OF HEALTH DURING THE MONTH OF JULY, 1918

Cause. Defendant Judgment

Violation of Quarantine Law Dr. G. A. Brown, Mt. Ulla___ Guilty : $15 and cost. Dr. W. G. Taylor, Mooresville Guilty: $18 and cost. Dr. J. W. Wilkins, Mt. Olive. Not guilty.

Dr. T. L. Helms, Seagrove__ Guilty : $1 and cost. Dr. C. E. Wilkerson, Randle- man Guilty Payment of cost. Dr. L. M. Fox, Asheboro Guilty $10 and cost. Dr. C. S. Tate, Ramseur ___ Guilty Payment of cost. Dr. F. B. Spencer, Salisbury. Guilty $5 and cost. Dr. J. E. Smoot, Concord Guilty $3 and cost. Dr. A. H. McLeod, Aberdeen. Guilty $5 and cost. Dr. H. E. Bawman, Aberdeen. Guilty $5 and cost. Dr. J. S. Massey, Monroe Guilty Payment of cost. Dr. F. D. Quick, Rockingham Guilty Ic and cost. Dr. J. S. Perry, Hamlet Guilty $10 and cost. Dr. G. P. Reid, Forest City. Guilty $1 and cost. Dr. G. P. Reid, Forest City. Guilty $1 and cost. Dr. Frank Rolinson, Lowell- Guilty $1 and cost Dr. D. A. Garrison, Gastonia Guilty $1 and cost. Dr. R. E. Rbyne, Mt. Holly__ Guilty $1 and cost. Dr. Chas. H. Pugh, Stanley.. Guilty $1 and cost. Dr. H. J, Erwin, Gastonia.. Guilty $1 and cost.

Total number of indictments for July 21 Total cost for bringing indictments for July $320.00 Total collected in fines for July 59.01

Loss to State during July $260.99

INDICTING PHYSICIANS IS AN ing upon the State Board of Health the

UNPLEASANT DUTY duty of enforcing its provisions.

Prosecutions were brought by the This duty is not a pleasant one but State Board of Health during the month it is one which the State Board of of July against twenty physicians of Health has no intention of shirking, the State for violations of the State Every case of a violation of the quaran- quarantine laws. The law with regard tine laws will be prosecuted regardless to the reporting of contagious and in- of whom may be affected. In doing this fectious diseases is very plain. Its the State Board of Health is not only language is such that it cannot be performing its manifest duty under the misunderstood by any intelligent per- law but it is rendering North Caro- son. It requires every physician to re- lina a safer place of residence for all port such diseases that he attends the people. The prompt control of con- promptly to the county quarantine olfi- tagious and infectious diseases is pos- cer. The law is equally plain in plac- sible only with a prompt knowledge of ; ;

54 The Health Bulletin

of their occurrence. Such knowledge can cent was imposed. In a number be obtained only when the attending others the fine was only one dollar. physicians make prompt reports as re- Apparently the magistrates of the quired by the law. State do not consider the violation of From a financial standpoint the pro- the State quarantine law a matter of secutions for July entailed a heavy much seriousness. The fact that in monetary loss upon the State. The cost each case the failure of the physician of bringing these actions before local to obey the law meant the useless ex- magistrates totaled $320. Fines were posure to illness and possible death of imposed totaling $59.01. The net loss a large number of people seems not to to the State in dollars and cents was be considered by the justices who sit $260.99. The fines in these cases go in judgment. When fines are imposed to the county school fund. In some of sufficient size to be felt there may be cases the convicted physicians were al- expected a material improvement in the lowed to go free upon the payment of observance of the law. R. B. W. the costs. In one case a fine of one

TWO CASUALTY LISTS A STUDY IN CONTRASTS

In France, to August first this year, 86 Tar Heels have given their lives glori- ously, or been wounded, in the great battle against the Huns. In North Carolina, during the same period, 1,379 citizens of the State have needlessly given their lives, or suffered through weeks of illness, because of typhoid fever. The 86 who died or were wounded in France fell in the performance of a necessary duty. The 1,379 who died or were sick in North Carolina from typhoid fever died or suffered from the most preventable of preventable diseases. Here are the two

casualty lists : . KILLED ON FIELD OF HONOR. KILLED AT HOME BY TYPHOID

Findley M. Shuler, Bryson City ; Ber- Artt Barbee, Durham ; Josie Hartman, B. tram T. Clayton, Salisbury : Robert South Side; lola Darden, Goldsboro;

Anderson, Wilson ; Silas Triplett, Hunt- Ady Williams, Wilson ; Ethel Whitner

ing Creek ; Raymond E. Cuthbertson, Huskey, Asheville ; John Hedden, More-

; Sevier Lil- Nebo ; Lewis T. Strickland, Cero Gordo head Hyman, Williamston ;

George C. Wright, Biscoe ; John E. lie Fleming, Greenville; Oscar King,

King, Asheboro ; Edward C. Pitt, Rocky Durham ; Walter Smith, Durham ; May

Mount; Cyrus P. Adcox, Fayetteville Welson, Winston ; Peris Denison,

Leslie Venters, Shelmerdine; James L. Tabor ; Frank Howard, Wilmington ; R.

Woodsides, Statesville; C. L. Capps, C. Melvin, Lake Creek ; Robert Baird,

Lucama; Harry Watson, Raleigh; Morganton ; George Yates, No. 5 Town-

Joe L. Orr, Matthews; Edward L. ship ; Georgiana Bennett, Bogru ; Car-

Sledge, Asheboro; David M. Wright, rie Crawford, Melville ; James Nichols,

Lincolntou; George A. Ball, Monroe; Asheville ; Albert Coffey, Elk Mt. ; Allid

Robert E. Wilcox, Hendersonville ; Wm. Griffith, China Grove; Ethel Mae Tay-

Dudley Robbins. Raleigh ; Jos. D. Roun- lor, Grassy Creek ; Horace Palmer Shea-

treo, Kinston ; Ashhy J. Downey, Roan- rin, Sixpound ; James Edwards, Gas-

oke Rapids ; Jasper W. Thomason, New tonia ; John W. McCollum, Greensboro

Bern ; John F. P.lalock, Hamlet ; John Sol McClaim, Hendersonville ; Addie

C. Pai.sley, Gibsonville; John C. Wil- Susan Huggins, Kinston ; U. S. Davis,

ford, Asheville ; Andrew J. Higgins, En- Crooked Creek ; Lillie Goodrich. Wil-

nice; Jean Kendall, Elkinville ; Arvin mington : Lloyd G. Hamilton, Wilming-

; F. D. Teague, Gastonia ; Marshall C. ton ; ChoUy Martin, Pantego Viola ;:; ;;

The Health Bulletin 55

Smith. Morganton ; Grady Humphries, Dixon, Durham ; Turner Simpson, Gil-

Laurel Hill ; Pressley R. Brown, Mor- mer, Joe Kickman, Columbia ; Dora ganton ; James C. Loder. Wilmington Brown, Forest City ; Lillie Sharp, Char-

W. T. Shaw, Jr., Weldon ; James H. lotte ; Otis Deberry, Cheeks Creek

Holmes, Hendersonville ; Curuey Page, Neoma Lee Boyd, Long Acre; E. V.

Wilson : Faison Harris, Goldsboro Umstead, Mangum ; William Williams,

Lynn H. Harriman, Concord ; John W. Elizabeth City ; George Dillon, Spray :

Hassell, Williamston ; John D. Huffman, Lee Baker. Monroe ; Ed. Russel, Nor-

Hickory : James Baughn. Washington lina ; Mary Robbins, Blowing Rock

Millard T. Parrish, Smithfield ; Arthur Lucy Dickery, Murphy ; John Calhoun

Bluethenthal, Wilmington ; Clayton Hall, Franklin ; Floyd Daniel Rash,

Worth Starr, Greensboro ; A. A. Thomp- Statesville ; Jone Spicer. Mayesville

Wm. Harold Adams, Hill ; Robert son, Efland ; Will Bowden, Morganton ; Sand

Clifif N. Bissett, Wilson; Max Swiuk, Earnest Fisher, Cedar Creek ; Jessie

Connelly Springs ; Guyser Canipe, Cher- May Garrett, Jerusalem : William Har- ryville; Harry Daly, Charlotte; Evans rison Elliott, Clefton ; Willie Graves,

Pegues, Osborne. Saratoga ; Hilda Pearl Watson, Pan-

tego ; Laura Estelle Brown, Pollocks-

ville ; Bessie Spence, Hertford ; Worth SERIOUSLY INJURED IN PER- Patterson. Stonewall ; Amanda Mc- FORMANCE OF DUTY Mimm. Hendersonville ; William Skin- ner, Rocky Mount ; Amos Monroe Car- ter. Rocky Mount; Sallie Bet Webb, James K. Rosser, Broadway ; William Marks Creek; Monroe Fisher, Gilmer; Mason, Forney ; Fred F. Sorrell, Burns-

Carrie Lewis. Weldon ; Mrs. J. H. Peele, ville ; Dolphous C. Cooper, Jacksonville

Franklinton ; Joe Thomas Solomon, Ernest G. Lawrence, Gastonia ; Edgar C. Lewis, Ashland; Willard Franklin, Warrenton ; Arthur Hunt, East Spen-

cer ; Simon Dixon, Olds ; Bertha Green Mountain ; Van Buren Hair, Elease; Henry W. Morrow, Albemarle; Huffmun, China Grove ; Margaret John H. Tritt, Gastonia; Fred W. Cor- Mace, Upper Fork ; Ora Lee McLean, Averysboro; Jas. M. McDonald, Con- zine, Concord ; Dewey A. Shepherd,

coi-d ; Clara Belle Broadwell, White Franklin ; Joe M. Parker, Stem ; Chas. H. Barckley, Rosemary; Ed Helmes, Oak ; Ira B. Massingill, Four Oaks Waxhaw; William A. Thompson. Dur- Harrison Sinclair, Charlotte ; Eugene Lewis, Charlotte ; Winnie Harper, Wil- ham ; William A. Cross, Frankliuville

mington ; McKinley Abernethy, Pitts- John E. Crow, Raleigh ; Bruce A. Spen-

boro ; Rebecca Elliott, Clefton ; Mamie cer, Campbell ; Chas. E. Dysart, Senia Grady, Burgaw ; Mary Davis, Sandy Jas. B. Chapman, Taylorsville ; William

Jessie Simms, Durham ; Willard Ridge ; A. Elkins, Fayetteville ; Jack Hicks, Write, No. 2; Eula White, Windsor; Durham ; Eugene Canton ; Charlie Beck,

Jas. A. Locklear, Lumberton ; Leonard L. Smith, Wadesboro ; Whitson Wesley,

Howie. Concord : Kellie Bell Colfield, Winston-Salem ; Grover C. Conrad, Lex- Edenton. ington ; AVilliam H. Campbell, Roanoke Rapids; Ralph J. Charles, Winston-

; Harry M. Joyner, Concord Salem SERIOUSLY INJURED THROUGH Paul E. Cobb, Gastonia ; E. McCollom,

Weutworth ; Allison M. Page, Aberdeen ; CARELESSNESS OR IG- Jos. Clark, Jr., Kenton ; IMartin Ven- NORANCE able, Winston-Salem. Aulsey Trolinger. Haw River, Route

1 ; Percy McAdo. Graham : John Holt,

Graham', R. F. D. ; Jno. Coble, Haw

River ; Lacy Freeland, Gralium ; Mrs. W. T. Hudgins, Burlington, R. F. D., 9; Carrie Crawford, Mebane, R. F. D. 1; Son of Robt. Ivittle, Taylorsville; Mrs.

D. H. Wall. Ridgeland : Mrs. J. L. Liv-

ingston, Wadesboro ; Winston D. Tyler, Wadesboro; Judea Mathis. Plumtree;

Glover Allen, Pungo ; Homet Currie,

Chocowinity ; Son of Jessie Barrington,

Chocowinity ; Child of Mrs. Fannie Mo-

zell, Washington. R. F. D. ; Mrs. E. Cox, ;;; ;;;

56 The Health Bulletin

Tilly, Granite Falls ; Harry John- Washington R. F. D. ; Mary E. Vicks, Mary

; Elizabeth Sudduth, Lenoir Pantogo; B. B. Dowds, Washington; son, Lenoir ; Blowing Rock; Mary, Lucille Bates, Washington : Mary Jack- Martha Hormon.

Mell- Lucy Robinson, Glass ; Ray- son, Washington, R. F. D. ; J. T. Jno. and burn, Belhaven; Zacky Bell Gray, mond McColl, Concord, R. F. D. 6 ; Lu- Bath, R. Misenheimer, Concord ; Child Washington : Mamsie Cooper, ther W.

; Daniel W. Morris, Concord, R. F. D. ; Beat- M F. I). ; Carl Daw, Belhaven of Jap

Julia Concord ; Troy Love, Stan- Blount, Ransomville, R. F. D. ; rice Russ. " Jr., Stilley, Edward; Ed Kilie Stilley, field, R. F. D. 2 ; J. M. McDonald, Con-

Stilley, Edward : Wil- ; Jas. Hough, Concord Hospital Edward ; Barney cord

; Child of D. lie Eliz. Cherry, Washington ; Etta Lee Walter Colloway, Concord

Allegood. Washington. R. F. D. ; Jno R. Yarboro, Concord; S. E. McDonald, Willie Col- Mrs. Faulk, Windsor, R. F. D. 4 ; Concord ; Novella Dry, Concord ; lins, Woodard; Child of Willie A. C. L. White, Concord; Geo. Benfield, Taylor, White. Askewville; Bernico Concord, R. F. D. ; Child of Jessie Ber-

Hall, Windsor ; Rob- ; Pharr, Con- Windsor : Bingham ryfield. Concord Jesse

ert Taylor, Windsor; H. B. Register, cord; Green Harris, Kannapolis ; Mrs. Hatley, Elizabethtown ; Henry Ezzell, Clarkton O. B. Efird, Concord; Master Florence Guyton, Council. R. F. D. Concord; Mary Weathers. Maiden;

Frank Ransom, Council ; Mary Browne, Newt Adams, Hickory; Lucy Thomas,

Council ; Austin Newton ; Council ; Love Butts, Hickory ; Mrs. Zell Weathers, Guvton. Council; John Johnson, Clark- Carl Hicks, Maiden; Roly Fight, Mai-

Bessie ; ton; Mattie Ezzell. Clarkton; den ; < jcorge Smith, Hickory Mc-

Ezzell, Clarkton ; Lilla Davis, Clarkton, Kiuly McCoble, Newton, R. F. D. ; Jes- R. F. R. F. D. ; Taft Davis, Clarkton, sie May Byrd, Morrisville, R. F. D. 1 D. y; Gilbert Davis, Clarkton, R. F. McKiniey Abernethy. Pittsboro; Thos. D. 3; Frances Joyner, Southport; Mrs. C. Ruth, Pittsboro, R. F. D. 3; Mrs. Wright, Lilly Swain, Southport; Pearl Sallie Headen, Siler City ; Lessie Marsh,

; Brown, Ashe- Elk' Mountain Evelyn Bear Creek ; Emma Thomas, Culberson

ville. R. F. D. 4; Thomas Andus. Ashe- Dillard McFee, Murphy ; Gertie Moore, ville, R. F. D. 5; Mrs. E. Burrell, New Murphy; William H. Bryant, Patrick; Bridge; Jean Rogers, Lincester, R. F. John Mayo's daughter, Tyner, R. F. D.

D. 1 ; Mrs. Clinton Hawkins, Alexander, Mrs. J. M. Private, Edenton; William

; Miss R. F. D. 1 ; Oscar Ingle, Odessa M. Williams. N. Edenton; Mabel Brid- Julia Israel, Candler; May Johnson, ges, Shelby R. No. 4; Lane Brooks, King, Mor- Morganton ; Child of Frank Shelby ; Samuel Brooks, Shelby ; Ran-

; Effie Walton, ganton ; Ota Novy, Joy dolph Hogan, Shelby, R. 7; Toni Nich- Harbism, Morganton ; Child of Daisy ols, Fair Bluff; Mrs. C. C. Saunders, Elmire Fulcher. Beaufort; Morganton; Freeman ; Joe Daniel, New Berlin ; Cal- D. Brooks. Beaufort; One Case, More- vin Everitt. Acme; Forest Williams,

; Lessie Finer, Willi- head City Hospital Bolton : Mrs. Nora Spicer, Bolton ; Rus-

; Cicero ston ; Elmire Saulter ; Beaufort sell Webb, New Berlin; Bessie Kelly, Bobb, Atlantic; Willis, Beaufort; Etta Bolton; Mary Bennett, Hallsboro ; W.

Level ; Bertie Salter, Polly Fulcher, Sea G. Boyd, New Bern ; H. B. Watson, New Salter, Beaufort; T. Beaufort; Gertie Bern; R. E. Phillips, Bridgeton ; L. H.

; Annie Swin- J. Mitchell. Beaufort May Wilson, Dover R. 1 ; R. D. Gurman,

; C. L. Bates, Morehead son, Mansfield New Bern ; Allila Davis, New Bern City ; Mrs. Cicero Wilkes, Beaufort Sylva Ward, New Bern; D. C. Gilbert, Miles, Altamahaw, R. F. D. 2; Martha New Bern, R. 1 ; H. A. Humble, New Jas. P. Walker, Union Ridge, R. F. D. Bern; Katie Bell Smith, New Bern;

; Loasburg ; Thomas 1 Lottie Williams, Jesse Murphy, Griffon ; Clarence Wood, Loa.sburg; Son of Wm. Wal- Williams, Cove ; P. A. Dixon, New Bern ; Frank

; Clark. ker, Valmad Thomas Newton Jones. New Bern ; Phillip, Fred and

li. ; Kaylor, Lenoir, F. D. 5 Rose Mary Dixon, New Bern ; Mrs. Geo. Justice. Rhodhiss ; Child of Mrs. T. Hud- Oglesby, New Bern ; Milliard Everitt,

; Penley, Morti- son, R. F. D. 1 Sarah Fayetteville ; Daughter of W. A. Hol-

mer ; James Williams, Rhodhiss ; Heber der. Fayetteville, R. F. D. ; Nonie Fair-

; Barker, Rhodhiss Lawrence Clow, cloth, Fayetteville, R. F. D. ; Inez Hol-

Hudson ; Mrs. W. H. Baker, Rhodhiss der. Fayetteville, R. F. D. ; Blanch

W. H. Baker, Rhodhiss; Hart Patter- Smith. Fayetteville, R. F. D. ; Koonie

son. Lenoir (West End) ; Roberta McLauchlin, Fayetteville, R. 3 ; Richard

Payne, Granite Falls ; Virginia Payne, Nunery, Stedman; Harry Scarborough,

; Granite Falls Maggie Moore, Globe Jr., Fayetteville, R. F. D. ; James V. ;;;; ;;;

The Health Bulletin 57

Roberts, Fayetteville ; Child of Clarence terfield, Durham ; Mrs. L. C. Adams,

Starling, Fayetteville ; Ella Elliott, Fay- Durham ; Margaret Thompson, Dur- etteville. R. 6; Elma Melvin, Cedar ham ; Marvin Travis, Durham ; Mrs. Creek, R. 1: Rosa Cromartie, Fayette- Dare. Mills, W. Durham; Mollie Wil- ville; Ed Brady, Hope Mills; Alice liams, Durham ; Mrs. J. A. Calvin, W.

Baker, Fayetteville ; Mrs. Alfred Green, Durham ; M. R. Bennett. Faison ; Mrs.

Fayetteville; Sarah Melvin, Cedar Jacob Baker, Magnolia ; A. L. Chest-

Creek, R. 1 : Robert Fisher, Lena ; H. nutt, Magnolia ; Mrs. J. J. Parker, Mag-

A. Caulk, Boardman; Willie McKay, nolia ; Jack Kornegay, Mt. Olive; Ben Fayetteville; Mrs. J. W. Adcox, Fay- Best, Mt. Olive, R. 2; Wilbert Riven- etteville, R. F. D. ; Rosa Bullock, Autry- back, Wallace ; Mrs. Cassie Dixon, Rose ville; Mrs. J. A. McLean, Fayetteville, Hill ; Susan Mclntire. Wallace ; Lillian

R. F. D. ; Zeb Lee Floyd, Lexington, R. Whitfield, Mt. Olive, R. 1; Mrs. Vance

; 1 : Oscar Fuller, Parker Town, R. 6 Phillips, Warsaw Betsy Bradshaw,

John Ledwell, Kernersville, R. 1 ; Mary Faison ; Louis Lewis, Faison, R. F. D.

Fitzgerald, Linwood, R. 1; Hartie Mary Ashford, Faison ; Thelma

Shoaf. Lexington, R. 6; Viola Hinkle, Graham, Mt. Olive, R. 2 ; Nancy Thomp-

; Dail, "Welcome ; Rosa Harrison, Lexington son. Seven Springs Walter Mt. Hill; Bessie Allison, Linwood, R. 1 ; Bettie Olive, R. 2: Ina Ritter, Rose

Hicks, Thomasville ; Julia Byerly, Luther Vandiford, Rocky Mt. ; Mrs.

Thomasville ; Roy Williams, Mocksville; James P. Hill, Rocky Mount ; Mr. Don Wiggins, Mocksville. R. 1; George Charlie Williams. Rocky Mount ; Fran-

Holman. Mocksville; Swade Koontz, cis Jackson, Louisburg ; J. B. Bowden,

Mocksville, R. 1 ; Jesse Lumlston, Louisburg; Badger Dorsey Joyner,

Cooleemee ; A. J. Wilson, Durham ; Mrs. Louisburg ; J. S. Dorsey, Louisburg

C. J. Seagrove, Durham ; L. C. Adams, Joe, Ella, Delia, Fred Spivy, Youngs-

; Youngsville Durham : Jessie Simms, Durham ; Edna ville Pauline Timberlake, M. Marshall, Durham; Sampson John- Ernest Green, Youngsville ; Ebba son, Durham; John Flintoft", Durham; Wright, Louisburg; Vessie Tago Wom-

Rosa Parker, E. Durham ; Boy of Mrs. frie, Louisburg; Isiah Mayo, Louis- Cora Yates, Durham; Ed Williamson, burg; Susan Green, Louisburg; Edd

Durham ; Elis Jones, East Durham Jarvis, Winston-Salem ; Child of Mr. C.

Leslie and Jessie Hopson, East Dur- Mebone, Winston-Salem ; Child of E. P. Mrs. Fred ham ; Elberta Tilly, Durham; Cora Cohill, Winston-Salem;

Lyon, Durham ; Mary Parker, East Freeze, Tobaccoville ; Annie Young,

Durham ; Mary McCullen, Durham Winston-Salem; Walter Rivers. Win-

Maggie Latta. Durham; Wallace Mar- ston-Salem ; Walter Swaim, Walkerton ; shall, Durham; Nossie Williams, Dur- Mrs. Ella Leonard, Winston-Salem;

Durham ; Fletcher Stella Winston-Salem; Samuel ham ; Bonnie Cotton, Cloud,

Harris, W. Durham ; George Strickland, Stoltz. Rural Hall, R. F. D. ; Herman

Durham; Alta Stone, E. Durham; Lu- Foster, Winston-Salem ; Major Shields, cille Barbar, E. Durham; Ike Richard- Winston-Salem ; Dora Archer, Winston-

son, E. Durham ; Myrtis Pickard, Lake- Salem ; Luther Good, Winston-Salem

Durham; ; Mrs. E. wood ; Mrs. Walker Tingen, Willie Alford, Winston-Salem

Onis Ellington, E. Durham; Junior J. Brewer, Winston-Salem ; Ada Butler,

White, W. Durham; I. Tanaka, Dur- Winston-Salem ; Arlie Whittington,

; Geral- Boyer, Winston- ham ; Lois Worham, Durham Winston-Salem; Pleas

daine Barbee, Durham; James Dooms, Salem ; Hernert Gunthrop, Winston-

Durham ; Ruby Weisner, Durham Salem ; Thos. Gunthrop, Winston-

Grace Weisner. Durham ; Temple Hart, Salem ; Edgar Chilton, Winston-Salem

Ruth ; N. Durham ; Ethel Joffe, Durham ; Sallie Cornatzer, Winston-Salem Joe

Davis, Durham ; Gertrude McCullum, Sparks, Winston-Salem; Thelma Cling-

Durham ; Jessie Guinn. Durham ; Lois man, Clemmons ; Alice Ashford, Bes-

Emery, E. Durham ; Lewis Rosenburg, semer City ; Joseph Hiatt, Mount Holly

Durham ; Eugene Stanford, Durham Mrs. Marshall Mitchner, Lowell ; Lillie Sylva Tyndall, E. Durham; Raymond Johnson, Bessemer City; Mrs. Lucy

Calvin, W. Durham ; Jas. Gooch, Jr., Hendrix, Gastonia ; J. L. Brackett's

E. Durham ; J. T. Grissom, Durham child. Groves Mill; Ardie E. Lambert,

Myrtle Barbee, Durham ; Taylor, Dur- Gastonia, R. F. D. ; Janie Roach, May-

ham ; Annice M. Daniels, Durham ; N. worth ; Joe Jenkins, Gastonia, R. 2

W. Glass, Durham ; Mary Faucette, Thomas Boyles, Jr., Bessemer City;

Durham ; Louise Roberts, Durham Exie Mayberry, Mount Holly ; John

Queen Debnaun, Durham ; Maud Por- Smith, Mount Holly ; Jessie Ward, 2 ;;; ;;;;

58 The Health Bulletin

Mount Holly; Lelia Pryor, Mouut boro; W. R. Edwards, Greensboro, R. Point Holly; R. E. Ingram, Gastonla; Ivory F. D. 3 ; Mrs. L. P. Byers, High Geo. Wall. High Point; Child of C. T. Roach, Oastonia ; Florence Robinson, Grissa, High Point; Amy Williams, Gastonia : Maggie Perkey. Gastonia High Point. R. F. D. 2; Mrs. Hendrix, Everett Hoover. Gastonia ; Josie Owens, Dallas: Polly Green, Mount holly; Es- High Point ; Elliott Hiatt, High Point ther Lowe, Mount Holly; Child of T. Jeff Oakley, Greensboro; Garland

Denny, Denim ; Will Sellers, Greens- M. Rrockman, W. Franklinvllle ; Wiley Jones, ; Alice Friday. Gastonia: Lonnie Ragan, Gas- boro ; Carry Weldon tonia; Etta Eothco and May Lethco, Powel, Enfield, R. F. D. 1 ; Nep Jenkins, Scotland Dallas: Charlie Carpenter. Mount Weldon ; Mrs. S. B. McLean,

Neck ; William Jones, Jr., Weldon ; Wil- Holly : Carl Mclntyre. (Jastonia ; Sid liam Lee, Scotland ; Nick Dempsey, Wel- Caldwell. Dallas ; Child of Mason Car-

don ; W. H. Allen and Edna Earl Allen, penter, Grouse ; Bobbie and Jehovah Harper, Jr., Rosemary Jenkins. Gastonia, 2; Maggie Parker, Enfield ; George ; Gastonia; Eetha Fox, Gastonia; Frank Robert Fleming, Enfield; Edity Briggs, Wiggins. Flent Mill; D. O. May, Gas- Roanoke Rapids ; Child of James Pres- tonia; Ed. Williams. Gastonia, R. 1; ley. Canton ; Hattie Frazier, Wayues- Ilallie Russell, Gastonia; Wilbern Carr, ville; Child of J. W. Treadaway, Can- Waynesville, R. Gastonia. Grove Mill; Frank Ford, ton ; George McClure,

F. D. 1 ; Mrs. John Smith, Canton Stanly : Susie De Lane, Cherryville J. W. Stewart, Canton ; Caley Jones, Mrs. Alonzo Killian, Mount Holly ; Al- Canton ; Nathan Bass, Dunn ; Mrs. bert Raby. Gatesvllle ; James Skinner L. B. Baggett, Dunn; Ora Lee Mc- Harrell, Eure ; Will Squilliams, Cherah Lean, Dunn, R. 3; Clarence McRay, Mrs. Dave Philips, Franks Creek ; Lu- Dunn, R. F. D. 3 ; Purvis Smith, Duke, cius Hyatt, Cherah ; Carmel Rich, Rob- binsvilie; Rilla Hyde. Cherah, R. 1; R. F. D. 1; Hattie Bell Tart, Dunn; Mrs. Clara Rich, Sweet Gum; Arthur Mrs. Make M. Porter, Duke ; J. W. Mc- Lillington; Tart, Dunn; ; Vena Rodg- Neill, Roena , Mountain Creek

Salomi D. Moore, Dunn ; Mattie Bell ers, Atorah, R. 1 ; Roy Colvard, Rob- Hinton, Dunn ; Lula Williamson, Dunn binsville ; Cora Jeffreys, Oxford ; Maggie Washington Monds, Dunn, R. F. Yancy, Oxford ; Mrs. J. R. Walton, Wm. D., Queen Esther Toon, Dunn; Wil- Wake Forest ; J. K. Edwards, Stem, 6; R. 2; Ed. Simmons, Bullock; George liam Smith, Duke, R. F. D. 1 ; Maggie Shepherd, Bullock; Eddie Shepherd, McNair, Dunn ; Mrs. J. P. Tart, Dunn Hodges, Lillington; Snow Hill ; Lonnie Grizzard, Snow Paul and Nora Williams, Henderson- Hill, R. F. D. ; Jim Shepherd, Snow Katie and Jessie

Hill, R. F. D. 1; Lee Best, Snow ville, R. F. D. 3 ; Mary Brown, Hender-

Hill, R. F. D. 4; Mrs. Swift Moor- sonville ; Lula Vaughan, Winton ; Essie ing. Snow Hill, R. F. D. ; Sam Sugg, Lee Myrick, Comeo ; May and Tom Pad-

; Padder- Snow Hill, R. 1 ; Fannie Sugg, Snow derson. Lumber Bridge Arquis

Hill, R. 1; Willie Beamon, Walston- sou, Dundarrach ; Cad Barber, Raeford ; burg; Willie Tason, Walstonburg; Ly- Flo.vd Rash, Statesville, R. F. D. 3; man Munroe, Snow Hill, R. F. D. 2; Ashley and Henry Benton ; Statesville Thomas Cannon, Snow Hill, R. F. D. 2 Child of C. W. Shenk, Statesville ; Child Mrs. Virginia Mooring, Hookerton of Ab Allison, Turnersburg; Birdie Simon Dixon, Snow Hill, R. F. D. 2; Stine, Statesville, R. F. D. 7; John Dewey Braxton, Snow Hill, R. F. D. 3 Horn, Statesville, R. F. D. 7; Knox

Alex Sugg, Jr., Snow Hill, R. F. D. 4 Gunn, Elmwood, R. F. D. 1 ; James L. Hanna Moore, Walstonburg; Beal Moon, Mooresville; Hood Reid, Trout- I

Bowen, Ayden ; Ellen Newborn, Farm- man ; Nathan Bullard, Troutman, R. F. ville, R. F. D. 1; Nicie, Wm. and Fred D. 2 ; Flora Connor, Mooresville

Woodard, Stantonburg, R. F. D. 1 ; Ed- Beulah Pressjey, Statesville ; Annie El- _ die Davis, Snow Hill, R. F. D. ; Walter liotte, Statesville; David Miller, Sails-

Grant, Snow Hill, R. F. D. ; Mrs. Fondy bury, R. F. D. 4; Georgia Stevenson, Hudson, Snow Hill, R. F. D. 6; Will Statesville; Alice Bates, East Spencer;

Edwards, Ayden, R. F. D. 1 ; Chas. Tay- Sam Hartsell, Troutman ; Clarence

lor, Greensboro, R. F. D. ; Frank Be- Martin, Whittier, R. F. D. 1 ; Clifton vans, Jamestown ; W. F. Chadwick, Moody, Erastus ; C. E. Moss, Webster

Jamestown ; Minnie Wyric, Brown Sum- Will Temples, Benson ; Moses Williams,

mitt ; Henry Kendricks, Denim ; Virgil Clayton, R. F. D. ; Pearly Cox, Pine

Kivett, Glenwood ; Geneva Newton, Level ; W. G. Pittman, Kenly, R. F. D.

High Point ; Lula Mae Young, Greens- 2 ; Mrs. Bennett Barber, Four Oaks ;;; ;;;

The Health Bulletin 59

Gilbert Jones, WiLson's Mills; Andrew Spencer Howard, Oak City ; John A. Ellis, Selma; Child of Clias. E. Lee, Manning, Jr., Jamesville; Harvey

Four Oaks, R. F. D. 1 ; Ira D. Massen- Brown, Hassell ; Hazel Brown, Palmira, gill, Four Oaks. R. F. D. 2; Dora R. F. D. ; Mary Page, Williamston ; Co-

Creech, Selma : Child of Otho Archibald, lumbvis Brown, Hobgood ; Mrs. F. E.

Clayton, R. F. D. 1 ; Elsie Mae Gardner, Boone, Williamston ; Mittie Taper,

Pine Level : Ida Woodard, Princeton Jamesville ; Archie Newton, Jamesville

Wilbert Striddard, Princeton; Arthur Alton Hodge, Jamesville ; Alphonzo

E. Langley, Pine Level, R. F. D. ; Dewey Purvis, Williamston; Marie Burnett,

Watson, Pine Level; Mrs. Willie Lee, Oak City ; Lizzie Brown, Hobgood ; Al-

Four Oaks, R. F. D. 2 ; Mrs. Julia Stal- bert Doggett, Oak City ; Phelix Staton, lings, Princeton, R. F. D. 3 ; Sudie Reid, Oak City ; Francis Jones, Williamston

McCullers, R. Vera Stubbs, Jamesville ; Luke Ed- Princeton ; Sandy Tarner,

F. D. 1; Mrs. Isaac Stallings, Prince- mundson, Palmira ; Howard Tayloe, ton; Sanford Aycock, Micro; Omega Williamston, R. F. D. ; Alice Pickering,

Watson, Pine Level; E. G. Allen, Four Charlotte ; G. G. Pope, Charlotte ; Mabel

Oaks, R. F. D. ; Alma Allen Lee, Four Silvey, Charlotte ; Sarah Leason, Char-

Oaks, R. F. D. ; Mrs. J. Jones, Smith- lotte ; J. F. Rhyne, Charlotte ; Aline field, R. F. D. 1 ; Jerman Jones, Smith- Monroe, Charlotte ; Blissie Yandle, field, R. F. D. 1 ; Mrs. Marshal P. Las- Charlotte ; Vernon Williams, Charlotte siter. Smithfield, R. F. D. 1; Arrah Dave Williams, Charlotte ; Emma Shoe-

Mitchiner, Smithfield, R. F. D. 1 ; Child maker, Charlotte; Margaret Yandle, of Turner Yarboro, Zebulon, R. F. D. 1 Charlotte; Mrs. Senter, Charlotte; W.

Jane Spicer, Maysville; Child of J. P. B. Ashley, Charlotte ; H. C. Beal, Char-

Rouse, Maysville; Emma Hines, La- lotte ; Earnest Wheatley, Charlotte ; D.

Grange, R. F. D. ; James Bryant, La- E. McGowan, Charlotte; Ornie Beck-

Grange, R. F. D. ; Leo Banks, Hooker- ham, Charlotte ; Mrs. E. R. Frank, ton. R. F. D. ; Child of Mrs. Norris Charlotte; R. D. Danner, Charlotte; Davis, Kinston, R. F. D. 6; Person Mrs. John L. Scott, Charlotte; Miss

Nicholson, Kinston ; Astizerl Rhodes, Nora Eyan, Charlotte; Miss Minnie Al- Webbs Block City; Elias Coward, Grif- lison, Charlotte; Francis Smith, Char- ton; Two Children of Jim Dunn, Grif- lotte ; Minnie Allen, Charlotte ; Norman Kinston Allen, Charlotte; Edna Allen, Char- fon ; Child of J. Ella Rhoades, E. E. Rouse, LaGrange; Raymond lotte; Elizabeth Hall, Charlotte; Mrs.

Brown, Kinston, R. F. D. 3 ; James Mc- Elizabeth Sawyer, Charlotte ; Edith

Rae, Kinston ; Charlie Ross, Kinston Beard, Charlotte ; Emma Tucker, Char-

K. Allridge, Deep Run; Gladys All- lotte ; Mattie Lee Tucker, Charlotte ridge, LaGrange; Iva Turner, Seven C. W. Tucker, Charlotte; Vera McTye,

Springs ; Child of Joe Kittrell, Kinston, Charlotte ; Chas. Antonio, Charlotte

R. F. D. ; , Falling Creek ; Rosa Willis Newsom, Charlotte; Willis

Askew, Kinston ; May Holt, Moncure, Hooper, Charlotte; Bertha Cook, Char-

R. F. D. ; T. A. Cox, Norman ; Cleveland lotte; Jesse Pope, Charlotte; Alver

Cody ; Lincolnton ; Mamie Kiver, Lin- Kizer, Charlotte; S. Davis, Charlotte;

; colnton ; Jennie Kiver, Lincolnton ; Mrs. Inez Coulton, Charlotte M. B. Alexan-

Julia Sain, Lincolnton, R. F. D. 2 ; Fan- der, Charlotte ; Alice Walker, Charlotte nie Michael, Iron Station ; Kate Seagle, Miss Zola Silver, Charlotte ; Mrs. T. R.

Lincolnton ; Hazel Leib, Marshall Gibbs, Charlotte; Edna Mayo, Char- Chas. Lander, Hot Springs; Novella lotte; Lenoir Wright, Charlotte; Mrs.

Bullock, Robersonville, R. F. D. 1 ; Ro- K. W. Selden, Charlotte ; Grace Connor, setta Holman, Williamson ; Fannie Bul- Charlotte; Florence Stuart, Charlotte; lock, Robersonville, R. F. D. ; Lawrence Francis Wallace, Charlotte ; James Gib- S. Ellis, Jamesville; Mayo Hardison, son, Charlotte; Lucille Cook, Charlotte;

Williamston ; Elizabeth L. Roebuck, Carl Johnson, Charlotte; John Paul

Williamston ; Chas. Manning, William- Jones, Charlotte; George Rhyan, Char-

; Har- ston ; Rosa Baker, Robersonville ; James lotte ; Louise Pressley, Charlotte

Pope, Robersonville; Earl Savage, Rob- rison Sinclair, Charlotte ; Arthur Roach, ersonville; Pearl Allbritton, William- Charlotte; Jessie Bell Nelson, Char-

; lotte; Mamie King, Charlotte; Mary ston ; Wm. H. Boston, Harden James White, Williamston; Pauline Sykes, Montaith, Charlotte; J. C. Russell, Darden; Mary Simpson, Darden; Charlotte; Lilie Ayers, Charlotte; San- Martha Boston, Darden; Mack Boston, ford Caudle, Charlotte; Eunice Moore,

Darden ; Maynard Boston, Darden Charlotte; George Campbell, Char- John Peaks, Williamston, R. F. D. lotte; Marshall Love, Charlotte; Will ;; ;;;;

60 The Health Bulletin

Dodd, Charlotte; Sally Alny, Charlotte; Savage, Burgaw ; Denis Artis, Burgaw Arthur Hill, Charlotte; Edd Barber, Mary Elizabeth Harrell, Hertford Charlotte; Dollie McKay, Charlotte; James Co.ston, Chapanoke, R. F. D.

Annie Orr, Charlotte; Lonnie Gill, Bessie Spence, Hertford ; Mrs. Nellie

Charlotte; Will Starns, Charlotte; Benson, Winfall, R. F. D. 1 ; Sydney

Radys Cureton, Charlotte ; Wash Greer, Hollowell, Hertford, R. F. D. 2 ; Ella Charlotte; Celestine Archie, Charlotte; May Skinner, Burgess, R. F. D. 1

Dr. Tyson, Charlotte; H. T. Holt, Ulysses Skinner, Burgess ; Elizabeth

Starr; Dave Armstrong, Dry Creek; Harrell, Hertford ; Marion Reid, Hert-

Eugene Reynolds, Queen ; May Sanders, ford, R. F. D. 1; Dorothy Reid, Hert- Capelsie; Mrs. Maude McMullan, Starr; ford, R. F. D. 1; Henry Walton White,

Brownie Armstrong, Sulphur Springs Tyner ; Catharine Bailey, Hertford

Ernest Jackson, Pinehurst ; Lacy Jack- Bessie Mebane, Hertford, R. F. D. 3 son, Pinehurst ; Alma McMillan, Nancy Edward Mebane, Hertford, R. F. D. 3 Two cases. Children of Lee Gillis, Lillian Mebane, Hertford, R. F. D. 3;

Aberdeen ; Ernest Brady, Southern Osby Perkins, Roxboro, R. F^ D. 2 Pines; Harold Johnson, Putnam; Wil- Ralph Wilkerson, Woodsdale, R. F. D.

lard Tipton, Green Mountain ; Leara 1 ; Sid Wrenn, Jr., Roxboro, R. F. D. 4

Tipton, Green Mountain ; Piney Lee Ruffin Prayer, Jolong ; Miss Addie

Parker, Elm City; Child of Thomas Reaves, Jolong ; Mary Carr, Grifton Ricks, Spring Hope; Mrs. Norman Pandalia Gorganus, Greenville, R. F. D. Dickens, Castalia; Ned Taylor, Whit- 3; Flossie Brigman, Greenville; George

akers, R. F. D. ; Martha Lucas, Wilson, Williams, Greenville; Jessie Lee Moore,

R. F. D. ; Lida Mae Hudson, Rocky Greenville ; Julius Johnson, Greenville

Mount; Ellas Stone, Nashville; Molly James Tournage, Greenville ; A. H.

Murphy, Nashville, R. F. D. 2 ; Frank Howell, Farmville, R. F. D. ; Frank

Hyde, Nashville, R. F. D. 1 ; Mrs. J. L. Brown, Winterville; Lee Williams, Ay-

Dawson, Rocky Mount; Five Children den ; Mrs. John Phillips, Ayden, R. F. of June Sanders, Whitakei'S, R. F. D. D. 1; Child of Ada Hunter, Grifton; Elenora Perry, Rich Square; Willie Herman Wilson, Winterville, R. F. D. Smith, Garysburg; Fannie Turner, Emma Mills, Greenville, R. F. D. 4;

Garysburg; Katie Smith, Garysburg; Willie Vines, Grimesland ; Mary Wilson,

Lorene L. Baughan, Rich Square; Mrs. Ayden, R. F. D. ; Isadora Morriss, Chi-

Willie Smith, Garysburg, R. F. D. 1 cod ; Benny Logwell, Farmville, R. F.

Helen White, Murfeesboro; Baby Sid- D. ; Raymond Ward, Fai'mville ; Lillie berry, Wilmington; Bennie Scotte, Wil- Ward, Farmville; Pearl Brosn, Winter- mington; Wesley McKay Keaton, Wil- ville; J. I. Barrett, Farmville; Jasper

Wilming- ; mington ; Jeneva Torrence, Cannon, Grimesland C. C. Johnson,

ton ; Rodney Fryer, Wilmington ; Bet- Greenville ; Lerpy Parker, Fountain ;

tie A. Daniels, Wilmington ; Chimmis Blanch Cherry Staton, Greenville;

Russ, Greenville Sound ; Bettie Lynn, Johnie Gray Currin, Greenville ; Mrs.

Durham; Lorena Kelly, Chapel Hill, R. Lucinda Nobles, Greenville ; Alice

F. D. 2; Frank Merritt, Chapel Hill; Baker, Ayden ; Mary Worthington,

Evander Faucette, Efland ; W. J. Smith, Greenville; Eddie E. Jackson, Green- Jr., Hillsboro, R. F. D. 1; Julius ville, R. F. D. 6; Mary E. Flowers, Ketchum. Jacksonville; R. C. Warlick, Ayden; Clarence Hackett, Millboro, R.

Jacksonville ; Kemston Huffman, Rich- F. D. 1; Cleston Hackett, Millboro, R.

lands; Child of Ed. Hall, Bayboro; F. D. 1 ; Paul Melton, Coleridge ; W. T.

Child of John Thomas, Grantsboro; Johnson, Ramseur ; Bessie Brantley,

Lowrv Overton, Elizabeth City ; Zenus Ramseur ; Child of Mannel Scotton, Griffin, Jr., Elizabeth City, R. F. D. 6 Liberty; Leon Elliott, Hill's Store;

Cooper McCay, Elizabeth City ; Hazel Noly Currie, Rockingham, R. F. D. 3 Stanly, Elizabeth City, R. F, D. 1; Lillie Allen, Rockingham, R. F. D. 1

Julius Jennings, Jr., Weeksville ; Henry Bossie Allen, Rockingham, R. F. D. 1 Shannon, Weeksville; N. Sawyers, Eliz- Flossie McLendon, Rockiucham, R. F.

abeth City ; Mrs. Mary Stanly, Eliz- D. 1; Lillie Craven, Ellerbe, R. F. D.

abeth City, R. F. D. ; Nancy Sessoms, 2 1 ; Lacy Morten, Ellerbe ; Condis Bald-

Weeksville; Children , Burgaw win, Covington ; Frank Jones, Hamlet

Jimmie Dailey, Burgaw ; Estelle Moore, Edna Matthews, Rockingham ; Bogan

Burgaw ; E. C. Sample, Elizabeth City, Chavis, Osborne; Mrs. Julia Webb,

R. F. D. 5; Ida Bell Moore, Burgaw; Hamlet, R. F. D. 1 ; J. R. Morgan, El- Ray Moore, Burgaw ; Clifton Moore, lerbe; Antry Lee Barnes, Rockingham,

Burgaw ; Loyd Moore, Burgaw ; Varner R. F. D. 2; Mrs. Susie Ussing, Ent- ;;;;; ;;;;;

The Health Bulletin 61

wistle; Four Children of Calvin Reid, Landis; Dorothy Trice, Landis; Crouch, Roberdel ; E. C. Fisher, Rober- Child of W. E. Lyerly. Mount Ulla, R.

del ; Ellen Biggs, Lumberton ; Warren 1; Susie Bostian, China Grove; Ray West, Jr., Lumberton ; Mrs. O. W. Pre- Hoffman, Landis; Mrs. S. J. Kyles,

vatt, Lumberton, R. F. D. ; Thurman Mount Ulla ; Amelia Stirevalt, Salis-

Parnell, Lumberton, R. F. D. ; Macie bury, R. 3 ; Rosa Overcash, Landis Brown, Maxton ; Mrs. H. Jones, Lum- J. C. Caskey, Salisbury; Roy Cauble, berton, R. F. D. 1 ; Pearl Locklear, Granite Quarry; Janie Gaskin, Salis-

Lumberton, F. D. ; Locklear, R. Jim bury ; John Hall, Salisbury ; Mrs. Wood

Lumberton, F. D. ; children of R. 2 Two Benson, AVoodleaf, R. F. D. 1 ; Eugene Jim Locklear, Lumberton, R. F. D. 2 Davis, Salisbury; Alberta McMullin, E. Mrs. Tom Locklear, Lumberton, R. F. Spencer; Mrs. Jerry Smith, Salisbury;

D, ; Councill, ; Mrs. 2 Rosa Lumberton Mrs. Reid Monroe, Salisbury ; Mrs. B. P. Williams, Maxton ; Harrison Tur- Ernest Hood, Salisbury; Mrs. Nig

ner, Fairmont ; Bullock, Lumber- Sham Graham, Barber, R. F. D. 1 ; Harry ton : Mrs. H. D. Tyson, Lumberton Moore, Spencer; Sadie Overcash, Lan- Sallie Harris. Springs, R. F. D. Red 2 dis ; Docie Carpenter, Landis ; D. M.

Luther Paul, Buie, R. F. D. ; Mrs. 2 Chatam, China Grove ; Mrs. J. V. Sells, A. M. Walker, Parkton; Travis Bass, Salisbury; Cletus Wyrick, Salisbury; Jr., Lumberton, R. F. D. 1 ; Mrs. Duskin Walter Brawley, Salisbury, R. F. D. 4 Williams, Fairmont, R. F. D. 3 ; Mis- Roy Life, Salisbury; Frank Slough,

souri Pearsal, McDonald ; Virginia Wil- Landis ; Gaynell Cooper, Landis : Clyde

son. Orrum ; George Wilson, Orrum Huffman, Landis; Bertha Huffman, Child of Butler. R. F. Dave Lumberton, Landis ; Guy Huffman, Landis ; Charlie

D. ; Child of Arch Chavis, Lumberton, Gilbert, Mount Ulla, R. F. D. 1 ; Delmer R. F. D. ; Ruth Thompson, Lumberton Austin, Salisbury; Child of H. E. Lea- "Viola Stephens, Lumberton, R. F. D. 3; fer, Melrose Hdqts., Salisbury; Mont

Wilkins, Buies, F. ; Kelley Abe R. D. 1 Bost, Landis ; Leroy Weaver, Landis

Johnson, Fairmont ; Robert Livingston, Howard Trexler, Salisbury ; Mary God-

Lumberton, R. F. D. 3; Sally Neal dy, E. Spencer ; Mrs. Jim Osborne, Lan-

Hooper, Maxton : George Steel, Maxton ; dis ; Joshua Cherry, E. Spencer ; Ha

Hattie Monroe, Maxton ; Ola Hutchens, Dedmon, China Grove, R. F. D. ; Essie

Mayodan ; Ella Hall, Draper ; Maggie Bost, Landis; G. B. Hollifield, Bostic;

Burge, Mayodan ; Mrs. Edwards, Belva Taylor, Henrietta ; Child of A. L.

Draper ; A. F. Robinson, Mayodan, R. Davidson, Henrietta ; Grayam Hughes,

F. D. 1 ; Walter Vance, Leaksville Henrietta; Theron Scruggs, Cliffside; Morris Sharp, Leaksville; T. M. Smith, Roy Early, Ellenboro, R. F. D. 2 ; John

; Mize, ; Spray Mattie Draper Exton Moore, Ellenboro, R. F. D. 2 ; Thelma

Steadman, Summerfield ; Matilda Sharp, Walker, Cliffside ; Kathrin Bradly, For-

Leaksville ; Mrs. George Martin, Spray est City; Mrs. J. S. Sherlin, Forest

Sanford Stowe, Spray ; Willie Austin, City ; Charles Crawley, Forest City

Draper; B. W. Gray, Mayodan; Will Lawrence Reece, Rutherfordton ; Alonzo

Hayden, Draper; Mrs. Edgar Gilley, Johnson, Forest City ; Virginia Padgett,

Spray ; Alfred Wilkins, Mayodan ; Sam Clift'side; Jimie Behealer, Cliffside; E.

Anderson, Draper ; Annie May Mitchell, A. Snipes, Delway ; V. Hobbs, Clinton

Reidsville ; Will Kizer, Draper ; Dewey Fannie Smith, Clinton ; Berta Murphy,

Dillon, Spray ; Jimmie Dixon, Draper Delway ; Mrs. Cora Herring, Parkers- Lonnie Duggins, Madison, R. F. D. 3 burg; Nina Rich, Clinton, R. F. D.

; Margaret South. Draper Ida Austin, Mrs. Ann Owen, Delway ; Roy Cashwell,

Draper ; Wm. Hayden, Draper ; Lola Garland; Dervie Faison, Turkey; Lucy

Knox, Landis ; Love B. Long, Landis Faison, Turkey, R. F. D. ; Rufus Dunn,

Francis Melchor, Landis ; Hubert Turkey; Robert Williams, Clinton, R. F.

Lyerly, Mt. Ulla, R. F. D. ; Wm. Craw- D. 1; Lula Thornton, Clinton, R. F. ford, Barber, R. F. D. 1; Chafman D. 1; Jackie McNeill, Marston, R. F.

Crawford, Salisbury ; Arthur Roseman, D. ; Alex Williams, Laurinburg, R. F.

E. Spencer ; Brude Butner, Salisbury D. 1 ; Hannah Williams, Laurinburg

Dallas Roberts, Landis ; Douglas Rob- R. F. D. 1 ; Jasper Baldwin, Laurin- erts, Landis ; Roy Trice, Landis ; Exie burg, R. F. D. ; Mrs. Moze Wilson,

Gogleman, Landis ; Hattie Fry, Landis Laurinburg, R. F. D. ; Amus Shaw, Lau-

Lovie Gower, Landis ; Gayville Cooper, rinburg, R. F. D. ; Bertine Gladdine,

Landis; Frank Slaugh, Landis; Gey Laurinburg, R. F. D. ; W. H. Campbell,

Huffman, Landis ; Clyde Huffman. Lan- Laurinburg, R. F. D. ; Child of Neal dis ; Bertha Huffman, Landis ; Shirley Chavis, Laurinburg, R. F. D. ; Woodrow ;;; ;;;;

62 The Health Bulletin

son, Fremont; Robert Walls, Mount Wilson Campbell, Laurinburg, R. F. D. ; Goldsboro, R. Sallie McCall, Laurinburg; Nellie Walls ; James Crawford, Smith, Laurinburg; Child of Sellers Mc- F. D. 5; David Boykin, Mount Olive; Queen, Hasty; Addie White, Laurin- Kirby Smith, Saulston, R. F. D. 1; Lau- Cleveland Anderson, Goldsboro, R. F. D. burg, R. F. D. 1 ; Thomas McKay, rinburg: Metta Shaw, Laurinburg, R. 3 ; Miss Clarissa Odem, Goldsboro : Wm. Laurinburg, R. Smith, Goldsboro; Viola Smith, Golds- F. D. ; Charlotte Shaw, F. boro; Eliza McCuller, Mount Olive; F. D. ; Trulie Bowers, Albemarle, R. Russell, Millard Barnes. Fremont ; Nolle Ben- D. 3 ; R. P. Rees, Badin ; Louise Norwood; Etta Blalock, Norwood; ton, Seven Springs; Mary Lilly Ben- ton, Seven Springs; Ociebell Bunn, Glennie Blalock, Norwood ; Slade Wad- Fremont, R. F. D. 2; Lewis Darden, kins, Norwood ; Roy Lowder, Albemarle, R. F. D. 4; J. O. Morton, Norwood; Fremont; David Thompson, Golds- boro; Chas. Barbour, Goldsboro; Child C. Carpenter, Norwood ; Nannie Morton, Norwood; Will Wright, Albemarle; of Fronie Kornegay, Mount Olive ; Ruth Bertha Carpenter, Norwood, R. F. D. 2; Best. Goldsboro. R. F. D. 5; Leslie Jas. Carpenter, Norwood, R. F. D. 2 Troublefield, Mount Olive; Minnie John Carpenter, Norwood, R. F. D. 2 Kornegay, Mount Olive ; George Ander- Mrs. Luther Furr, New London; Clegg son. Goldsboro, R. F. D. 2; Paul John- son, LaGrange; Willie Wilson, Dudley, Green, Locust ; Child of John Smith, Albemarle; Frank Vernon, Walnut R. F. D. 2; Thomas Stockton, Golds- Cove, R. F. D. 6; Nancy Lash, Walnut boro; Gladis Grady, Mount Olive, R. Cove; Ed. Wilson. Walnut Cove; Eliza F. D. 7; Child of Sam Faison, Mount Chatman, Winston; Susan Jones, Pin- Olive, R. F. D. ; William Barfield, Fre-

F. D. ; John Henry Turnage, Goldsboro, nacle ; Roy Fulp, Walnut Cove, R. mont

; Margaret Grady, Goldsboro 1; Cary Boles, Tobaccosville ; Sadie R. F. D. 1 Houchins, Dalton; William Houchins, Charles Smith, Goldsboro, R. F. D. 4; Dalton; Perry Pretty, King; Nellie Eunice Whitley, Dudley, R. F. D. 2;

Hill, Kenly, R. F. D. 1 ; Minnie Joyce, Mayodan ; Ernest Reivson, To- Wm. P.

Pikesville, R. F. D. ; Essie M. baccosville, R. F. D. ; Sadie Wood, Mt. Howell, Airy. R. F. D. 2; Harrison Cockran, Patterson. Popular; J. M. Taylor,

Olive ; Willie Merritt, Goldsboro Rusk ; Mrs. M. L. Key, Rusk, R. F. D. Mount 1; Lora Taylor, Mount Airy; Royal Rissell Sanders, Fremont; Ashton Sanders, Fremont; Two Children of Smith, Kapps Mills ; Houston Southard, Goldsboro, R. F. D. 2 ; Elkin, R. F. D. ; John Steele, Elkin, R. Sam Kelly, Goldsboro, R. F. D. ; One case at F. D. ; Luther Wood, Rusk; Child of Grady, Pike, Robert Ertus, Bryson City; M. Baw- Walter Brown's, Goldsboro ; Ollen Olive, R. F. D. 7 : Nursie Carter, man Wiggins, Ela ; Sarah Pegg, Ela Mount R. F. D. ; Ed. Pearsall. Jr., Anna Rucker, Proctor ; Lucy Shyller, Goldsboro, 4 Bedford. Jr., Pikes- Bryson City ; Mamie Medford, Bryson Goldsboro; John Pearsall, Mount Olive ; Lela City; Bertha Watkins, Bryson City; ville ; Mary Children of Mr. Best Latton, Brevard Davis, Goldsboro; Lorenza Cain, Fai- Pikesville, R. F. M. Lex Brooks, Unionville, R. F. D. 2 son ; Henry Grantham, Pikesville, J. F. Helms, Monroe; J. Thomas, Bu- D. 2; Child of Ed. Harris, Pikes- ford Township; Lee Griffin, Monroe; R. F. D. 1 ; Clenon Granthum, Daniel, Pikesville, Jas. Caskey, Monroe, R. F. D. 2 ; Jane ville: Child of Bud Pikesville Faulkner, Matthews; M. F. Overby, R. F. D. 1 ; John A. Walker, Seven Springs; James Henderson ; Child of Bud Robinson, Clara Campbell, Goldsboro; Jack Langston, Dabney ; One case at Fred Scott's, Tour- Matthis, ville; One case at Brooks Branch's, Goldsboro; Fannie Kornegay, Golds-

; Child of Tobe Korne- Manson ; Cora Daniel, Henderson, R. F. boro, R. F. D. 4

F. D. 4 ; James Wil- D. 7 ; Blaney Harris, Henderson, R. F. gav, Goldsboro, R. R. F. D. 2; Ludie D. 1 ; Sam Vass, Henderson, R. F. D. 1 liams, Goldsboro, Mrs. Martha Julie Wolfe, Henderson ; N. A. Bowen, Thompson, Goldsboro; Covell Cash- Henderson, R. F. D. 7 ; Miss Lucy Bur- Love, Mount Olive; Eva

F. D. : Marion roughs ; Henderson ; Goode Cheatam, well, Mount Olive, R. Bordours, Henderson ; Gilbert Capps, Henderson, Keen, Goldsboro; Baby Goldsboro R. F. D. 5 : Lorena Hall, Henderson Goldsboro ; Wendall Taylor, Willie Williams, Henderson; Horrace Fab Watson, Knightdale ; Five Children

Knightdale ; Net- Shearin, Macon ; "Doc" Hicks, Wise of Richard Sandeford, Placie Mrs. R. H. Thompson, Warren Plains, tie Bailev, Raleigh, R. F. D. 2 ; Chester R. F. D. ; Levi Jones, Warrenton : Theo- Bailey, Raleigh, R. F. D. 2; Morrisville, dore Hill, Goldsboro; Harvey Thomp- Grant, Oberlin ; H. Barbee, ;;;; —;

The Health Bulletin 63

R. F. D. 1; I. Barbee, Morrisville, R. ville ; Child of Jim Wilkins, Boonville F. D. 1; W. Barbee, Morrisville, R. F. Thomas Adams, Honstonville, R. F, D.

7 ; Carrie D. 1 ; Monroe Mims, Apex ; Eunice Swaim, Boonville, R. F. D. 1 Child of John Swaim, Boonville, Council, Apex ; Emma Burnett, Youngs- R. F.

D. 1 ; ville ; Marv Ellis, Knightdale ; Hazel Annie Lee Vanhoy, Cycle ; Winnie Ward, Pool, Raleigh, R. F. D. 4 ; L. D. Griffin, East Bend ; Child of Luke Myers,

Knightdale ; Mrs. L. D. Griffin, Knight- Hamptouville ; Lawrence Martin, East dale; Frank Davis, Gary, R. F. D. 1 Bend; Mrs. Ross Wyatt, Micaville; Charlie Pallard, Willow Springs, R. F. Child of Mrs. Hassie Hall, Celo; Ada Penland, Paint D. 1 ; Mrs. Ramae Broadwell, Apex, R. Gap; Dallas Robinson, Burnsville; Neta F. D. 2 ; Monroe Mims, Apex ; Louise Young, Rurnsville; Mrs. Rex Mcintosh, Dalbey. Willow Springs : W. W. Davis, Cane River; Child of John Gillis, Walthall ; Clyde Williams, Apex, R. F. Paint Gap; Mr.s. Dave D. 2; Mrs. Snow Blalock, Willow Shuford, Celo; Mrs. Cindie Mcintosh, Bald Creek. Springs ; King Ray, Holly Springs To these names should Julius Reed, Apex, R. F. D. 2 ; Mrs. be added fifty- Calvin Humphrey, Apex, R. F. D. 2 four cases occurring in cities as named Crayton Humphrey, Apex, R. F. D. 2; in which the names of the patients were not reported Mrs. Lonnie Keith, Holly Springs, R. F. ; Durham 1 ; Rocky Mount, D. 1; Joseph King, Gary, R. F. D. 1; 5; Winston-Salem, 24; Greensboro, 3; Charlotte, 14; Wilmington, Ruth Harward, Morrisville ; Jesse 5; Ral- eigh, 2. Wright, Zebulon : Joseph White, Mac- keys ; Irene Conklin, Plymouth ; John Baum, Creswell. R. F. D. Statha 3; NEEDED LEGISLATION Sawyer, Creswell, R. F. D. 3 ; James

Jordan, Plymouth ; Fannie Davis, It is gratifying to know that South- Mackeys, R. F. D. 1 ; Lorenzo Sawyer, ern legislators and governors are be- Creswell, R. F. D. 3 ; Murrell Sawyer, ginning to take Creswell ; Lizzie Cradle. Plymouth increasing interest in Soloman McCullough, Jr., Plymouth, R. the patent medicine evil. Wisely

F. D. ; Rufus Phelps, Creswell, R. F. 2 enough does the state say that in order D. 1 ; Virginia Ford, Plymouth ; Jessie to practice in person, a man must Bryant, Creswell ; Mrs. Hamp. Bobbins, show good character Blowing Rock ; J. T. Coleman. New and must attend Castle; Rufus McNeill, North Wilkes- a medical college for a certain num- boro; Mrs. C. P. Crysel, Wilkesboro, ber of years, and must pass a speci- R. F. D. 1; Millard Johnson, Wilkes- fied examination as proof of his abil- boro, R. F. D. ; Thomas Nunn, North ity. And yet the Wilkesboro ; Joe Bambill, Wilkesboro, same state turns

R. F. D. 1 ; Calvin Eller, N. Wilkesboro right around and allows any man to Mrs. Robert Ballard, Hays ; Acy Wil- advertise cure-all patent medicines liams, Wilson ; Charles Beers, Wilson ; without proof of character, without Hester Banks, Wilson ; Arthur Tugwell, college or hospital training Wilson ; Lorenza Barnes, Wilson ; Mrs. and without T. E. Stancil, Wilson ; Jack Jones, Wil- any examination whatever to show son ; Jessie Montague, Elm City, R. F. that he knows or cares anything about D. ; Amanda Anderson, Elm City, R. F. medical science! There is nothing at D. 3 ; Aaron Barnes, Stantonburg ; Child all to prevent a negro of Abram Barrum, Fountain ; Child of just off the

Roscoe Ford, Elm City, R. F. D. 2 ; Ed. chain-gang from fixing up a so-called

Jones, Fremont, R. F. ; D. 1 Mrs. Wal- medicine, advertising any sort of ter Farr, Elm City, R. F. D. 4 ; Gordon claims about it and selling it to ignor- McKeel, Saratoga ; Child of Rufus ant people the same as if it Whitley, Walstonburg, R. F. D. ; Bertha were the

Tyson, Saratoga ; Alonzo Cheek, Cycle product of the most famous medical Lura Bohannon, Boonville; Pearl Riv- expert of the century. Here is a good ens. Tadkinville, R. F. D. 1 ; Child of chance for some legislation, and we C. H. Todd, Yadkinville, R. F. D. 2; Ralf Coram, Boonville; Resella Size- hope it is coming in all our states. more, Boonville ; Myrtie Buxton. Hamp- Progressive Fanner. stonville ; John Bray, Yadkinville ; Opal

Wolfe, Jonesville ; John Brown, Boon- ville, R. F. D. 2; Drake Reece, Boon- —

PUBLIC HEALTH RND SANITATION

SEX HYGIENE AND CHARACTER THE BIGGEST HEALTH PROBLEM

"The sex instinct, when normally developed, wisely directed and controlled, becomes a source of power, of capacity for achievement, and of inspiration to the noblest of ideals. When misdirected, uncontrolled, and sensualized, it tends to physical decay, intellectual confusion, and spiritual ruin. It is one of the greatest influences determining human character, happiness, and destiny." M. J. Exner, M.D., Secretary Student Department, International Committee Young Men's Christian Association.

RELATION OF THE SEX GLANDS TO THE DEVELOPMENT OF BODY AND CHARACTER

Experimental Evidence. There were termined ; his will was strong to do once two colts ; these colts had the same whatever he set himself to do. The sire and their mothers were sisters ; at horse had individuality ; he had char- six months of age the colts were exactly acter. alike in size, form and behavior. At The horse that was operated upon, this age, one of the colts was castrated, the horse that had grown up without or "altered," that Is to say its sex the influence of its sex glands, had glands were removed. Three years no particular pride in his appearance or later, the colts which were exactly alike acquirements. His head was not held at six months of age, were entirely dif- so high ; he had no beautifully arched ferent both in appearance and be- neck, no vital spark in his eye, and, havior. comparatively speaking, took little in- The horse that was not operated upon terest in his surroundings. He seemed hold his head erect on a beautifully to lack the self-respect and the self- arched neck, and his eyes flashed an in- esteem, in short, the pride of the uncas- terest in his surroundings ; both form trated horse. He was not courageous; and movement expressed alertness, keen he always ran from the stallion ; he perception, and self-respect that bor- was little interested in learning tricks. dered on laudable pride. At work, he never pulled against the On gala occasions, he would catch bit, and he lacked the endurance of the spirit of the crowd and take part the other horse ; he seemed always will- in the festivities, keeping step with the ing to adapt himself to the course of music. He was quick to learn and least I'esistance; he could be easily seemed to take pride in acquiring new bridled, and a child could handle him. tricks that his master taught him. He He was what his surroundings and his was courageous ; he never ran from a associates cared to make of him ; he fight ; in the pasture he was the ac- was servile ; he lacked individuality. knowledged leader of the herd. He had As between the castrated and uncas- exceptional endurance ; he was de- trated horse, so between the bull and :

The Health Bulletin 65 the steer, there are the same physical public sentiment; he never swims and psychic difference. And so again in against the current ; he has no individ- is of the herd, and as the rooster: "If these glands are com- uality ; he a part pletely removed from a young rooster, such moves with it. He has no initia- as he finds he never develops into a fighting cock. tive ; he takes conditions He is healthy, big, selfish, soft; will them and, therefore, is not resource- never rush to defend a hen and will not ful. With no pride, he has no reason fight, because he is just naturally a pol- for endurance, for long hours, or stren- troon. He has no beauty—fine plum- uous effort. He is a steer-man, docile, age, comb, graceful bearing; no crow, servile, without character. and only a semblance of spurs." These Luther H. Gulick, formerly in charge same physical and psychic differences of physical education of the public hold throughout the animal world be- schools of New York City, says: "I tween the castrated and the unca'^tvated have no hesitation in saying that castra. animal. tion of the human male has an effect similar to that of castration of ani- The Human Castrate or Eunuch mals, that these effects are greater The removal as a religious rite, or by rather than lesser, and that the effects accident, or by surgical operation for are greatest in the realm of character some malignant disease, of the sex and spiritual life." glands of the human animal before the Internal Secretions. There are a age of puberty? that is, the twelfth or in the body that take thirteenth year, results as follows number of glands the blood circulating Physically, the usual change in the substances from them, and out of these sub- voice of the boy from the high-pitched through stances make fluids which are re-ab- treble of boyhood into the clear, ring- sorbed by the blood and diffused ing tenor of manhood, or from the low through the body. These fluids are alto of boyhood into the deep, sonorous spoken of as internal secretions. The bass of manhood does not occur. There internal secretions of certain structures is no growth of hair on the face or the thyroid gland, the pancreas, other parts of the body; there is a like pituitary body, the adrenal, and deficient development of the hard, mas- the other glands that produce internal se- culine, muscular limb ; there is lacking very wonderful effects on the normal immunity against infectious cretions, have the nutrition and the development of diseases ; there is deficient physical en- mind. The effects of durance. the body and be studied in two Psychically, self-realization (self-re- these structures may the removal, complete spect and self-esteem, personal pride) is ways: (1) By partial, of the structure and observ- absent. Where there is no self-esteem, or o£its absence; and (2) by no personal pride, there can be no ing the effect extracts of the structure into courage, neither moral nor physical, for injecting for example, the injection the individual who has no respect for animals, as, of thyroid extract into animals and self, no pride, has nothing to defend, effect. In this way we and, therefore, the absence of courage, observing its that the thyroid gland, if re- and without courage there is a lack of know or if it becomes diseased and honesty. The coward lies whenever it moved loses its function, stops work, is fol- is inconvenient or dangerous to be a condition known as cretin- truthful. He has no fixed convictions lowed by ism. to enunciate or defend when circumstances necessitate one's taking a posi- Cretinism is a retardation almost to point of complete cessation of bodily tive stand. He drifts ; he floats with the 66 The Health Bulletin

and mental development, and the accu- The pancreas is composed of two very mulation in the flesh or tissues of the different structures. One of these struc- body of a mucus-like material. Most tures of the pancreas, if destroyed, is of us have seen cretins, that is, dwarfs, followed by the inability of the body to say, twenty years old and upward, who assimilate or use sugars. The sugar are physically no larger than a child passes right through the body, unutil- of eight or ten years, but with the ized, by way of the kidneys. This is features of an old person. Their body the basis of the disease, diabetes. is thick and heavy in proportion to its There is another small structure height ; their features are stupid ; their known as the adrenal gland, which lies hair is scant and coarse ; their mind is just upon top of the kidney and which, dull. By taking the thyroid glands if it becomes diseased, is associated of sheep and extracting it and injecting with great muscular weakness and the this extract into cretins, their entire at- deposit of a brownish pigment in the titude changes. They become inter- skin, a rare disease named after its ested in their surroundings, and they discoverer, Addison's disease. begin to learn; their mental dullness These examples of internal secretions gives place to alertness, and if the treat- are cited for the purpose of impressing ment of the cretin be established early, the reader with the importance of a before cretinism becomes marked, the number of structures of the body that, condition is completely prevented. On operating through internal secretions, the other hand, if thyroid extract is in- are powerful in their influence on nutri- jected in continuous and large doses tion and development of both body into a normal person, that person's and mind. pulse is enormously quickened, the per- Now, to return to the discussion of son becomes very nervous, he has mus- the work of the sex glands, we find one cular tremors, and the eyes protrude of the most potential of the internal se- from their sockets, a condition called cretions to be produced by these glands. exophthalmos. And so there is a dis- The sex gland begins to produce this ease, the opposite of cretinism, in which internal secretion about the age of the thyroid gland overworks, and we twelve or fourteen years. It is this in- have this condition of exophthalmos, ternal secretion that causes the develop- sometimes called exopthalmos goiter. ment of those physical and psychic There is another gland known as the charteristics, that differentiate the nor- pituitary body, lodged at the base of mal from the castrate. the brain. Disease associated with the Sex and the Discipline of Youth.— destruction of this gland results in an It is a common experience of parents enormous growth of the bones. Post- to become discouraged with the disci- mortems on giants usually reveal some pline of the child as he passes from abnormality of the pituitary body. An- childhood into and through the adoles- other rare condition associated with the cent stage. This is because parents disease of the pituitary body has the know not of those physiological laws difficult name of acromegaly, a combi- that God has determined shall have nation of Greek words meaning en- jurisdiction with the youth over any larged bony prominences. In acrome- orders from the parents. Until the age galy, the features, the jaws, the malar of twelve, the child, physiologically bones and nose are tremendously en- speaking, has no sex glands (these larged, also the hands and the feet. glands until then are dormant), and he Such a person has to have his gloves is as docile as the castrated horse or the and shoes made to order. steer. But after this period, with the The Health Bulletin 67

development of the sex glands and with an intelligent grasp of the significance the influence of the internal secretion of sex is vital. of these organs on the mind of the Functional Castration or Self-abuse. youth, he begins to develop an individ- At the same age that the sex gland be- uality. If he does not, if he is not gins to produce the internal secretion, head-strong, determined, resourceful, as it begins to form another secretion compared with his former existence, called the external secretion. The two then he is not normal, and it is not fluids or secretions are formed by en- likely that in later life, when he entirely different structures within the counters obstacles, that he will over- gland. The internal secretion is taken come them. up by the blood and circulates through The willfulness of the youth after the the body, producing its marvelous ef- twelfth or fourteenth year, when he fects, while the external secretion or wanders in the wilderness of temptation fluid accumulates in a system of small trying to find and pursue the path to tubules or minute ducts within the his own life, is the God-determining, gland. These tubules become united physiological course, and no parent, if very much as small streams unite to the youth is normal and strong in his form a large stream until finally the sex endowments, can block the way. entire system of tubules are converged Parents may influence and guide, espe- into one large duct that opens on the

cially if they sympathetically realize exterior of the body ; hence the name, the physiological status of the youth, the external secretion. but parents can never more command. The accumulation of the external se- Out of the self-realization of adoles- cretion within the tubules of the sex cence and out of the knowledge of the gland causes a certain amount of pres- tree of good and evil, the individual sure on the delicate, sensitive nerves in conscience comes and ascends the the walls of the tubules. This pres- throne, and the scepter of power passes sure causes these nerves to carry sexual from parent to offspring. To break the impulses to the brain. Sexual im- spirit of the child at this time is to pulses caused by the accumulation of break his soul. Fortuately, God has the external secretion within the tubu- given most children spirits that parents les is relieved by the discharge of the cannot break. secretion, and the consequent desire to Castration After Full Physical and discharge the secretion underlies the Psychic Development. After the sex temptation to sexual sin. The dis- glands have produced the physical and charge of the secretion under any cir- psychic characteristics of the mature cumstances constitutes, in effect, the animal, the removal of the sex glands sexual act. does not cause the loss of the physical The control of this desire or tempta- and mental effects that these glands tion results in the delicate, nervous

have produced. Says Gulick : "The mechanism's becoming accustomed and operation does not undo the growth of adjusted to an ever-increasing extent to body, mind, or character that has taken the pressure of the accumulated secre- place." This is all important to remem- tion. With this adjustment, the sexual ber. The work of the sex glands in impulse becomes less and less notice- making a strong body and a strong able and the temptation to sexual in- character is a thing that is accom- dulgence becomes easier to resist. The plished between the twelfth and twenty- paramount duty of the young person,

seventh years of life. It is, therefore, therefore, is to make a determined fight with respect to this period of life that during the first few months or the first :

68 The Health Bulletin

year or two of tbe beginning of his energy to be diverted into the internal active sex life in resisting the impulse secretion, which goes into the develop- to sex indulgence, and in so doing ac- ment of body, mind, character—and, quire an adjustment or an immunity some would say, soul. There are some to this, perhaps, the most heavily pun- that use 100 per cent of their sex gland ished sin. endowments in the building of strong

If, instead of resisting the temptation bodies and great characters ; others use to sex sin the person yields to the sex- less, some 90 per cent, some 80, some ual impulses and the external secretion 60, and, alas, some even less. Chastity of the sex gland is discharged and the is the coin with which a man buys pressure upon the nervous mechanism character. relieved, then, instead of acquiring an Difference in Sex Control Between adjustment or an immunity to this Loiver and Higher Animals. Among the pressure, the nerves become increas- lower animals living in the infranatural ingly sensitive to the secretion, the realm, that is, under the laws of nature, sexual impulse increases in both fre- the male animal is protected against quency and intensity, and the resistance himself, against the premature use of to sex indulgence becomes weaker and the external secretion of his sex glands. weaker. THE SEX GLAND, UNDER In order for the male animal in the THESE ABNORMAL CONDITIONS, natural state to indulge in the sexual BEGINS TO DIVERT ITS ENERGY act, he must be fully matured both in FROM THE FORMATION OF THE bodily strength and courage, so that he INTERNAL SECRETION, WHICH may overcome the opposition of the ac- PRODUCES STRENGTH OF BODY knowleclged male leader of the herd. AND CHARACTER, TO THE PRO- And thus nature protects (under article DUCTION OF THE EXTERNAL SE- one of her constitution, the great law CRETION WITH CORRESPONDING of the survival of the fittest) the lower LOSS OF BODY AND CHARACTER animal against the premature diversion DEVELOPMENT. Thus the tree of of the energy of the sex gland into sex- life, like the barren fig tree, never pro- ual indulgence and away from the de- duces those finer fruits for which God velopment of bodily and mental planted it in the Garden of Eden, but strength. Examples of what would yields its sap to aberrant and fruitless occur in the animal world if this pro- sprouts that spring prematurely from tecting scheme of nature were inter- its base. fered with, is seen not infrequently in The sex gland may be compared to a man's interference with this natural person with two divergent channels of law. If a stock-raiser permits the endeavor open to his energy or talents growing colt, the future stallion, or the One -channel lies through self-gratifica- young bull to run with the herd and to tion and leads to the selfish, the small, indulge in sexual acts, the colt or bull and the evanescent things of life; the becomes stunted and dwarfed physi- other channel lies through self-denial cally, and both in appearance and be- and leads to the unselfish, the larger, havior suggests the castrate—the horse and permanent values of life. So with or the steer. the sex glands. There are two diverg- But man does not live under natural ent channels through which they may laws; he lives in the supernatural, for dispose of their energy. If this energy immediately after his creation he was is disposed of in the external secretion, given "dominion over the fish of the for selfish and evanescent pleasures, sea, and over the fowl of the air, and then there will be correspondingly less over the cattle, and over all the earth, : ; : :

The Health Bulletin 69

and over every creeping thing that "This periodic filling of the seminal creepeth upon the earth." Man, was put vesicles, and the consequent tendency to in charge of nature, over nature. The sexual stimulation, as a result of a protective checks which hedge about distention of the vesicles, gives to the the lower animals, that lack endow- sexual life of the young man a more or ments of reasoning and self-control, less definite ebb and flow or periodicity, are not placed about man. He is as it is technically called. This ac- thrown upon his own responsibility counts for the fact that most young put upon his honor. He is a free agent. men will every two to four weeks ex- His is the choice to waste his substance perience strong sexual desires and in- or build imperishable character. clinations. It is at just such times that Nocturnal Emissions. The following the temptation to self-abuse becomes is taken from the book entitled "From greatest, and it is just at these times Youth Into Manhood," by WinSeld S. that the young man needs to get a grip Hall, a book that every youth should on himself and control his inclinations. read. It costs 50 cents and is distrib- If he can do so for a few days. Nature uted by the Young Men's Christian As- will probably come to his relief in a sociation Press of New York City nocturnal emission, and the physical "Little has been said about the semi- cause of his temptation will be removed nal vesicles. These little bladder-like for another period of two to four organs possess glandular walls, which weeks." secrete a gelatinous albumen, intended The fluid discharged in the nocturnal by nature as food for the spermatozoa. emission is not the internal secretion This albumen is not a vital fluid. It produced by the sex gland, and, there- collects in the seminal vesicles until fore, does not interfere with the influ- these organs become distended, when ence of the sex gland on physical and nature relieves the pressure within the psychic growth. organs by causing them to empty out. Remedies. The best remedy for in- This emptying of the seminal vesicles creasing one's resistance to sexual temp- usually occurs in the night and is for tation is a prescription written long that reason called a 'nocturnal emis- years ago, a prescription that has never sion.' Healthy young men of seventeen been improved upon and never will be.

or eighteen, sometimes younger, experi- Saint Paul wrote it. It is a prescrip- ence these nocturnal emissions. It is a tion for the sanitation of the mind, and perfectly natural experience that results is as follows in no loss of vitality, only a slight de- Finally, brethren, whatsoever things pletion of material, and has on the are true, whatsoever things are honest, whole a rather sedative and quieting ef- whatsoever things are just, whatsoever fect following the stimulation caused things are pure, whatsoever things are by the distention of the vesicle. lovely, whatsoever things are of good "When the young man first begins report, if there be any virtue, and if to experience these emissions, they are there be any praise, think on these likely to come only once in two or three things.—Philippians 4 :8.

months ; a little later they may occur A clean mind, in brief, chastity, is the as often as once in a mouth or six first line of defense in the protection of weeks. If they should later come as the continent life. Once that line is frequently as once in a week or ten broken, all is in peril. Interesting ex- days, nothing is to be thought of the periments have been done to show the matter unless the young man should ex- effect of thought, the efllect of the perience a very noticeable languor and mental attitude, on glandular action. weakness following it One of these experiments is as follows 70 The Health Bulletin

accentuation of sex A mail is laid upon a table \Yhich is environment for the impulses. The exercises, or, so far as delicately balanced upon a pivot ; the interesting work or man is asked to do hard, mental work, that is concerned, with say, to work out in his mind some com- recreation, keeps the mind engaged plicated formula or to recite a difficult healthful thoughts to the exclusion of unhoalthful thoughts, and when the piece by memory ; the end of the table on which the head rests gradually overwork or play or recreation is laid aside, balances the other end of the table and the natural physical fatigue gives the sin of speedy and sound this end of the table goes down ; if, now, safety from the man is asked to concentrate his slumber. thought on running a foot race, the Another thing to be remembered in equilibrium of the table is gradually re- maintaining the ideal of continence is established and, finally, the foot of the the avoidance of constipation. Consti- table sinks. This experiment shows that pation means the accumulation of waste thought can influence, and does influ- products in the intestines, particularly ence to an extent, the distribution of in the lower bowel. The pressure of the blood in the body. the accumulated waste products upon Now, to return to the question under the small blood vessels not only in consideration. If the mind yields to im- bowel walls, but in the surrounding pure thoughts and considers the sexual organs, including sex glands, causes a impulses, and there is an accumulation congestion or a surplus of blood in of blood or congestion in the sex glands, these parts with increased activity and, the result will be a larger formation naturally, stronger sexual impulses. from the excess blood supply of the ex- Cost of Incontinence. Go to a typical ternal secretion, an increased pressure pool room, one of the eddies off the upon the nerves in the tubular walls, vital current where the driftwood of

and greater difficulty in resisting the society floats in and out ; see the aver-

temptation to sexual indulgence ; there- age age ; note the number of youthful

fore, avoid all acts and situations that smokers ; listen at the language of the tend to excite or augment sexual im- place; pick out not the exception in pulses. the herd, but the type, and study it. The second line of defense in the pro- Do you see anything in the features or tection of the continent life, is healthful the form to indicate moral or physical

exercise. This helps in three ways : In courage, conviction of character, initia- the first place, in exercising, the blood tive, leadership? I of the body is diverted into those parts They belong to the gang; belong is of the body undergoing the exercises, the word. Mentally, they have never, namely, the muscles, and this means learned to stand alone; as the gang

that relatively less goes to the sex thinks, they think ; the social views of

glands, and that there is less external the gang are their views ; the gang's po- secretion formed, less pressure, and litical attitude is their political atti-

weaker sexual impulses. In the second tude ; the gang's religion or irreligion is

place, the mind, occupied in recreation theirs ; they float with the current ; they and in competitive games, is less sus- come and go with the thought tides, lit- ceptible to sex impulses, just as a per- tle noticed, soon forgotten. son listening to beautiful music is less After seeing the type, one is in a posi- apt to hear the whisperings of the ob- tion to recognize its variations that are scene. In the third place, healthful ex- encountered all too frequently and in ercises and recreation get rid of the numbers which it is useless to dwell devil's workshop, idleness, a favorable upon. The Health Bulletin 71

As we write this section, we have in this country ; we have in mind main mind tuberculosis, costing our coun- laria and hookworm, and all their try 150,000 lives and an invalidism of blighting effects on tropical and sub-

from 1,000,000 to 2,000,000 people an- tropical races ; we have in mind what

nually ; we have in mind pneumonia, we shall speak about in our next Bul- with a death rate almost as high as letin, venereal diseases, which, accord- that from tuberculosis and with a ing to the Surgeon-General of the army, sickness rate approximating a total cause more incapacitation of troops on of 750,000 cases of the disease annu- the western front than wounds re-

ally ; we have in mind cancer, which ceived in battle ; and with all these in causes the death of about one-tenth our thought, we give it as our delib- of all women and one-twelfth of all erate judgment that the cost of in- men over forty years of age, causing continence or improper sex living is the a total of over 80,000 deaths annually biggest of all health problems.

SWIMMING POOL SANITATION

Practical Suggestions for Making and Keeping Swimming Pools Safe and Sanitary

The increasing interest in the matter handholds to assist in getting in and out of adequate swimming pool sanitation of the pool. All drainage and waste suggests the value of a short article from these gutters and the floor around along this line at this time. the pool should be into the sewer and Proper design and construction of not back into the pool. swimming pools and equipment warrant the first important consideration. Pools Tite or cement floor. ^Waste vtertvr qi/rter t should be lined with some white, easily cleaned, water-tight material, prefer- \T ably white enameled tile set in cement mortar. Care should be taken to have Overflow or shmming t anti handhcJd. no cracks, rough places or sharp or re- [ cessed corners or edges. Rounded cor- CfOSSSECTXTML VIEW ners and edges are much easier to keep OF TILE AT TOP EDGE clean. The depth of the pool should SWIMMING POOL vary from 2 to 3 feet at one end for Outlet to sener-b wading to from 7 to 8 feet or more at the other end for diving. Along the Only the best quality of rigid substan- top edge of the pool should be a special tial apparatus such as spring boards, tile having two small gutters one on ropes, rings and other equipment should the top surface of the tile to prevent be provided. waste water splashed out of the pool To better insure that bathers will from returning and another along the take a shower bath before entering the inside face of the tile to serve as an pool it is well to have the bather's overflow or skimming weir for the pool entrance to the pool pass through the and to afford bathers a place to spit. shower room. In laying out the ar- The accompanying figure shows a cross- rangement or plan for the shower, sectional view of such a tile. Both of locker and pool rooms it is usually ad- these gutters will be found to be of visable to have it so arranged that a great assistance to bathers in affording single attendant or towel clerk may —

72 The Health Bulletin have bis desk or post so located as to Common towels, combs, brushes and have a general view into all the rooms drinking cups should be prohibited and for purposes of oversight and superin- towels and bathing suits when used tendence. Such an attendant should be should be of a fast color, liutless and familiar with the technique of resus- thoroughly laundered and sterilized citation of drowning persons and proper after using. To sterilize towels and equipment should be available for rescu- bathing suits in laundering excellent re- ing and resuscitation. sults may be obtained by adding one Ample toilet facilities, urinals and ounce of calcium hypochlorite (chloride sanitary drinking fountains with pure of lime or bleaching powder) to the hot water should be provided for the con- water used for every 30 pounds of dry venience and safety of the bathers. material laundered. Conspicuous notices should be posted Diseased and intoxicated persons in regard to drinking only from the should be prohibited from using the drinking fountain, using the urinals and swimming pool. toilets before taking a shower bath and Locking the pool room or other ade- taking a thorough shower bath before quate steps should be taken to prevent entering the pool. Anti-spitting notices persons from accidentally diving into should also be displayed. the pool while emptying, cleaning or re- Adequate sanitary management and filling. fixtures, traps clos- control of the water in the pool, the All plumbing and premises and the bathers themselves ets should be kept in proper working Flies mosquitoes should be are of prime importance. The sanitary order. and reasonable effort quality of the water used in swimming sci'eened out and every pool well pools should equal that of water used made to keep the and premises for drinking and general domestic pur- lighted, clean and inviting. By so doing better cooperation reas- poses. From a physical viewpoint much may such water should be free from color, onably be expected on the part of the odor, turbidity, and sediment. A soft bathers. For further suggestions on this sub- water is preferable to a hard water ject the reader is referred to Standards but the former is not always available. In general the bacterial count should for Swimming Pool Legislation by Wal- lace A. Marsheimer, Ph.D., of New be less than 100 per cubic centimeter with no colon bacilli present in 10 C. C. York, in the Medical Record, March 9, quantities. 1918, from which much of the above material has been taken and to articles Where ample water is available fresh water should be added continuously at on Public Bathing by H. A. Whittaker one end of the pool and withdrawn at of Minneapolis in the Journal-Laucet the other end. In the interest of econ- under dates of February 15 and June, 1918. omy of water and heat it is usually advisable to recirculate and refilter the If you want to be miserable, think water. Recirculation and proper filtra- about yourself, about what you want, tion followed by disinfection of the what you like, what respect people water by means of chloride gas or cop- ought to pay you, and what people sulphate gives even better results per think of you. Charles Kingsley. than the addition of fresh water. Very small chlorine outfits such as are now I think that saving a little child on the market for treating water from And bringing him to his own, the smallest public water supplies will Is a derned sight better business be found suitable for sterilizing the re- Tban loafing around the throne. filtered water. —John Hay, "Little Breeches." HOW TO HOLD OLD AGE AT BAY and kept clean. If it gets dirty, it is given a bath at once. (An Editorial from Good Health for Most important of all, the master of

June, 1918.) an automobile will take care to feed it properly. Oil adapted to its bearings, It's simple—treat yourself as well as and gas of the finest quality. No oil you do your automobile. The body or gas is too fine for a high-priced auto- grows old just as an automobile does mobile. and for the same causes. Noiv that is the way a man should Let two automobiles leave the factory treat himself if he icants to live out all at the same time, finished on the same his days, if he desires to hold that grim day. At the end of a year one may be enemy, old age, at bay as long a time as old and worn-out, fit only for the junk- possible. heap, while the other is "good as new." To keep an automobile young, one It's altogether a matter of care. uses it sensibly and cares for it scientifi- There is one important difference be- cally. To keep a man young as long tween a man and an automobile. The as possible, it's only necessary that he idle automobile keeps in fine shape, should live scientifically, biologically. while the idle man rapidly deteriorates. That is, HE SHOULD LIVE NATUR- Activity is essential for the preservation ALLY. of the living machine. But he doesn't do this. As Seneca, A man who wishes to get the most, the wise old Roman philosopher said, the longest service, out of his automo- "Man does not die, he kills himself." bile gives it excellent care. He contin- That's the real truth. We destroy ually guards it against accidents. He ourselves with bad habits, abuses and doesn't use it for a battering ram to beat neglects. The average man lives less down telephone poles and fence posts. than fifty years. If he took as good He selects the smoothest road he can care of himself as he takes of his auto- find instead of rushing over ditches, mobile (if he has a high priced car) he plowed fields and stone heaps. He would live a hundred years at least. drives slowly over rough places and climbs steep hills on low gear. the owner of a PROTECTING THE HUMAN Every few months MACHINE worth-while machine has it looked over by an export who takes care to tighten The statistics obtained from the every loose bolt and screw, to inspect medical examination of the men in the and adjust every automatic device, to first draft revealed the fact that more clean and oil, in short, to correct every than one-fourth of our male popula- defect. Such an inspection will cer- tion in the prime of life (21 to SI un- tainly precede a long touring trip. And, years) , was physically defective and also, the automobile is properly housed fit for military duty. The records of 74 The Health Bulletin physical examinations of industrial It is certainly the duty of every true workers and the vital statistics reports citizen—a duty to himself, his family, of the population at large show that and his nation—to visit a physician at there is a marked decline in the power regular intervals and undergo a com- of American citizens to withstand the plete physical examination. Only in strain of our modern life. this way he will be able to know of the Of course, it is the natural order of approach of any insidious disease and, things for the human machine to wear what is more important, be able to take out and for life to end. But—Ameri- measures to prevent the disease from cans are wearing out sooner, now, than developing or arrest its development. they did a few years ago. Why have In other words, defer death and prolong the chances of early death after reach- life. ing the prime of life increased? That this lamentable condition is true is THE NATURAL LIMIT OF proven by the yearly increasing num- HUMAN LIFE ber of deaths from diseases of the heart, Students of longevity have collected arteries, kidneys, and of the digestive numerous authentic examples of persons and nervous systems. A study of the who have lived far beyond the 100-year Vital Statistics Reports for North Caro- mark. This fact settles at once the lina will show that these diseases of old question whether the natural limit is age are increasing among people in mid- three score years and ten as has been dle life and even younger. generally held. The Cardinal de Soils, The disea.ses of old age are handicap- Archbishop of Seville in Spain, was 110 ping the industrial life of America in years old when he died. He used to two ways, both of which have been tell his friends, when asked what regi- clearly brought forward by the rapid men he observed to enable him to live preparation of the nation to take its so long, "By being old when I was part in the great war. These maladies young, I am able to be young when I are not acute, but develop very slowly am old. I led a sober, studious, con- and the person affected may have the templative, but not lazy life." disease for many months, or even It would mean a great deal to the na- years, before his body breaks down tion and more to the individual if each and he becomes aware of it. But dur- citizen would learn and observe the ing all this time the individual's work- rules of nature as they affect the way ing capacity is lowered and he doesn't of living. If every one knew how to recognize the cause. This lowered vi- care for his body and preserve it and tality is responsible for many accidents, how to ward off disease it would be for damaged machines and inferior common, instead of rare, for men and goods, and other costly errors. The old women to live to the ripe old age of one age diseases are the concealed enemies hundred years. of vitality, alertness, accuracy, and effi- But, unfortunately, this important ciency. And, secondly and of equal im- knowledge has not yet been diffused. It portance, they shorten the working, pro- is held by a few informed persons but ductive period of life. the great mass of people have not taken Thousands of American citizens are the time and trouble to learn about at present afflicted and handicapped personal hygiene and its tenets. The with various diseases in an incipient majority is guided by the principle used form. It has been estimated that the by the young mother in feeding her in- mortality from the old age diseases has fant. The baby was eating a large cu- nearly doubled in the last fifty years. cumber pickle when a neighbor, in pro- The Health Bulletin 75

test, exclaimed, "The child will kill York City. "The purpose of the Life himself !" "But he has never choked on Extension Institute embraces the exten- it yet," the mother replied. "Anything a sion of human life, not only as to child can swallow without choking is length, but also, if we may so express all right." it, as to breadth and depth. It en- deavors to accomplish this purpose in REFORMS IN DIET HABITS many ways, but especially through in- aims the The regulations and restrictions of dividual hygiene." The of Life Extension Institute and of life ex- the Food Conservation Committee have tension work are: To provide the done more in a few months to reform (1) individual and the physician with the the vicious diet habits of the American conclusions on individual people and have done more to educate latest and best hygiene; to ascertain the exact and the people as to food values and the (2) special needs of the individual through value of correct diet than has been periodic examinations; (3) to induce accomplished by all the diet reformers all persons are found to be in put together during the past century. who medical attention visit their Meatless days have given the people need of to physicians. a chance to discover that meat is not is interesting to note that a Unit necessary to strength and comfort and It Life Extension "Work is being intro- that a person may feel better and be of duced among the activities of the North able to do better work without it. Carolina State Board of Health. This Wheatless days have made it necessary unit at present forms part of the regu- to employ other cereals as substitutes lar program of work of the nine coun- in making bread and our citizens have (Davidson. For.syth, Lenoir, Nash, been quick in learning that bread made ties Pitt, Robeson, Rowan from these varied and coarser substi- Northampton, Wilson), cooperating with the Bu- tutes have been more easily digested and Health Work and will and have, in many instances, been com- reau of County extended to other counties. plete cures for chronic constipation. later be plan of work is to have the county Another lesson of great importance is The ofiicer take a thorough course the necessity for a more liberal use of health of and practice in physical diag- fresh vegetables in the diet. study nosis at the State Sanatorium in order A better regulated and more rational to familiarize himself with the latest diet will exert a great influence for bet- and best methods of modern medical ter health and will not unlikely result diagnosis. The health officer then sets in a noticeable improvement in health apart one or more days each week for and longevity and a lessened number the examination of adult citizens who of cases of sickness and death from apply at the health department. This Bright's disease, apoplexy, heart trou- work is already being successfully con- bles, and other old-age diseases. ducted in Lenoir and Robeson counties ORGANIZED WORK TO PROLONG and will begin in Davidson and Wilson LIFE at an early date. One of the most important and far- The purpose of the examination is to reaching movements in modern medi- detect disease in its early stages, to find cine is the organization of specific work minor defects which may impair the to ward off the diseases of old age. citizen and decrease his working ca- This movement has been popularized pacity, and urge medical attention be- and given great impetus by the work fore the condition may become serious of the Life Extension Institute of New or permanent. The examinations are 76 The Health Bulletin made in the county health office, which berculosis or consumption was found in has a completely equipped laboratory, 38 persons, the majority of whom were and includes urine and blood pressure not aware that they were victims of this tests. Adults above the age of 20 are dreaded disease. examined, but in no case is treatment Of the minor diseased conditions 94 given. Where medical or surgical at- per cent had some trouble with their tention is thought necessary the patient teeth and gums, 49 per cent suffered is referred and chooses his own physi- from chronic constii^ation, and 58 per cian. Twelve to fifteen examinations cent from what is commonly called "in- can be made in one day ; and in order digestion." Ninety per cent of the total to facilitate the work each applicant examined had regularly committed er- brings with him a filled history blank. rors in personal hygiene and 87 per cent Each person examined is given a writ- errors in diet. ten report, with verbal and printed advice, together with suitable literature It should be remembered that Robe- on health conditions in which he is son county is not an exception but an interested. average county and statistics of indus- The report of the life extension work trial examinations and of the examina- done in Robeson County is instructive, tions of men for the army show that the and is an average of what would be same conditions exist in all parts of found in any county of the State. Dur- North Carolina. The bright feature of ing the past six months TOO persons the whole thing is that the citizens of have taken the examination, and 98 per Robeson county have become interested cent of these were found to have physi- in the prolongation of life and are not cal defects of some degree. At least only being examined but are following 40 per cent of those examined were un- advice and are having their defects aware of any impairment, while 20 per remedied. Dr. W. A. McPhaul, Direc- cent had been sick for six months or tor of the Robeson County Health De- longer without consulting a physician. partment, sums up the value of the life One half of the 700 had defects which extension work in his county in a- very may be readily remedied by exercise, interesting letter, written at the time proper diet and ways of living, and ad- exactly 500 persons had been examined. vice as to personal hygiene was given to He writes : "Think of it, 2,000 years of these. Exactly half of the total num- service have been added to our county. ber examined were referred to their We have examined about 500 people. family physician or specialists for fur- Some of them will not pay much at- ther examination and treatment, while tention to what we told them, but the a still larger number were advised to majority will, and some of them will consult a dentist. live ten to fifteen years longer. Let's The physical defects found include strike an average of four years which the following: Faulty eyesight, 48 per gives us 2,000 years of service. You cent ; faulty hearing, 6 per cent ; rup- just can't figure it in dollars and cents. ture (unoperated), 4 per cent; over- I expect to examine 1,000 people during the weight, 21 per cent ; underweight, 15 year." per cent. The proportion found to have As an instance of just such a thing. serious diseased conditions was also Dr. McPhaul tells of the case of a large: Organic heart disease was found woman on whom a cancer was discov- in 15 per cent of the persons examined, ered and later removed. He adds that, thickened arteries in 23 per cent, high "no doubt fifteen to twenty years were blood pressure in 45 per cent, and added to this woman's life as a result tumors were found in 4 per cent. Tu- of this discovery." :

MEDICAL INSPECTION OF mation desired by the teachers after SCHOOL CHILDREN making a preliminary examination of each child were placed in the hands of the county medical inspectors, some- Review of First Year's Work Under direct and in some cases through State-Wide Law times the county superintendent of schools. By G. M. Cooper, M. D. Personal Equation School inspection was undertaken in the fall of 1917 in the following named In at least twenty-five counties ninety counties per cent of the teachers did a practi-

Buncombe, Caldwell, Camden, Ca- cally perfect piece of work ; and entered tawba, Currituck, Davidson, Davie, fully into the spirit of the undertaking. Edgecombe, Forsyth, Franklin, Gaston, In only a few isolated instances did the Guilford, Haywood, Hertford, Lenoir, teachers complain. Some schools re- Macon, Madison, Martin, Mecklenburg, ceived the cards too late for their re- Montgomery, Nash, Northampton, Pas- ports. Of course some teachers made quotank, Robeson, Rowan, Swain, Tran- exceptionally good records. Many of sylvania, Wake, Warren, Watauga, Wil- them did far more than merely meet son and Pitt. the legal requirements, depending altogether upon the teacher's individual Brief Sketch of Methods conception of service.

During the summer and fall the direc- County School Superintendents tor of the Department of Medical In- spection personally attended all the dis- In every county the move has had trict meetings of the county superin- the unqualified support and the cordial, tendents of schools in the State except sympathetic assistance of the County two. He also visited, and personally Superintendent of Schools. It would explained the requirements of the law be impossible to overestimate the good to the full teachers meetings of twenty these men are doing in North Carolina. of the above named counties; and sent of Examiners Institute a representative of the State Board of Board and Conductors Health to seven of the other counties. This responsibility was assumed and Many difiiculties in launching this the duty well performed by the County work last year, and in making prepara- Medical Inspectors in three other coun- tions for the perfection and extension ties. Though repeated efforts were this year, have been overcome much made in the remaining two counties, no easier through active and sympathetic meeting of the teachers was ever called. assistance of the State Board of Exam- A carefully devised card, got up with iners and Institute Conductors of the the aid of the U. S. Public Health Ser- Department of Education. It would be vice, was supplied the teachers for difficult to estimate the good these con- each child. About two hundred and secrated men and women are doing for twenty-five thousand were distributed. the teachers and children of North These cards when filled with the infor- Carolina. 78 The Health Bulletin

Some Results Already Obtained The next generation will indeed bless the memory of all physicians like John- the fact that nearly Notwithstandini,' son. In Gaston County one child's life phy- all the activities of the schools, the was saved through an operation for sicians, and the people generally for chronic appendicitis ; another seven- been very properly the past year has year-old child probably had his life requirements devoted to the various saved by treatment for hip joint disease necessary to help in the war, the suc- —all through the school work. In Rob- of school cess of the medical inspection eson County two children were discov- children has been better than antici- ered with incipient tuberculosis ; both this country pated. P'or one thing, have been placed in the State Sanato- has real- like England in the Boer War rium. In Mecklenburg County several soldiers and a ized tliat to have good cases of trachoma, a dangerous eye dis- population there must be strong civil ease, were discovered solely through the the children of school age no neglect of medical inspection service, conducted before. and in Charlotte by Dr. C. C. Hudson and three thousand teachers More than in the county by Dr. McLaughlin. filled the cards after a careful pror)erly In Pitt county where the health de- preliminary examination of more than partment was reoi'ganized in January, these cards, one for 150,000 children; the schools of only two townships were each child, were passed into the hands inspected, but of all children found de- inspector in each of the of a medical fective 85 per cent were treated within thirty-two counties above mentioned. In sixty days. The records show literally the passed through the most cases cards hundreds of other cases equally as im- the county superintendent of hands of portant as those mentioned. schools. Of the above number of children, 34,- Free Dental Clinics a Distinctive nearly one-fourth, have been oS7, or Feature carefully examined by the school physician or a specially trained school nurse An original plan for offering free of experience. Of the children found dental treatment to school children, defective, 2,689 had been reported especially the very young ones, was in- treated up to July 1, 1918. This num- stituted about the middle of July. The ber is for the most part exclusive of records of thousands of examinations dental treatment. of school children in North Carolina An idea of the thoroughness with the past five years have shown that at which this follow-up work has been un- least 75 per cent of them have teeth (lortakon may be had from the follow- needing the attention of a dentist. It ing illustrations : One Raleigh special- was also known that less than one per ist has made repeated visits to Louis- cent of them had ever visited a dentist. burg operating on 64 children for the Acting in conjunction with the county removal of tonsils and adenoids. Some boards of health in eight counties the of these children have already made re- Bureau of Medical Inspection of the markable improvement. In addition to State Board of Health employed five the Franklin county physician, Dr. Ma- excellent young dentists for the sum- loue, Drs. Yarborough, Burt, Perry and mer. They were equipped with a port- other physicians have assisted in get- able outfit and set to work in the rural ting this excellent work done. Another districts of five counties about the mid- Franklin county physician, Dr. B. C. dle of July. They do free dental work Johnson of Bunn, took 18 of his little of a limited class, such as examinations, school patients to the Louisburg clinic. cleaning, extracting, fillings with amal- : :

The Health Bulletix 79

gam, etc. Tliey also are teaching oral Dr. West in Northampton County was hygiene as it has never been done in consulted by (55 little patients in one this State before. The tirst week these day during the beginning of the work. young men treated (586 children. One The response in Robeson, Davidson and man in Robeson County walked eight Lenoir has been equally as enthusiastic. miles and carried his ten-year-old boy for treatment. The counties having Lessons or Suggestions for Next Year live health ofHcers and who have arranged for this work jointly with the 1. The children in the public schools State Board of Health this year are of North Carolina are literally our Caldwell, Davidson, Forsyth, Lenoir, "second line of Nash, Northampton, Rol>eson and Wil- defense" in peace as son. Rowan will install a permanent well as war. To them the State owes dental infirmary in the courthouse at a longer school term, better paid teach- Salisbury by the opening of schools. So ers, and an even chance to every child. will Leuoir at the high school in Kin- In the language of Hon. Y. ston. These infirmaries will be open on J. Joyner, certain afternoons each week for free whose powerful assistance in this great treatment to all the school children of work the people should never forget, the county. This is made possible as a "the greatest tragedy in this world is a permanent arrangement through the co- diseased child." To the "Pseudo-Pa- operation of the local dentists of these two cities. triots, the Patriots for revenue only," This plan of helping children in need who would relax, or postpone, or hin- of dental treatment has been carefully der this work for the thousands of worked out and is bound to succeed these little ones in North Carolina this and be of untold benefit to the people, year, the answer must be "They shall because it is based on correct principles. The movement has the endorsement of not i)ass." the North Carolina Dental Society 2. The successful teaching of applied which adopted a formal resolution to hygiene and sanitation throughout the that effect at the last meeting at length and breadth of the State is a Wrightsville. This resolution was introduced by Dr. J. Martin Fleming of job for the teachers of the elementary Raleigh and was unanimously adopted. schools. Hence better training along That everybody in the State may these lines for all teachers must be had, have a definite idea of just what this and hygiene, sanitation, and medical work means to the counties adopting it, inspection must be a part the report of Dr. H. L. Keel for the made of ev- first week in Nash County is herewith ery college and high school curriculum. appended 3. The medical part of the work in Total No. the counties must be assumed by physicians Children treated 230 who are capable and who are honestly anxious to help the children. Children's teeth thoroughly 4. The "follow up" cleaned 78 work must be done through organized agencies and Teeth filled with amalgam 133 in a systematic manner. Teeth extracted 162 5. Free treatment must be provided Temporary fillings 9 regardless of class, and the treatment Medical treatments 2 —medical, dental or special—must be done by men whose ability is unques- Operations 2 tioned. Children whose teeth need (>. If our citizens of the future are to nothing 7 be made "Fit to fight or fit to work," no Children refused treatment sane person can longer the im- (unmanageable) 4 doubt portance of medical inspection of school Children fainting 1 I children in bringing about this physical f Conservative estimate of cost fitness. "Where there is no vision the if done in private oflice $370.50 people perish." I

EVERY FLY SPECK A CASE OF TYPHOID FEVER There have been t nearly fourteen hundred cases of typhoid in North Carolina from January 1 to August 1 this year. The fly is the greatest distrrbuteri"u>-t;i ofoi theme ge?mrofTh?germs oi ine disease, conveying them from the open-back privy. NOTICE TO READER.—When you finish reading this magazine place a one-cent stamp on this notice, hand same to any postal employee and it will be placed in the hands of our soldiers or sailors at the front. NO WRAPPER-NO ADDRESS.

PublislN^dbH TAE.iM?RmCAK9LI/^A STATE. D?ARDs^AmLTn

Thl5 Bunelirxwillbe aenl free to arwj citizen of the Siaie upoi\ request. !

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

1918 Vol. XXXjf / OCTOBER, No. 4 IN FOUR COFFINS.

Nori-I^Car-

}{med irpTio- rUriCafoW-Qcx bij TubQfcu- losis, R.,071- 7/orf^ Car- olinians Killad Ir? CaTolinaXhildrQri uridef -iru^o ijears old. 94 oil cau.SQ5, SjOZT MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

J. Howell Way, M.D., Pres., Waynesville Chas. O'H. Laughinghodse, M.D., Richard H. Lewis, M.D., LL.D., Raleigh Greenville M.D., Wilmington J. L. Ludlow, C.E., . . Winston-Salem Edward J. Wood, Thomas E. Anderson, M.D., Statesville Cyrus Thompson, M.D., Jacksonville

E. C. Register, M.D Charlotte F. R. Harris, M.D., . Henderson Official Staff

FREE PUBLIC HEALTH LITERATURE

Whooping- cough Clean-up Placards Malaria Hookworm Disease Spitting Placards Smallpox Public Health Laws Sanitary Privies Adenoids Tuberculosis Laws Residential Sewage Measles Tuberculosis Disposal Plants German Measles Scarlet Fever Eyes Typhoid Fever Infantile Paralysis Flies Diphtheria Care of the Baby Colds Pellagra Fly Placards Teeth Constipation Typhoid Placards Cancer Indigestion TuBBRCUxosis Placards SEX HYGIENE BULLETINS Set a—For Young Men Set D—For Parents A Reasonable Sex Life for Men. When and How to Tell the Children. Sexual Hygiene for Young Men. Vigorous Manhood. Venereal Diseases—A Sociologic Study. Smash the Line. (The case against the The Need for Sex Education. restricted district.) List of Reliable Pamphlets. List of Reliable Pamphlets. Set E— Set B—For Public Officials and For Girls and Young Women Business Men Your Country Needs You. (Especially Public Health Measures in Relation to for girls 11 years of age and over.) Venereal Diseases. Venereal Diseases—A Sociological Study. Note.—For girls under 11, see Smash the Line. The case against the "When and How to Tell the Children."

restricted district.) (Set D) : portions of "Yniir r^inntry The Need for Sex Education. Needs You" also may be read to A State-wide Program for Sex Education. younger girls. Girls 15 and over may List of Reliable Pamphlets. be given "The Nation's Call to Young Set C—For Boys Women," at the discretion of the parent. Vigorous Manhood. (Especially for boys 12 years of age and over.) The Nation's Call to Young Women. Note—For boys under 12, see List of Reliable Pamphlets. "When and How to Tell the Children" portions of "Vigorous Set F— (Set D) ; Man- For Teachers hood" also may be read to younger boys. Boys 15 years and over may be The School Teacher and Sex Education. given Bulletin "A Reasonable Sex Life Sex Education in the Home and High for Men" (see Set A), at the discretion School. of the parent. Venereal Diseases—A Sociologic Study. Sexual Hygiene for Young Men. Smash the Line. List of Reliable Pamphlets. The Need for Sex Education.

Any of the above will be sent without charge, Please send for only those bulletins for which you have definite use.

MNTINO OOMPAN IriI@M

PU6LI5AELD BY TAL hOR-TA CAIgOUMA 5TATL BQAIgD e^MEALTM~||L°] B I

Vol. XXXIV OCTOBER, 1918 No. 4

EDITORIAL

TWO TEACHERS work? You are paid, the physician who follows this work is paid, the dentists Reader, Which Would You Prefer for and specialists are paid." Your Child? In other words, this teacher is willing to sit in his chair and ask his pu- The writer recently explained to a pils once a day how many bones in splendid gathering of seventy-five teach- the human body or the effect of to- ers, composing a County Institute, the bacco on the nervous system, but he is provisions for the physical examination unwilling to get up out of his chair to of all school children in North Carolina look for an actual condition that may at regular intervals. This particular be ruining the child's health for life. body of teachers was composed of a This man is the principal of a State large per cent of college graduates. The High School, but like a member of the great majority of them were intensely "Nut-Crackers" union, he is only will- interested and heartily in sympathy ing to crack one particular kind of nut. with the elTorts of the State Board of He believes in cramming down Latin Health to make this law of great serv- Grammar, even if the child's throat ice to all the State's school children. is so thick with adenoids he has to use Under the law the teacher is asked to an intubation tube to do it. Practical devote about thirty minutes to each physiology and hygiene mean nothing child once in three years, in the effort to him—unless there is to be a finan- to procure and record some vitally im- cial consideration. portant information concerning the Now, I know the pay of many teach- child. This information i& to be used ers is pitifully small. Most of them specifically in helping any child who should receive double their present needs it. About three thousand teach- salary and more. But this teacher ers cheerfully performed such service accepts his contract and should render last year. service accordingly. If he is not satis- After the talk here is a record of a fied with his wage, the world of op- conversation which took place on the portunity is just as wide open to him school stairway between the writer and as to any of the rest of us. It cannot two teachers, a man and a woman be love for his work that is holding teacher. him ; if so his motto would be "Serv- The Man Teacher ice" and not "Pay." This man is a college graduate and has been teaching many years. He The Woman Teacher wanted to know if the law compelled This woman is a college graduate. him to do this, and if so, "show it to She has been teaching several years.

him." He said : "Who pays me for this She came out to tell the writer (as •

84 The Health Bulletin hundreds of other good teachers have There are only three classes of real vegetables, milk, and meat. done) how glad she was to know that food : edible the State was taking up this work this Vegetables are primary in character, year in her county. and all other foods are derived from She said that last fall, when the them. No single vegetable food is county physician insisted on postponing complete in itself and consequently, the work of medical inspection until in feeding upon vegetables, one must this fall (1918), she was disappointed. use a large variety in order to make She said she was determined to have sure of supplying the various needs of the inspection done in her school any- the body. For complete nutrition all of way. But after making repeated efforts the plant is needed—seeds, leaves, and she failed to get the county physician roots. Taken together these supply interested. However, this did not de- starches, proteins, cellulose, salts, and ter her. Instead of complaining of vitamins—all the essentials needed for "extra work and no extra pay" she the human body. quietly made arrangements with her In milk we find these same elements own family physician to go out and in different form and in a proportion look her school over. She even offered wisely adapted to the needs of a young to PAY him out of her own meager growing animal. The cow in grazing salary (less than half the high school makes a selection of all the different principal's). Be it said to the credit kinds of plants necessary to furnish of this private physician that he did the food essentials and serves them up an excellent job and refused to accept as milk in a form ready for easy di- one cent of this woman's money. gestion. Egg is another naturally pre- This consecrated woman teacher re- pared food. gards the opportunity that medical in- Meat is a far more complex food than spection affords this year as a privilege vegetables or milk and eggs, and is not to better serve her little charges. intended by Nature for food. The flesh All the money in that county would of an animal is part of a creature in- not be enough to increase her salary to tended to use energy, to conserve food what she is worth. G. M. C. rather than to serve as food—an eater rather than a thing to be eaten. Meat contains concentrated food, but also DIET much that is not food. It contains the Dietetics is one of the most impor- poisonous products of animal activity— tant divisions of Personal Hygiene. the ashes of the vital fires which have Every intelligent citizen should know burned during the life of the animal. the relation of the various foods to the These deleterious elements are not body needs in order to conserve his found in vegetables, milk, or in eggs. health, and every patriotic citizen These three classes of food are capa- should learn his own exact needs in ble of constituting a complete and con- order to conserve food for our Army venient human bill of fare. Meat, how- and for our Allies. The questions con- ever, is not essential since vegetables, nected with diet and nutrition are not milk, and eggs supply all the needs of nearly so complicated as they are usu- the body. ally supposed to be. It is by no means In the section on Personal Hygiene necessary to know about calories and an effort is made to give a simple ex- metabolism and such technical subjects planation of the main facts of dietetics. in order for a man to feed himself and If you think it worth while to follow his family rationally and practically. the simple advice contained in the :

The Health Bulletin 85

article you cau certainly improve and Physical training for all the grades maintain your healtli and conserve will be given a place in the schools this fall. This feature has long been neg- valuable food. If you do not ttiink it lected. It is our purpose simply to worth your while to do this then send make a beginning this year. It will be to the State Board of Health for a copy rapidly developed from year to year. of the last Vital Statistics Report and Several states make physical training in all the schools compulsory. It is a see for yourself that more than one- crime to allow a child to develop one or half of the deaths in the State occurred several of the defects so often found in people under 60 years of age, and a among school children. This work will large percentage of them because they be under the direction of a teacher who is studying physiology of exercises and did not know how to feed their bodies. corrective exercises at Columbia Uni- B. E. W. versity. I quote from her letter of

August 1 : "I am immensely interested in physical education, and am so glad A MODEL CITY SCHOOL you suggested my taking it. I had a SYSTEM very narrow conception of it before I came here, but now my eyes have been We are publishing below an extract opened and I realize that it is the foun- from the report of Prof. Kader R. dation of all true education. Physical Curtis, head of the Kinston City training has the same object in view as medical inspection." G. M. C. Schools. This report was recently made to the school trustees by Professor Curtis. PRIVY RANGE This report shows the trend of all progressive and common-sense high Town Privy Has Ten Times Range of school officials. Without a doubt Mr. Country Privy Curtis is pioneer representative a of The privy is like a dangerous gun. the of will type men who soon head all The flies are its bullets. Its range is the big schools in Carolina. North the fly range, that is, the distance of Pusey, of Durham, of Greens- Archer the average flight of a fly, from 200 to boro, Latham of Winston-Salem, Hard- 400 yards. The bullets of the privy ing of Charlotte, Coon of Wilson, and never become "spent" ; after doing their Underwood of Greenville are others. deadly work, they return to their ren- Read carefully these two paragraphs dezvous, are recharged with poisonous of Mr. Curtis' report germs, and sent on another deadly Medical inspection of school children errand. The danger of a privy, like has more than justified the expendi- the danger of a gun, is dependent upon ture. A sound mind in an unsound its range. body is impossible. Retardation in school can in most cases be traced to This makes a great difference in the some physical defect. Many defects danger of the country privy and the have been discovered and corrected. town privy. The country privy has a They are found to exist among children fly range of only one family, as a rule, representing all classes of homes in the city. By constant care and supervision that is to say, it is within disease reach the nurse has been able to prevent to a of from five to seven people. The town large extent the spread of contagion in privy, located in a block, has a fly the schools. As a second step in the range of all the people living in the effort to keep the children well the State Board of Health, with your per- block, say, of eight homes of from five mission, will equip and maintain a free to seven people each ; that is to say, it dental clinic in the Grainger Building. has a fly range of from forty to fifty Other avenues of health service will be people. The town privy is, therefore, presented for your consideration from time to time. from eight to ten times more danger- —

86 The Health Bulletin

principle holds ous than the country privy. But this is penalty. This general the way, including sex not all or even the worst with respect to true all along Bulletin dealt with the danger of the town privy. Each life. The September the lost re- person living in the block, unlike a the negative punishment, mind, and person living in the country, is within ward of strength of body, unhygienic sex fly range not of one privy, but of from spirit resulting from October Bulletin, five to ten. The possibility of a vulner- living. In this, the the posi- able or even a fatal shot is to that ex- will be found a discussion of penalties of vene- tent increased. Then there is another, tive punishment, the an additional element of danger in real plagues—gonorrhea and syphilis the careless town privies. From one to three per which are imposed upon cent of all persons who have had ty- and loose sex life. high phoid fever continue to carry typhoid It has been said by those of germs. These persons are otherwise authority that gonorrhea and syphilis are not crimes, but diseases. This is a well ; we call them "carriers." Accord- superficial viewpoint. ing to the laws of probability, the short-sighted and country danger of a carrier using a privy within Every one knows that in this of venereal diseases fly range of a home is eight or ten times 90 to 95 per cent of greater in the city block, with the large are caused by the breaking down accord- number of persons using privies, than moral barriers that society, in divine and natural laws, has it is with the small number of persons ance with using the country privy. erected and strives to maintain for self- The time has come when the privy protection. barriers constitute the is to be outlawed in North Carolina. These moral line of North Carolina is going to lead in this first and the most important If work of civilization and not follow the defense against venereal plagues. intact, other states. Asheville many years ago, this line can be held everywhere rewards and Wilmington, also, got rid of the not only would those positive of chastity, social strength and char- insanitary privy ; Greensboro took this and step three years ago; Winston, two acter, be secured, but gonorrhea years ago. Charlotte will not have an syphilis would disappear. This first insanitary privy after thirty days. The line of defense is largely under the Capital City of North Carolina, Ral- command of those social agencies that especially with the eigh, alone among the leading cities of concern themselves the State, maintains the deadly tradi- morals of society. great tions of the past and permits 1,632 open, Every minister should give this serious dirty, dangerous privies to do their problem of social hygiene his fatal work. W. S. R. thought, because it is (1) a moral problem, and (2) to any one who will take an hour and read what our Sep- THE NATURE OF THE SEX tember and October Bulletins have to PROBLEM say on the subject it is one of the major

The straight and narrow way is problems of life—far transcending in its importance the question of alco- hedged in on both sides : on the one side, by rewards for right decisions, holic prohibition, important enough as and on the other, by penalties for that is. The minister or other iierson wrong decisions. Wrong doing receives who gives this problem the thought a double punishment: a negative pun- that it deserves will find little diffi- ishment in a lost reward, and a posi- culty in understanding it ; his trouble tive punishment in the imposition of a will come when he attempts to present —

The Health Bulletin 87

it to others ; here the fool will rush in STRIKE A BALANCE where angels fear to tread. The sub- Do not squander reserve of nervous ject must be presented to the sexes energy just because you happen to be and to different age groups, separately. living in strenuous times and under Much study has been given to, and high mental pressure. Brain fag and much experience is available on meth- nervous exhaustion are not so much a ods of presenting the subject of social question of what or how much work hygiene to the different groups con- you do, as it is what you do after cerned. The wise man will take ad- work. vantage of this by writing to the State Osier advises the cultivation of a Board of Health or other qualified hobby. Cabot says, "play." Both are agency for references to lielpful litera- right. The essential thing is to get ture before attempting to lecture on the relaxation that really relaxes, that re- subject. creates, that makes you forget the Once the moral barrier has given day's cares and tribulations, and wipes way and tlie man with gonorrhea or the slate clean and gives you a fresh syphilis breaks through, the only pro- start for tomorrow. That's relaxation, tection that society has is the second that's the cure for brain fag and nine- line of defense—the line of sanitation. tenths of all the cases of "nerves." Here the moral problem passes over But what is, "play," what is a into a pliysical or health problem, and "liobby"? That's up to you. You it is for the health officer to take should be your own judge. In general charge. In taking charge of gonorrhea it should be about as far removed and syphilis, the health officer has to from what you do during working do with diseases, diseases that are in- hours as possible. If it combines or fectious, contagious, hereditary ; trans- includes outdoor exercise, fresh air, missible, it is true, to the morally pleasant company, sunshine, or a good loose, but also to the innocent traveler, bath, so much the better. A mail car- the unsuspecting companion, to the wife rier would scarcely be interested in or and to the children unto the third and benefited by an evening's walk nor fourth generations. The health officer would the student likely find the best must deal with gonorrhea and syphilis recreation in reading a book. Find in the same way that he deals with your recreation and then proceed to smallpox, tuberculosis, and typhoid redeposit in your bank of nervous en- fever. W. S. R. ergy each day what you check out during working hours. Strike a bal- SAY YOU, KEEP WELL! ance daily. Do not overdraw this ac- Keep well during the war. Your count or you may soon find yourself country needs your very best services a nervous bankrupt. now as never before. Sick people are liabilities. We need good strong, healthy assets to win this war. Con- Don't worry! To worry about the serve your country's medical service. past is to dig up a grave; let the The army and navy need every avail- corpse lie. To worry about the future able doctor at this time. Spend your is to dig your own grave; let the money for thrift stamps and Liberty undertaker attend to that. The pres- Loan Bonds. Uncle Sam will take care ent is the servant of your will. of all the doctors he can get. Keep Haddock. well. It is your everlasting patriotic duty. _ j

The BbiALTH Bulletin

IN THE TOILS OF THE LAW PROSECUTIONS BROUGHT BY THE STATE BOARD OF HEALTH DURING THE MONTH OF AUGUST, 1918

Gaxtse Defendant Judgment

Violation of Quarantine Law Dr. N. H. Andrews, Rowland $10 and cost. Dr. W. P. Exum, Maxton ___ Ic. and cost. Dr. D. S. Curtis, Parkton— ?5 and cost. Dr. W. F. Stephens, Fairmont $5 and cost. Dr. G. W. Locklear, Pem- Ic. and cost. broke Dr. H. H. Hodgin, Maxton— Dr. B. F. McMillan, Red Judgment suspend- Springs ed on payment of Dr. R. D. McMillan, Red cost. Springs Dr. R. D. McMillan, Red Springs Not guilty. Dr. R. B. Wilson, Newton Grove $20 and cost. Dr. R. B. Wilson, Newton Grove $10 and cost. Dr. R. F. Quinn, Magnolia.- $5 and cost. Dr. R. F. Quinn, Magnolia— $5 and cost. Dr. A. A. Kent, Lenoir $1 and cost Dr. Joe Laferers, Lenoir — $1 and cost

Dr. J. F. McKay, Buies Judgment suspend- Creek — ed on payment of ( cost. Dr. L. L. Selt Cherryville— $2 and cost. Dr. L. L. Self. Clierryville_ — $2 and cost. Dr. L. L. Selt Cherryville_ — $2 and cost. Dr. L. L. Selt Clierryville— $2 and cost. Dr. W. L. Strutt, Maiden ___ $7.50 and cost Violation of Vital Stat, law Dr. R. D. McMillan. Red

Springs ' $5 and cost

Total number of indictments for August 22 Total cost of bringing indictments for August $.320.00 Total collected in fines for August 82.52

Loss to State for prosecutions for August $237.48

PHYSICIANS MUST OBEY THE eases to be brought in local courts •HEALTH LAWS OF STATE against physicians of the State for violations of either the State quarantine law or the vital statistics law. State Board of Health Will Bring Convictions were obtained in twenty- Prosecutions Against All Found one of these cases, and fines imposed Violating Quarantine and ranging as high as $20. In four cases Vital Statistics Law judgment was suspended upon payment During August the State Board of of the costs, in two cases fines of one Health caused a total of twenty-two penny were imposed, and in several The Health Bulletin 89 other cases nominal fines were imposed. fever, of which only three had been In several instances more than one reported to the State Board of Health. charge was brought against the same At Magnolia twelve cases were found, physician, so that while there were of which only three had been reported. twenty-two cases in all, there were but The physician guilty of failing to com- fifteen individuals brought into court. ply with the law in each instance was The enforcement of the provisions convicted and fined, but the effects of of the State health laws is made a part the physician's failure to properly have of the duties of the State Board of the first cases quarantined had already Health, and officials of this Board have allowed the spread of the disease to no intention of shirking the responsi- others, so that in the two towns there bility, unpleasant though it may be. were twenty-six cases. On the other hand the Board has The State Board of Health is hopeful every intention of prosecuting every that the physicians of the State will case discovered where the laws are vio- become fully awake to the necessity of lated, without regard to whom the guilty fully complying with the health laws, individual may happen to be. It is of and so making unnecessary this part of interest to note that during the past the work of the Board. In the mean- month one of the defendants brought time, however, inspectors of the Board into court and convicted was a former will continue their work of investiga- member of the General Assembly of tion. R. B. W. the State. The cost of bringing these cases again CONGRESSMEN AND OUR CHIL- exceeded the amount of the fines im- DREN posed, and this condition will continue "If are sending out to until local magistrates are awakened we men instruct the people how to raise hogs to the seriousness of the charges. The and how to take care of pigs, are we total cost of this work for the month going any further when we send them was $320. The total amount collected out to instruct people how to take care in fines and turned into the school of children and to take care of those funds of the respective counties was questions that arise out of maternity ? $82.52. The net financial loss to the The babies and the children of this State was $237.48. country are somewhat more valuable During August the first indictment as an asset than are its pigs and was brought for a violation of the vital hogs."—Senator William S, Kenyon, of statistics law, which requires the re- Iowa. porting of all births and deaths. The "It is only recently that children case was against Dr. R. D. McMillan, have come to be regarded as a of Red Springs, who was' found guilty national asset, instead of a burden. A of having failed to report a birth, and healthy, strong, promising child is an who was fined $5. asset; a puny, weak, sickly child is The importance of prompt reports of a burden to tht •community, if not to the occurrence of communicable dis- its parents; and anything we can do the eases was strikingly shown during here to direct the best thought of a month in two instances. From the nation toward the children's move- towns of Magnolia and Oherryville ment will be attention well bestowed." there came requests for special investi —Senator Henry F. HoUis, of New gations of epidemics of typhoid fever. Hampshire. At Cherryville it was discovered that "Militarists tell us that the first line there were fourteen cases of typhoid of defense of a country is in the navy 90 Jhe Health Bulletin and that the second line is in its coast- vice and prevention of venereal dis- line fortifications and that its third eases among the great problems of the line of defense is in the army. I deny war. that. The first line of defense of this Venereal diseases are the "camp-fol- or any other country is the children of lowers" of prostitution and alcohol. the country, and if by any appropria- They are a triple alliance behind the tion or any amount of money there can lines,- and as much the foes of an be built up in this country a strong, army as the enemies in front. active, fighting race of men and Prostitution, alcohol and venereal women who are able to take care of diseases must be beaten, just as the themselves, that money, in my judg- enemy in front must be beaten, or ment, will be well and economically they may cripple, even defeat, an expended." — Congressman Wni. E. army. Cox, of Indiana. A soldier with syphilis or gonorrhea, and one with a wound, are both VENEREAL DISEASE IN GERMAN ARMY out of the fighting and a drain on an army. But the former is the more During the past twenty years the serious, for his disability was prevent- in the frequency of venereal diseases able and in acquiring it he did not German army has shown a steady de- register a blow against the enemy in cline, which continued during the first front but literally gave a victory to year of the war. The incidence of the enemy behind the lines. Nor does syphilis and gonorrhoea in the German the consequence of his defec-tion end army in 1895 was 137 per 1,000, and there, for he may become a carrier of during the first year of the war it was disease among his comrades. only 14.4 per 1,000. We have no means During the first year of the war one of knowing what the venereal disease nation had more men disabled from rate is in the German army at the venereal diseases than from wounds present time, but it is certain that this and disabilities incident upon warfare. maintained reduction ha^ not been A regiment stationed in a training since August, 1914. Reports from camp sustained greater casualties (Jcrmaiiy in thf early part of the war from venereal diseases than did an- indicated prevalence that the was other (recruited at the time) in one greater in the occupied hostile terri- of the bloodiest battles of the war. tory behind the lines than at the The stronghold of this triple alii- front. A celebrated Austrian army ance for evil is the segregated or surgeon estimated that the incidence red-light district—the so-called "line." of the venereal diseases in the German Here, prostitution, fortified by official army during the war is bound to rise tolerance and supposed medical inspec- M to 40 per 1,000 in an army of 7,000,000 tion, is strongest. It is in this segre- men. gated district, popular misconception to the contrary, that venereal dis- SMASH THE LINE eases have their widest opportunity to The primary objective of the Amer- spread, insidiously as a poison-gas at-

ican men on the western front is to tack, and wreak greatest • havoc. A smash the enemy's line, to drive him careful study shows that the majority back, weakened in morale and strate- of infections have resulted from com- gic position, until he is finally beaten. mercialized vice, for the medical in- The chiefs of the allied armies have spection of prostitutes is inevitably been forced to rank suppression of inadequate and futile. It is in the seg- —

The Health Bulletin 91 regated district, too, that alcohol is concerning it false and misleading invaluable as an aid to prostitution. statements are made about its com- Remember that this problem of position. prostitution is a problem of public 2. False and misleading claims are health as well as of morals; that the made about its curative powers. venereal diseases, in their malignancy, 3. It is used for illegal purposes. communicability, prevalence, and af- 4. It contains large amounts of alter-effects, constitute a more serious cohol or habit forming drugs. menace than any of the well-known 5. It goes by the name of a cure diseases, such as typhoid, tuberculo- for example, "consumption cure." sis, or smallpox, all of which the com- Men have always taken medicines munity is fast learning to control. and always will. Instinctively the beasts seek out medicinal grasses. The PATENT MEDICINE RULES men of the Neolithic Age brewed their teas. The savages of Prof. Wilbert. of the public health today do the same. The twentieth century man service. su.i:.i,'ests ten rules for those takes his herbs, as did the cave man. who want to take proprietary medi- The only difference is that he insists cines and household remedies. The that his shall be dispensed attractively. first five are specifications with which Nine times out of ten he does not medicines should conform to be ac- need the medicine he takes. A little ceptable. By acceptable he means this: rest, a little abstinence from food, a no man should be willing to take a little sunlight, a little exercise would medicine into his own stomach or to be incomparably better for him in give it to his wife or his child unless most instances. it conforms to these five requirements: Sometimes the medicines do him 1. The label must give accurate and positive harm. Sometimes they do complete information as to the active harm by causing him not to seek the drugs present and the amount of each medical care he needs. Sometimes in each ounce of the mixture. they lead to drug habits, including 2. There must be no claims as to drunkenness. curative action of the mixture unless The best we can possibly hope for is said claims can be readily and satis- pro- factorily demonstrated. a gradual change in the custom of miscuous medicine taking. Centuries 3. The label must give adequate old customs not change radically in notice of any untoward effect the (\v\v^ do a day. But, while the change is being may have. worked out, every man should follow 4. The medicine must be free from these Wilbert rules. Dr. W. A. Evans. objectionable quantities of alcohol and — habit forming drugs.

5. preparation not bear a The must He spent his health to get his wealth, name suggesting curative properties And then, with might and main. or specificity. He turned around and spent his wealth the first four of these we can With To get his health again. all agree. The fifth might as well —Buffalo Sanitary Bulletin. have been omitted. He advises no man to use or permit his family to use any medicine against Sickness is what costs. If we would which any one of the following objec- stop as much sickness as possible, the tions can be urged: saving would be enough to run the 1. It is a secret preparation, and State government. PUBLIC HEALTH RND SANITATION

THE VENEREAL DISEASES GENERAL IMPORTANCE

"As a danger to the public health, as a peril to the family, and as a menace the venereal diseases to the vitality, health, and physical progress of the race, ." J. Rosenau, are justly regarded as the greatest modern plagues . . —M. Professor of Preventive Medicine and Hygiene, Harvard University. were As a Military Burden: A Big ending December 7, 1917, there from 31 cantonments, 21,742 Problem reported new cases of venereal disease. The in- A Statement of W. C. Gorgas, Sur- capacitation of these men involves not geon General of the United States only loss of time; in addition, it has Army: "The army loses more days of cost the Government to keep them service from Its men due to venereal during the period of hospital confine- diseases than from any other cause. ment (which varies from one to eight If the medical department of the army weeks) more money than is required had a choice presented to it, say if some to maintain the entire command at man came with a wand, and it was Camp Dix (the cantonment in New demonstrated that with this wand every Jersey with 20,859 men) plus an ad- wounded man could be gotten back into ditional sum for medical treatment. the line at the end of the second day, "This is not all. Ine^vitably the with his wound cured; and another disease will relapse in hundreds of course were presented by which all these cases, in many instances after the venereal diseases could be eradicated men have been transported to France from the army, and our choice were and presumably put into condition for given, permitting us to leave out all service at the front, at a cost to the sentimental reasons, such as the moral nation of probably $1,500 for each effect upon the community, and allow- man." ing us merely to consider the good of Statement hy representative of office the army, and our ability to keep in the of Surgeon General, United States line the largest and most efficient fight- Army, from page 65 of "Hearings Be- ing force, I think there would be very fore the Committee on Military Affairs, little hesitation on the part of our United States Senate," on the Army Ap- department in choosing the eradication propriation Bill, 1919: Over 80,000 of venereal disease. We, in the course cases of venereal diseases have been re- of the year, should be able to keep more corded in the United States Army be- men in the trenches and have a more tween September, 1917, and June, 1918. efficient force by having eradicated Of these men who came into camp, venereal diseases than by eradicating about 128 per 1,000 were infected with wounds." venereal diseases. Statement from Council of National The following are the official figures Defense: "During the twelve weeks for the armies of the different coun- The Health Bulletin 93 tries appearing in the following tabu- The following diagram, prepared lation: from reports made to the Surgeon General of the Army and published by Venereal Infection Per Thousand Army, Men—Year Rate ^^^ Surgeon General of the of venereal disea- U S Army 1909 196.99 shows the prevalence -"-" ses the different subdivisions of our U. S. Navy 1909 159.83 ^ whole, corn- Japanese Navy 1907 139.75 army, and in the army as a with the prevalence of other com- British Navy 1908 122.49 Pared municable diseases. It will be noted British Army 1908 75.8 that the venereal disease rate is almost Russia - — —1906 62.7 times the rate of the other com- Austria 1907 54.2 ^^^

diseases named : JapaneseArmy 1907 37.6 municable France 1906 28.6 Prussian Army 1907 18.7 DIAGRAM Showing Prevalence of Venereal Diseases Compared with other communicable diseases

in the United States Army

Prepared from Reports made to the Surgeon General

m.9 25.7

E S = is i: c E • I i £ E i i I £ i S I I I .2 1* • * > Q O O Q > 5 5 da > 3 5 o ia > S o 6 S Regular National National Three Armies Army Guard Army Combined

LEGEND Venereal DiseaMS

Other Commanicable Diseases, L •. S Pneumonia, dysertery, typhoid, paratyphoid, malaria,^ meningitis, and scarlet fever (not including measles). :

94 The Health Bulletin

As a Civilian Problem: A Bigger Gonorrhea is responsible for frum 25 Problem to 33 per cent of all blindness. Gonorrhea permanently maims one The (liaj^ram above referred to fur- in hundred, kills one per- nishes most interesting? and convincing l>erson a aud in evei-y two hundred. evidence as to the civilian prevalence son as a cause of death ranks of venereal diseases. For example, the Syphilis pneumonia, and diagram shows that in the army group with tuberculosis, fartherest removed from the people, the cancer. 10 to 20 per cent Regular Army, there was less venereal Syphilis causes from all insanity. disease than in that army group some- of that 10 per cent what nearer the civilian population, Syphilis, assuming of the insane in the three large State namely, the National Guard : that there Hospitals in North Carolina are there was less venereal disease in the Na- result of this disease, costs North tional Guard than in that army group as a Carolina annually in appropriations just from the ranks of the iieople, rep- for these three hospitals, 1-10 of $570.- resenting all races, industrial and social that is, $57,000. Of course, this classes, the National Army. The evi- 000, does not include the ravages and losses dence of the chart is that the nearer syphilis outside of the State in- we come to the civilian population, the from higher rate of venereal disease encoun- sane asylums. tei-ed. This is in conformity with the evidence presented to the Military Af- fairs Committee to the effect that 83 RULES OF HEALTH 1-3 i)er cent of the venereal diseases in The American Commission for com- the army were brought in as the drafted bating Tuberculosis in France is circu- men came into camp, and only 16 2-3 lating among children an excellent set per cent were contracted after the men of rules for health, of which the fol- came into the ranks. The evidence in- lowing is a translation dicates that big as the venereal disease 1. Breathe fresh air at all times. problem is from a military standpoint, Fresh air and sunlight destroy the it is bigger as a civilian problem. germs ot contagious disease.. A representative of the United States 2. Wear light, loose, and porous cloth- I'ublic Health Service estimates that ing. there are annually 2.50(),0(X) new cases 3. Live as much as possible out of of venereal disease in the United States doors. —about one person in forty becoming 4. Sleep in a well-ventilated rot mi.

infected each year. The Council of 5. Practice deep, slow respiration.

National Defense estimates that there 6. Avoid eating too much, especially are over 50,000 cases of venereal disease of meat and eggs.

in North Carolina. This figure may be 7. Eat a variety of food and chew it cfmipared with the total number of an- thoroughly.

nual cases of tuberculosis, typhoid, 8. Be sure the bowels move regularly. diphtheria, scarlet fever, measles, 9. Maintain an erect posture in sit- whooping cough, and meningitis in ting and walking. North Carolina, amounting to about 10. Avoid drugs. They contain poi- 45,000. sons. Gonorrhea is responsible for 60 per 11. Keep the body strong and clean. cent of the surgical operations on This will increase resistance to disease. women. 12. Work with energy, but take Gonorrhea is responsible for 50 per proper rest and recreation. cent of all sterility. 13. Keep a contented mind.

i The Health Bulletust 95

FEAR AND WORRY. wound defeats the object of the operation and leads to certain local recur- Plague went forth in the land, and rence. one met him, asking him if he could 6. Late Cancer is incurable though stay his cruel hand. Plague answered not always unrelievable. Radium, that he meant to be merciful; he X-rays, ligation, cautery, or palliative would only take five thousand from operations may change distress to the earth." Some time afterwards comfort and may even prolong life. these two met again. "So thou art a 7. Cancer of the Breast. All chronic liar as well as a murderer!" said the lumps in the breast should be removed other to Plague: "Thy five thousand without delay. Benign tumors can be meant fifty thousand!" "Not so," an- removed without mutilation. Examine swered Plague; "I took but my five all specimens microscopically. An im- thousand—Fear and Worry killed the mediate microscopical examination is others."—From the Arabic. desirable since, if positive, it permits a radical operation at the same sitting. CANCER DECALOGUE A radical operation performed ten 1. The Classical Signs of Cancer are days after an exploration is almost the signs of its incurable stages. Do never successful in curing cancer of not wait for the classical signs. the breast.

2. Early Cancer causes no pain. Its 8. Cancer of the Uterus. Any irreg- symptoms are not distinctive but ular flowing demands thorough inves- should arouse suspicion. Confirm or tigation. Offensive or even very slight overthrow this suspicion immediately serous flows are especially suspicious. by a thorough examination and, if Curette and examine microscopically. necessary, by operation. The advice, Amputate all eroded cervices which do "Do not trouble that lump unless it not yield promptly to treatment. Do troubles you" has cost countless lives. not wait for a positive diagnosis. 3. There is no sharp line between 9. Cancer of the Digestive System the benign and the malignant cancer. is difficult of early diagnosis and Many benign new growths become therefore unfavorable in prognosis. malignant and should therefore be All persistent and recurring indiges- removed without delay. All speci- tions (more especially if attended by mens should be examined microscop- change of color and loss of weight) ically to confirm the clinical diagnosis. and any bleeding or offensive dis- 4. Precancerous stage. Chronic irri- charges demand prompt and thorough tation is a source of cancer. The site investigation. Do not wait for a pos- and the cause of any chronic irritation itive diagnosis. should be removed. All erosions, ulcer- 10. Cancer of the Skin. Any warts, ations, and indurations of a chronic moles or birthmarks which enlarge, character should be excised. They are change color, or become irritated likely to become cancer. should be removed promptly. They 5. Early Cancer is usually curable are likely to become cancer. Do not by radical operation. The early oper- wait for a positive diagnosis. ation is the effective one. Do not per- radical operations on favor- form less Nature exacts to the last farthing in able cases than you do on unfavorable the payment of her debts contracted ones. The chances for a permanent in violation of her physical laws. Now cure are proportionate to the extent of and again physical bankruptcy is de- the first operation. Make wide dissec- clared, the legal symbol of which is tions; incision into cancer tissue in the the death certificate. 96 The Health Bulletin

FRESH AIR REFORMS IN MOD- sleeping quarters, particularly more ERN HOMES and larger windows, than the science of architecture has ever known. If Demands for Fresh Air Sleeping Make the demand for more windows and Modern Homes Glass Houses. larger windows becomes much greater, Fresh air is revolutionizing modern they declare, modern homes will be architecture, particularly modern little more than glass houses. dwelling houses, according to archi- That this reform in houses is rap- tects and contractors who say that idly coming about is good news to there is a greater demand for open air those who have long been styled

MAKIXG FRESH AIR AVAILABLE Showing manner in which any home may be easily arranged for out-door sleeping.

"fresh air cranks" but who have kept good health, and are directly respon- on cranking till they are about to get sible for much of our ill health. Before somewhere with their propaganda. As we had houses, tuberculosis was un- a matter of fact, our houses in the known. Colds, pneumonia, grippe and past have been chief offenders against bronchitis were rarely heard of. But The Health Bulletin 97

lungs, since we have become a race of shut- eases of the nose, throat, and to be even more ins, and wedded house-creatures, and now it is known these con- afraid of and unused to fresh air, valuable as a preventive of tuberculosis has become a veritable ditions. scourge with us. Pneumonia ranks The reason that open air sleeping is second as a cause of death, while not more popular is because people do grippe and colds make their annual not prepare for it, especially in winter. winter raids always leaving our death Therefore, they don't enjoy it. They rate greatly increased. get cold feet about the first eflfort But houses are not always bad. It they make and then they abandon it is the bad use we make of them. for more comfortable quarters. The When we overcrowd them or fail to same thing is true about sleeping in a let out the foul, used up air as well cold room with the windows open. sunshine and fresh air, as let in the The main secret about open air then it were better from a health point sleeping is going to bed warm. Of that we lived out of doors. of view course you must have a thick com- Having fresh air in many of the fortable bed with plenty of light warm not always an easy old-time houses is covers, preferably woolen blankets, not necessary that a matter. But it is and your night clothes must be thick has once been built without house that and warm. The teddy bear style, a and the means for sufficient windows one piece garment that covers the feet, air and sunshine should al- admitting and can be made to cover the head and ways remain so. The cost of removing ears, is probably the best suited for weatherboarding from one or more the out door sleeping. If necessary, ordinary house and plac- sides of any eiderdown foot warmers should be windows instead ing in two or more worn. Further essentials are a heavy little or nothing compared to will be bath robe and warm slippers that will benefits to health that will be de- the enable you to go to and from your rived from such a change. The fresh warm dressing room without chilling. air room shown in the picture, on Those who have really known the account of its rows of windows on two outdoor sleeping, and have sides may be used as an ideal living benefits of were prepared room, work room or sleeping room. enjoyed it because they will never again be satisfied to It is light and airy and will be the for it, indoor air while they more desirable for whatever use is breathe stale, sleep. They recognize at once the dif- made of it summer or winter. As an in their mental as all year round sleeping room, this ar- ference it makes physical feeling. Fresh rangement is to be preferred to the well as their curing and ordinary sleeping porch. It can be air, aside from its value in one made comfortable for any kind of preventing respiratory diseases, is mental slug- weather, whereas the sleeping porch is of the best antidotes for feeling, and usually abandoned in cold winter gishness, physical bad Everybody should weather at the time it is needed most general inefficiency. sleeping quarters with to keep up health and efficiency. examine his if he is not The sleeping porch, however, has reference to fresh air, and should make dif- lost none of its virtues. Every home getting his share, he his own should have one and the weaker mem- ferent arrangements. If it is put in more windows or bers of the family should use it sum- home, he can porch, if it is not, he mer and winter. Open air sleeping build a sleeping elsewhere with two long ago proved its value as a cure can secure a room for many diseases, particularly dis- or more windows. 98 The Health Bulletin

HOW TO RECOGNIZE Smallpox CONTAGIONS The illness is usually well marked Whooping Cough and the onset rather sudden with feverishness, severe backache, and sick- Begins like cold in the head, with ness. About third day a red rash of bronchitis and sore throat, and a cough shotlike pimples, felt below the skin, which is worse at night. Symptoms and seen first about the face and may at first be very mild. Character- wrists; spots develop in two days istic " whooping " cough develops in later, then form little blisters and about a fortnight, and the spasm of after two days more become yellowish coughing often ends with vomiting. and filled with matter. Scabs then Measles form which fall off about the fourteenth day. Begins like cold in the head, with feverishness, running nose, inflamed and watery eyes, and sneezing; small WATER-TIGHT WELL TOPS groups of mulberry-tinted spots appear about the third day; rash first seen on forehead and face. The rash How One Bad Well Top Caused Twen- varies with heat; may almost disap- ty Typhoid Cases if the air is cold, out pear and come Twenty cases of typhoid fever were again with warmth. recently reported from a hamlet of Scarlet Fever eighteen houses. Upon official investigation it was found that every case The onset is usually sudden, with was traceable to one poorly con- headache, languor, feverishness, sore structed well top. It appears that the throat, and often vomiting. Usually owner in endeavoring to conserve within twenty-four hours the rash ap- water had left a small hole or over- pears and is finely spotted, evenly dif- flow open so that any excess water fused, and bright red. The rash is instead of being carried away by a seen first on the neck and upper part waste pipe was allowed to run back of chest, and lasts three to ten days, into the well. A man who had been when it fades and the skin peels in infected with typhoid elsewhere was scales, flakes, or even large pieces. cared for on the same premises with The tongue becomes whitish, with this well. The conclusion reached by hri};ht red spots. The eyes are not wat- the investigators was that utensils ery or congested. used by this man had been rinsed at Diphtheria this well and some of the waste water Onset insidious, may be rapid or contaminated by typhoid germs had gradual. Typically sore throat, great polluted the water which was later weakness and swelling of kernels in used by the other victims. the neck, about the angle of the jaw. The State Board of Health unhesi- The back of the throat, tonsils, or pal- tatingly recommends the use of water- ate may show patches like pieces of tight well tops, preferably cement irrayish-whito kid. Tlie most pro- tops provided with a good iron pump. nounced symptoms are great debility To this should be added a good water- and lassitude, and there may be little tight trough with a drain to remove else noticeable. There may be hardly all waste water from the vicinity of any symptoms at all. the top of the well. The Health Bulletin 99

The old fogy idea that an iron breather becomes a garden in which pump may in some way injure the many bacteria may thrive. The mouth quality of the water is about as rea- breather's blood is not normally pure, sonable as to suppose that cups and and his mental operations are often glasses, plates, knives and forks in clouded thereby. He is more than some way injuriously affect our food likely to be somewhat hard of hear- and drink. If an iron pipe could in ing. This intensifies his mental back- any way seriously affect the quality wardness. Germs caught on the tonsil of water what would become of the are more likely to poison the system millions of city people who get their than those caught in the front of the water only after it has been pumped nose, and the mouth breather is there- through miles and miles of iron pipes ? fore more liable to sickness.

If it is really a question of iron, we But mouth breathing is not only have knovim of several concerns who harmful for the breather, but he be- have made fortunes selling so-called comes a great menace in the com- "iron" tonics to credulous individuals munity. Mouth breathers have a for fancy prices. The facts are that habit of blowing when they talk, and iron pumps in no way injure the often they puff with slight exertion. quality of well water but on the In thus blowing or puffing they thi'ow other hand by eliminating the old out droplets of moisture laden with bucket and rope or chain and the bacteria. Nature gave man a nose the open well tops, they keep the water openings of which point downward. free from pollution from dirty hands Unless in the act of sneezing any to say nothing of the dust, dirt, and bacteria coming from the nose are bugs. By all means use a water-tight driven towards the floor, but bacteria well top, a good pump and make sure coming out of the mouth of a mouth that the waste water is piped away breather are thrown out into a stra- and that surface rain water drains tum of air which others breathe. away from rather than towards the SHUT YOUR MOUTH! well. A good bath is the best kind of a MOUTH SHOWS CHARACTER "night cap." "Adam's ale," the pure, unadul- terated kind, is the best drink. Mouth Breathers Dangerous to Them- Many people are sick because they selves and Others are unacquainted with the personal Do you want to be considered an touch of a toothbrush. idiot, or a mentally deficient person? Tonsils are very important in con- Idiots and mentally defectives gen- sidering the source of rheumatism, erally let their chins drop, and they heart or kidney disease. breathe through their mouths. Men of If you want " pep," keep your sys- marked character keep their mouths tem " hitting on all cylinders." shut except when they have something If you need a doctor, select one in worth while to say, or when they are whom you have confidence and then eating. follow his advice.

The mouth breather generally gets Good health is 100 per cent, effi- enlarged tonsils. The tonsils catch and ciency—not merely absence of sick- hold the germs which would normally ness. be caught in the front of the nose It's the songs you sing and the

and " then thrown out at the next smiles you wear, that's a-making the breath. The nose of the mouth sunshine everywhere. : : :

DIETETICS all sorts, including fish and fowls, milk, cheese, dried peas and beans, and I. Kinds of Food nuts. Protein is also found in cereals The human body has been well de- and bread. Eggs and flesh foods need scribed as an engine, and it needs fuel to be limited in quantity because too just as an engine needs fuel. An en- much of them make trouble for the gine works best when it has the right human machine, leaving undigested kind and amount of fuel, and the same wastes in the body. The following is thing is true of the human body. Again, a list of the more important protein an engine has to be built and repaired foods and oiled and regulated, and again the same thing is true of the body. Beans (dried The body needs three kinds of food Fuel food, building or repair food, and regulating food.

Fuel Foods The fuel foods are the foundation foods of the diet, the foods that supply energy for the muscular work. There are three groups of fuel foods

1. starchy Foods 2. Sugars 3. Fats Cornmeal Sugar Lard Hominy Corn syrup Pork Oatmeal Candy Bacon Flour Molasses Butter Rice Fruits Cream Macaroni Peanut butter Dried lima beans Split Peas Bread Potatoes Fats, starchy foods, and sugars are almost pure fuel. At least 80 per cent of the food should come from this group, using starchy foods in largest amounts, fats next, and sugars least.

Building and Repair Foods

The body is in constant need of food for repairing or rebuilding worn parts. Building foods, generally speaking, fall into two groups, called proteins and mineral salts.

Protein, the chief building food, is represented in the diet by lean meat of The Health Bulletin 101

Regulating Foods just as different types of engines vary in the amount of gasoline they need. Mineral salts, as stated above, are The following are good practical rules building foods. They also help to keep by which a person may feed himself the body machinery running properly. without weighing his food. Weigh Water is the most important regulat- youi'self twice a month. If you are ing food. Most people do not drink above the average weight you need less enough of it. A glass should be taken fuel. If you are below the average on arising, one before each meal, and weight, and losing weight, you need another on going to bed. Water at more fuel. Have you some bulky food, meals is beneficial except for persons some raw food, some whole cereal, some who are too fat. fruit, and some milk in your diet each Bulky foods are also needed, as a day. Eat protein foods (meat, fish, diet containing no vegetable fibers is and eggs) only once a day, and then in insufficient except for babies. This moderate amounts. Have a meatless bulky food counteracts constipation day each week. and gives adequate work to teeth, jaws, Get the right kind of food, have it stomach, and bowels. Examples of prepared correctly, and then chew it bulky foods are vegetables, as lettuce, well. Many foods (bread, potatoes) turnips, celery, cabbage, tomatoes, and are partly digested in the mouth, and onions ; fruits, as apples, pears, prunes, all foods are prepared in the mouth for dates, and figs. stomach and bowel digestion. There- Vitamins are minute substances pres- fore, again, chew your food thoroughly. ent in very small quantities in a num- Eating keeps you alive, and it is worth ber of foods and apparently absolutely doing well. necessary to bodily growth and health. They are not found in all kinds of food III. Special Advice material, which makes it necessary to If you are overweight, you are carry- have a diet of variety. Milk, eggs, ing an unnecessary burden that may whole wheat, corn, oatmeal, potatoes, break down your health. Eat less fats, and oranges are some of the foods starchy foods, and sugars. Eat more known to contain them. Cooking re- fruit and vegetables. Exercise daily. duces the amount of vitamins in most If you are underweight, eat freely of foods, hence it is well to eat some raw all the foods. Do deep breathing and food and fresh fruit daily. setting-up exercises. Eat more fresh II. Feeding the Human Body fruit, vegetables, and eggs. A worker in an office doing no hard If you are constipated, eat freely of labor requires only about half the fuel whole cereals, bran bread, lemon and necessary for a very hard-working man. orange juice, cabbage and other bulky A farmer needs about one-third more vegetables. Avoid mineral water, pUls, fuel than the average clerk, while the and laxatives. Exercise, drink water average woman needs about one-third freely, and have regular times for less food than the average man who bowel movement. has more muscular tissue and is more If you do light indoor work, eat active. Children burn fuel quickly. A lightly of starches, fats, and sugars, girl of fourteen to seventeen will need and try and get plenty of fruit, green as much or more than a full-grown vegetables, and milk. woman, and a boy of the same age will If you do heavy work, eat freely. need more than a full-grown business Watch your weight. Eat enough to keep man. People vary in their fuel needs your weight at the average for thirty : A

102 The Health Bulletin

years. Eat less bread and Imtter. Syrup of Ipecac.—Esiiecially u.sed in sugar, sweets, and cereals if you tind croup to make children vomit. Dose, that you are getting fat. Putatues do one teasix)onful. not matter. Bismuth.—Four tablets powdered Lightweight is not a disadvantage if afford a safe remedy in diarrhea. one is otherwise in good health. Carbolated Vaseline. — Used exter- Overweiglit is always a disadvantage, nally for burns. and should he avoided, especially by Boracic Acid.—Dissolve as much as those approacliing middle life. possible in water. This solution is an Note.-—Tlie main facts in the above excellent eye-wash. article were taken fi'om the little book Soda Mint.—Use in case of gas on the entitled "Food—What to Buy. How to stomach or stomach burn. Cook It. How to Eat It," by Eugene Oil of Cloves.—For toothache. Put Lyman Fiske of tlie Life Extension In- a drop on cotton and place in the cavity. stitute. The book is recommended to Talcum Powder.—For all inflamma- all who want to learn more about the tions and irritations of the skin. important subjects of food and diet- Antiseptic Gauze.—To cover wounds. etics. Gauze Bandages.^—To hold wound dressings, splints, etc.. in place. Red Cross First Aid Outfit.—A handy FIRST AID MEDICINE dressing for wounds. Full directions In the August issue of the Bulletin are found on the container. a list of First Aid ^Materials for the Collodion.—Paint on cuts and slight home medicine cabinet was given. The injuries to the skin. following descriptions of these mate- Corn Plasters.—To prevent rubbing rials should be of value, especiall.v to of tender corns. the housewife General Directions Alcohol. — Useful externally f o r sprains, strains, and bruises. Will take Certain general rules should be fol- the place of any liniment for this pur- lowed when you have to take care of pose. any one who has been taken sick or Aromatic Spirits of Ammonia.— who has met with an accident. The fol- stimulant in fainting, shcjck. or any lowing rules are important: condition of weakness or depression. Don't get excited and don't get hur- Dose, one-half teaspoonful in half glass ried. Great haste is rarel.v necessary. of water. . Keep people away. A patient needs all the fresh air he can get. Castor Oil.—A mild purge. Dose, Loosen any tight clothing. one-half teaspoonful to one teasix)onful Always put a sick or injured person for an infant, one to two teasix)onfuls in a lying-down position with the head for a child. not raised, unless the face is very Seidlitz Powder.—Mild purge for con- flushed, when a small pillow should be stipation, sick stomach, or bilious put under the head. headache. Don't be in too much of a hurry to Mustard Powders.— ^TeasiKJonful in a get the patient into bed. Always be glass of luke-warm water to cause sure that before doing so you are not vomiting. going to do further injury. Syrup of Ginger.—For cramp in the Important.—Unless .vou are sure that stomach and diarrhea with cramps. what you are doing is not beyond your Dose, one-third teaspoonful in glass of power, send for a doctor at once. In water. doubt, send for a doctor anyway. —

The Health Bulletin 103

EXERCISE CARE OF THE EYES Four years ago, two business men, The following excellent suggestions both past fifty years of age, visited a on the care of the eyes have been that specialist because of the fact issued by the Illinois Society for the " slight exercise brought on palpita- Prevention of Blindness. They are tion of the heart." well worth reading and remembering: inquiry and examination the fol- On Take as good care of your eyes as lowing facts were developed: Both you would of your v/atch. You can buy were hearty eaters, rode to and men a new watch, but you can't buy new from their business, drank " mod- eyes. erately" of alcoholics, used tobacco to Wear glasses if the doctor advises excess and omitted everything in the you to do so. way of exercise. Both had increased blood pressure, Don't use your eyes in a poor or transient attacks of dizziness and flickering light. marked irregularity of heart action Have the light shine on your work after slight effort, such as walking or book—not in your eyes. briskly for several blocks. Hold your work or book 14 or 15 advice was Practically the same inches from your eyes. given in each case. One man followed Don't rub your eyes with dirty the advice, the other did not. The hands. one who did not is occupying perma- Don't use other people's towels, nently " six of earth " in a beautiful wash cloths, handkerchiefs, etc. suburban cemetery. Judging by his ancestry he died from twenty-five to Have sore eyes and granulated lids thirty years before his time. treated promptly, and as long as the The other sold his auto, reduced his doctor thinks necessary. allowance of food and tobacco and If you suspect eye trouble, see an secured a permanent separation from oculist at once.

the demon rum. He took up a form of Don't let any one but an oculist con- exercise that necessitated long, examine your eyes. tinuous excursions in the open air, and sunshine. It wasn't easy work and entailed considerable suffering at first, A man with a had tooth or a callus for his muscles were soft and flabby on his foot is not wanted in the army. and sore spots developed so fast that Minor ills, endured or ignored by the it difficult to keep up with them. was civilian who has no time to waste on fourth year he can At the end of the petty things, are matters of concern walk by the hour, doesn't know that in the army. Neglected teeth and feet he has got a heart, has lost twenty- seem like small impediments to the is thinking seriously eight pounds and development of the full power of a a commission in the of applying for man, yet either of them may slow up officers' corps of the Of reserve army. greatly the operations of an army. course, one swallow doesn't make a summer. The other man might have died just the same, even if he had fol- Insanitary and neglected conditions lowed the doctor's advice, but it is of rural schoolhouses is credited with worth noting that the one who did is the failure of 75 per cent of the men still on earth and promises to live out who have been rejected from the army his " three-score years and ten." upon medical examination, according Cincinnati Sanitary Bulletin. to Dr. J. A. Nydegger, of Baltimore. FREE DENTAL CLINICS All the reports show that at least seventy-five per cent of all the children Review of First Seven Weeks Free examined, over seven years of age, had Dental Clinics for School permanent teeth decayed. Children In only two localities in one county, This summary covers results ob- and a few in one other county, have the tained in the first seven weeks of den- people failed to take full advantage of tal work ending Saturdaj', August 31, the opportunity. The accompanying 1918. The work has naturally been cut indicates the kind of interest superficial in some particulars, experi- aroused among all classes. mental to some extent, largely educational, and in part in the nature of a A druggist in one town states that he survey. But the quality of work done has sold more toothbrushes during this for the children has been of the best. seven-week period than he had in the The specific object intended has been previous twenty-five years combined. A

achieved ; and that is finding a system private dentist in a town in an adjoin- of follow-up work after medical inspec- ing county to one of the counties tion which is practical and within worked, states that he had treated just reach of every county. Instead of twenty-five children within two weeks simply notifying the parent of a child after the work closed. The children now when a physical defect needing had been examined in the clinics, and treatment is found, and recommending as preference is given the smaller chil- treatment, something specific is done dren, the dentist not having time to do

. for the child ; therefore removing the all necessary treatment for all, their only criticism that has ever stood parents had taken them to the dentist

against medical inspection of school ill question and had the necessary work children. completed. Many other reports are This summary does not include the equally as good. report from Guilford County, as we counties completing the work have only half the record to date from The are Northampton, Nash and Lenoir. As there ; but a review of the work there this is written (September work is will be included later. 2) Caldwell, To August 31st the dentists had held continuing in Guilford, Da- there), open dispensaries at one hundred and vidson (two dentists at work forty-six places. Three thousand seven Forsyth and Robeson. The Wilson work hundred and sixty-three children had will start September 23d. been treated. conservative estimate A The equipment has already been pur- of the cost of this work, had it been chased and is at hand ready to open a done in private oflSces, would be more permanent clinic at Kinston and at than $6,500. A majority of the chil- Salisbury. dren treated had never seen a dentist before. Many of them would have been A fuller review will be given in the unable to pay anything for the work. November Bulletin. The Health Bulletin 105

ADENOID CLUBS from necessity, and which has already proved its usefulness on numbers of We have iu North Carolina "pig occasions since first tried in 1914. This "corn clubs," "canning clubs," clubs," we term "The Adenoid Club." "book clubs," "women's clubs," "coun- In the medical inspection of school try clubs," "city clubs," "hunting children, there are discovered in every clubs," "political clubs," "union clubs," school a number of children with dis- and clubs for the wise men and the eased tonsils, excessive adenoid growth, dubs. But few know of the existence defective vision, and ear diseases. To of a club which has been organized

FREE DENTAL DISPENSARY One of the many held in Lenoir County during July, 1918.

simply notify the parents of these chil- hospital. Some don't have anything dren that the condition exists and done because their neighbors do not. recommend treatment proved wofully An operation by a first-class throat inadequate. A few of the parents al- specialist costs from $25 to $35 gener- ways acted on the advice, but the ally, besides often hospital or other majority did nothing, to the subsequent extras are demanded. We have found cost of the child's health. Many of the that the services of a first-class opera- parents do nothing because they are tor can be secured for a day's opera- financially unable. Many fear a trip tions for $100. For that amount he away from home to a strange office or furnishes his own equipment, which in- 106 The Health Bulletin eludes the most modern operating in- When diseased tonsils and adenoids are struments, such as the electrical removed in time by a capable operator and trained nurse, vacuum apparatus, a the result is always a one hundred per etc. He also pays his own expenses cent improvement. One condition is and that of tlie nurse in getting to and required, and that is a medical inspec- from the meeting place of the club— the place where the children needing tion of schools, the first step of which operations assemble. He can operate is done by the teacher, and shall have on about fifteen children in one day. taken place in your school district, con- For about $50 the services of an extra ducted in compliance with the State- trained nurse may be secured for the wide law. This was done in thirty- day. also two local physicians, who assist the operator in giving the anes- two counties last year, and will be com- thetic and help look after the little ones pleted in as many more this year. until they "come round" properly ; and For full particulars address the Bu- provides for a few rooms with cots, etc.. reau of Medical Inspection of Schools, at a local hotel or some place for the North Carolina State Board of Health, children to use until able to start home. We find that on an average, the pa- Raleigh. G. M. C. rents of at least twelve of the fifteen children are amply able and willing to When will parents learn that there pay $12.50 each for tbe operation, is a cure for diphtheria, if only it is which saves them from 25 per cent to taken in time ? How can it be brought 75 per cent on the operation and the home to them that delay is dangerous; expense of a trip, in most cases, of that the doctor's services cost far less many miles away from home. Thus than do those of the undertaker, to allowance is made for at least three say nothing of the saving in grief, sor- children in every club whose parents row and heartache ? Then by all means are poor in this world's goods to have when your child complains of having the advantage of a good operation free a sore throat, call your doctor and of charge. insist upon having antitoxin admin- From the standpoint of the specialist istered at once. It can do no harm if the plan is strictly ethical and works the child has not diphtheria; but it well. The more children' that are will save its life if it has. treated and therefore have the fear of a simple operation removed from the minds of their immediate family and Tuberculosis is contagious. One per- their neighbors, the more common will son who is sick with it may give it to this great preventive procedure become. all the other members of the family. To September 1, 1918, the most re- It can be cured, if taken in time; but markable results have been obtained that time is very early. Don't wait till in Hertford and Franklin counties. you are sick in bed, or spit blood—it We will be glad to communicate with will be too late then. If you always any one desiring to organize one of feel tired, if you are under weight for these clubs. There are no by-laws or your height, if you have a cough all initiation fees and but one meeting. A the time, or get colds one right after second meeting is never necessary. the other, go to the nearest tubercu- The only danger is delay—delay until losis dispensary and get examined. It the affected child is too old to be bene- will cost you nothing and it may save fited materially from the operation. your life. fUBERCHLOSiS

TUBERCULOUS SOLDIERS AND of all needs, consistent with its organi- REGISTRANTS TO BE zation. and Anti- ASSISTED 6. State Boards of Health Tuberculosis agencies of the states of North Carolina, South Carolina, Ten- State Sanatorium and Red Cross nessee, Georgia and Florida, recogniz- Co-operating ing this as an extraordinary opportunity to promote their efforts toward the Basic Considerations prevention and cure of tuberculosis,

1. Tuberculosis, always a serious realize also the need of cooperating menace to social welfare and a drain agencies and believe the American Red upon state and national energies, in Cross to have the local organizations war times, becomes a special problem best equipped to assist them in this for solution through untiring, patriotic problem. endeavor. Therefore, in view of the above con-

2. The war has revealed hundreds of siderations and present conditions, and cases of tuberculosis not previously in harmony with the spirit and pur- known— (a) Tuberculous soldiers dis- poses of the American Red Cross, State charged "in line of duty," (b) Tubercu- Boards of Health and Anti-Tubercu- lous soldiers discharged "not in line of losis agencies, it is deemed absolutely duty." and (c) Men rejected by the essential that these combined forces draft boards because of tuberculosis. shall agree upon an effective plan,

3. There is imperative need of im- whereby they may cooperate in the care mediate and adequate machinery for and treatment of all tuberculosis pa- the care and treatment of all soldiers or tients arising from or revealed through rejects, or members of their families, the war and war conditions. affected by tuberculosis, and for the The general plan of agreement be- adequate care of their families while tween the American Red Cross on the they are being treated. one hand, the State Boards of Health 4. There is furthermore at this time, and Anti-Tuberculosis agencies on the in view of the manifold calls for serv- other, shall provide for a general policy ice, more than ordinary need for pro- and a definite procedure. grams that will conserve energy, time Provisions and money, as well as promote efficiency in accomplishing the desired re- First. That, in case of tuberculous sults. soldiers discharged either in line of

5. The policy of the American Red duty or out of line of duty, the Bureau Cross, always providing for the maxi- of Civilian Relief of the Southern Di- mum service and cooperation in the use vision of the American Red Cross, of people's funds entrusted to it, in this through its local Home Service Sec- instance recognizes an unusual oppor- tions, shall provide care during the tunity to i)erform a definite service and interim between their return to the offers to direct its forces to the relief home communities and the time that 108 The Health Bulletin more permanent provision may be made ties reported as having anti-tuberculo- for them ; and that the families of sis societies. such soldiers shall be provided for in Second. Such reports when received accordance with the regular policy of from Home Service Sections shall be local Home Service Sections. forwarded by the Division Office of the Second. That in the more perma- Red Cross to the proper Anti-Tubercu- nent treatment it will be the policy of losis Association or State Board of the Red Cross to provide for one-third, Health for further consideration as to or more, of the necessary expenses as plan for more permanent treatment. determined by the exjiediency of the Third. That after the initial contact case over and above what the family and report is made by the American can provide. Red Cross, the Anti-Tuberculosis Asso- ciations or State Boards of Health shall Third. That in providing for the re- cause an expert examination and diag- maining two-thirds expenses for more

nosis to be made ; shall outline tlie permanent treatment of tuberculous

proper care and treatment ; and shall soldiers, the effort shall be made by make every effort possible to provide the State Boards of Health and Anti- means for the more permanent care of Tuberculosis agencies to divide such ex- such returned soldiers. In the cases penses equally between local agencies, of discharged soldiers they may ex- private or public, and State aid or pect the cooperation of the Home Serv- agencies, through effective legislative ice Committees in carrying out such appropriations in accordance with a plan of treatment as may be agreed definite State Health Program. upon. In the cases of rejected regis- J"'ourth. But that nothing in this trants they shall not expect or request statement of general policy shall be such cooperation, but may use the re- construed to interfere with the jurisdic- port received from Home Service Com- tion of State Departments of Public mittees as the basis for developing local Health or local Health authorities, or interest in securing treatment through to detract from the function and oppor- other sources. tunities of anti-tuberculosis societies, or to vary the program of the Civilian State Board of Health to Furnish Relief Department of the American Red Cross Addresses of Tuber- Red Cross. culous Registrants fob Investigation Red Cross Takes Initiative Fourth, That State Boards of Health First. The initial contact with re- and Anti-Tuberculosis agencies shall turned tuberculous soldiers and re- furnish to the Bureau of Civilian Re- jected registrants shall be made by the lief of the Southern Division of the Southern Division of the American Red Red Cross a record of rejected tubercu- Cross through its Bureau of Civilian lous registrants with whom they wish Relief. This contact shall include in- contact made by Home Service Com- vestigation by Home Service Commit- mittees, and also a record of all re- tees of all cases referred to them by turned tuberculous soldiers with whom the Division Office. Home Service Com- contact has been made prior to this mittees of the Red Cross shall also for- agreement, which record shall contain ward to said office information concern- all information now in their possession ing all local cases discovered by them. relative to such soldiers. Except that initial contact by the Rod Fifth. Form letters to be used by the Cross shall not be made in those locali- cooperating agencies in carrying out The Health Bulletin 109 this agreement shall be submitted for the air will be rapidly carried av^ray, mutual approval. In the event of diffi- and the danger of infection greatly culties arising in any case, the super- reduced. visory agency involved shall be notified immediately and adjustment made ac- ROBBING THE UNFORTUNATE cordingly. The National Association for the Study and Prevention of Tuberculo- HOW TO GET TUBERCULOSIS sis is authority for the statement that not less than $20,000,000 is invested is caused by tiny germs Tuberculosis in the business of manufacturing and M^hich live and multiply in the human exploiting fake cures for consumption body. When these germs are coughed It is also estimated that the annual these concerns and indi- up, sneezed out and otherwise dis- income from viduals is not less than $15,000,000. charged by those having the disease, Of this amount, about one-third is they are frequently carried to others spent for advertising, leaving the tidy in one or more ways. sum of $10,000,000 as profit. Germs of tuberculosis are much The Association aptly styles this more active and likely to cause the sum as blood money, taken from ignorant consumptives, who have parted disease when they have just been with their' dollars without receiving coughed, sneezed or spit out than they benefits of any kind. As yet no drug are after they have been outside the has been found that will cure con- human body for a week or more. No sumption; but under medical guidance expose him- one should ever needlessly it is known, that, when taken in time, tu- self by breathing dust from dried good food, fresh air, sunshine and rest bercular sputum. It is highly danger- are the agencies that will avert the ous also to breathe in an atmosphere progress of the disease and in time room, or in a close unventilated effect a cure. Moral—don't buy bottle church, store or shop, where a careless goods to cure consumption. consumptive has been coughing, sneez- spitting. By so doing, one is ing or TUBERCULOSIS INFECTION DUR- inhale the fresh viru- very likely to ING CHILDHOOD lent germs of tuberculosis sprayed out into the air by the consumptive. In It has long been known that a large a closed room such germs may float percentage of post mortem examina- around in the air for hours. tions show evidences of old lesions of The same principle applies to con- tuberculosis which have healed, show- tracting colds, pneumonia, " Grippe," ing that many more persons have the diphtheria and several other diseases. disease at some time or other during On the other hand, we should avoid their lives than is generally recognized exposing others to our diseases known from the number of pronounced cases or unknown. Whenever indoors or near with which we are familiar. A more any one else, one should always cough recent addition to our knowledge is or sneeze into a handkerchief, or spit, the fact that by modern specific tests when necessary, where it will harm which we possess, from 70 to 80 per no one. By living outdoors and in the cent of all children are found to react fresh air as much as possible any positively, showing that the infection dangerous germs which have been prevails widely in some form or other coughed, sneezed or expectorated into among children. These facts, among 110 The Health Bulletin other things, have given rise to the insanitary condition of the school thought that tuberculosis in adults is room, lack of ventilation, over-heating, due in most, if not all cases, to infec- lack of light, and sedentary occupations received in early childhood. It tion. is therefore more than ever incumbent But not only is the health and life of upon us to guard and protect children the teacher at stake; the student also against infection with this dread dis- is exposed to these evil conditions. ease. Precautions which are within The pupil is cramped up many hours our power to invoke are the insurance a day, in improperly constructed seats, of a safe milk supply for children, bending over books in ill-lighted, im- either in the form of certified milk properly ventilated, often dusty and from tuberculin tested cows or by overheated school rooms. pasteurization. Children should also It is time now, not next year, or the be protected from close association year after, to give this matter most with adults who have tuberculosis and serious consideration. those adults who are necessarily in intimate contact with children, such as PENALTY OF NEGLECT parents, should be made to realize the examination of 10,- absolute necessity of observing all or- The compulsory dinary precautions against spreading 000,000 of our citizens for army draft to infection. purposes has biven a new impetus the annual medical examination idea and particularly to the anti-tubercu- MORE WORK FOR TUBERCULOSIS losis phase of the movement. For ASSOCIATIONS tuberculosis alone from 1 per cent to 6 per cent of these men are being re- The physical examinations at the jected, which means a sharp revision time of the selective draft have re- upward of previous expert estimates vealed to many a young man that he of the prevalence of the disease. On has tuberculosis in the early stages. this basis at least 200,000 of these men If he is merely stunned by the news will found to be tuberculous. Most and does nothing but brood over a be of these cases, the experts declare, gloomy outlook, he will probably in would never have developed had the a few years become a burden to his preliminary symptoms been discovered relatives or the public. If he seeks in time. These results, it competent advice and supervision at and treated is pointed out, clearly indicate the wis- once, his disease will usually be ar- of extending the periodic exami- rested and he will live a long and use- dom nation to all citizens. ful life. County tuberculosis associations and those local health departments which employ public health Why call upon the children and wo- nurses should do their utmost to help men to do all the conserving? Why and advise these men to overcome should not the men do with less to- their infection before it is too late. bacco, less booze, or less vice? Why should not men do without these needless and harmful luxuries altogether? TEACHERS AND TUBERCULOSIS Such practical conservation would save There is a higher rate of mor- enough to pay off more than one-half tality from tuberculosis among school of the annual war debt and leave the teachers than among stonecutters and race in a fine condition to meet the re- barkeepers. The reason for this is the construction period. ' w =* NOTICE TO READER.—When you finish reading this magazine place a one-cent stamp on this notice, hand same to any postal employee and it will be placed in the hands of our soldiers or sailors atthe front. NO WRAPPING—NO ADDRESS.

Published bM TRE. N9^m. CAKPLI/m STATE. 5

-serNt to Thi5 BuIlgtirvwiUbe free arxg citizen of 1he 5tcrte upor\ request |

Entered eu eeeend-clats 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. G.

Vol. xxxti/ NOVEMBER, 1918 No. 5 EDITORIAL

400 DEATHS FROM DIPHTHERIA The inauguration of this new policy coincides with the distribution by the A Question of Embarrassing Re- State Laboratory of Hygiene of a sponsibility: A child dead from diph- potent diphtheria antitoxin, practically theria with the well-informed always free of cost, to all our people. I say raises the question as to who blund- practically free of cost, because the ered. A death from this disease in- charge for a package of antitoxin, irre- variably casts shadows of suspicion spective of its size, 1,000 units or 10,000 first on the parent, second on the phy- units, is 25 cents, the cost of the sician, and third on the health officer. syringe and the package. In the last four years (during which time North Carolina has accurately re- The New Policy of Fixing Responsi- corded the deaths and the causes of bility: The State Board of Health pro- deaths occurring in the State), there poses to make a careful investigation has been an average of 400 deaths a by personal visit of a trained epidemi- year from diphtheria. In 1914, there ologist, of one hundred deaths from were 371 deaths; in 1915, 525 deaths; diphtheria. The selection of the deaths in 1916, 418 deaths; in 1917, 287 deaths. to be investigated will be indiscrimi- The average number of deaths by nate, the deaths for certain months of months for the four years were, for the year being selected as those for, in- January, 41; February, 22.5; March, vestigation. The investigation will be 17.7; April, 15.5; May, 11.7; June, 7.5; very careful; the facts will be accurate July, 9.5; August 26.7; September, and certified to. 54.5; October, 78.2; November, 65.7; From now on, the Bulletin proposes December, 49.5. During the entire to publish type cases, giving details, four-year period, October, with the showing (1) deaths from diphtheria single exception of November, 1915, has where parents were apparently respon- been the month of the largest number sible; (2) deaths from diphtheria of deaths from diphtheria. Such is the where the attending physician was ap- diphtheria situation in North Carolina parently responsible; (3) deaths from at the time of the inauguration of a diphtheria where the health officer was new policy of the Board of Health, apparently responsible; and (4) deaths which is designed to establish respon- from diphtheria where there was ap- sibility of various parties for deaths parently no responsibility attaching to from this easily preventable disease. any one. 26 The Health Bulletin

Reaching a Verdict: In determining (2) When a child living in a com- responsibility, the primary and the munity where diphtheria exists, or has fundamental question with the State recently visited a community in which Board of Health will be when did the the disease exists, develops a sore child get antitoxin? With the excep- throat and perceptible fever. tion of one, possibly two, per cent of (3) When a child living in a family the deaths from diphtheria, children in which diphtheria has appeared sev- die because antitoxin is not promptly eral times at Intervals, of several administered in proper amounts. The months for a year or two, develops a following table, based upon 4,000 cases sore throat and perceptible fever. (The of diphtheria carefuly recorded by the indications here are that some member Chicago Health Department, shows the of the family is a diphtheria carrier.) effects of antitoxin on the fatality of GIVE THE CHILD THE BENEFIT this disease when the remedy is admin- OF THE DOUBT. TRANSFER THE istered promptly and also late in the RESPONSIBILITY TO A PHYSICIAN. disease: When the Doctor is Guilty: (1)

Antitoxin When the doctor is called on the first, Cases Died. Mortality Administered second, or third day of a case of diph- Injected 1st day 355 1 0.27 per ct. 2d day 1,018 17 1.67 " " theria and fails to give antitoxin. In " " 3d day 1,509 57 3.77 this case it makes little difference " 4th day 720 82 11.39 " •* later 469 119 25.37 " " whether the doctor made a diagnosis of Less than 6 per cent of the children diphtheria or not; however, if he made treated with antitoxin, even as late as a diagnosis of diphtheria and neglected the third day, die. Less than 2 per to use antitoxin, the question of crim- cent so treated during the first two days inal practice projects itself. of the disease, die. This table, with (2) When a child living in a family many other similar tables from health in which the doctor has treated a per- departments, prove that diphtheria son a week or ten days previously, or treated promptly with antitoxin, and when a child has been exposed to diph- in proper amounts, is one of the least theria and the exposure called to the dangerous of all diseases, but treated doctor's attention, is not immunized late with antitoxin, is one of the most by the doctor and develops a case of dangerous of all diseases. The ques- diphtheria. The attending physician tion, therefore, of guilt in the death is under obligation to immunize all of a child from diphtheria resolves it- children and grown persons in a family self into determining who was respon- where diphtheria occurs, and which he sible for the delay in the use of the treats unless (a) he applies the Shick antitoxin. test and finds the exposed person or When Parents Are Responsible: persons with a natural immunity; (b) Parents are responsible for delaying unless the exposed person or persons the use of antitoxin and of contributing have indications of a predisposition to thereby to the death of their child, serum shock; (c) unless the doctor is when they fail to call a physician on a in a position to exercise careful, al- reasonable suspicion of diphtheria. most daily, supervision over the family The question, then, shifts to what con- to detect secondary cases of diphtheria stitutes reasonable suspicion. Reason- in their inception. able suspicion exists: When the Health Officer is Guilty: (1) When a child has sore throat (1) When a child dies in a county in and fever, and a whitish, yellowish, North Carolina because antitoxin is not grayish membrane or deposit on the available at a price within the easy top or back of the throat. financial reach of any family. The The Health Bulletin 27

State Laboratory of Hygiene now pro- AFTER THE "FLU"—WHAT? which may be had duces an antitoxin Any disease affecting the respiratory for any size package. The at 25 cents tract, such as Spanish Influenza, has responsible for county health officer is a tendency to "light up" any tubercu- that this State supply of anti- seeing lous infection that might have been is made conveniently available toxin lying dormant. So if you should fail for the people of his county. He should to recover promptly from the Spanish arrange for several depositories for this Influenza—if you should find yourself antitoxin at convenient stations in the with a little rise of temperature, 99 or county, and should see that these de- above, in the afternoon, with a sub- made known to the pub- positories are normal temperature, 98 or below, in the notices in the county lic through official morning, you had better suspect tuber- papers. culosis and have a thorough examina- The health officer is responsible (2) tion of your lungs by your physician if a death from diphtheria occurs in a or by a specialist.—L. B. McB. family living in a community in which when the diphtheria has occurred DIPHTHERIA ANTITOXIN FOR health family has not received from the TWENTY-FIVE CENTS officer, as is required by the State law, of Hygiene now a notice of the occurrence of diphtheria The State Laboratory antitoxin of its own in that community, and an official state- has diphtheria distribution in the ment as to the danger of the disease, manufacture for and the way of avoiding the danger. State. Distribution is Simple: When Nobody Is Responsihle : (1) The Plan of by cash When antitoxin in sufficient amount is The antitoxin is distributed per package, administered to the sick person on the sale at twenty-five cents contains 1,000 or first or second day, and in certain in- whether the syringe twenty-five cents stances on the third day of the illness. 10,000 units. The syringe and pack- As to what constitutes a sufficient covers the cost of the itself amount, see the article on this subject age and in reality the antitoxin direct from on page 30 of this Bulletin. If the is free. Any doctor can buy but this doctor talks about the danger of anti- the laboratory if he chooses, adminis- toxin, see the discussion of this ques- often entails a delay in the druggists tion on page 31 of this Bulletin. tration of the antitoxin. The antitoxin on the (2) When the disease occurs in an also can procure the laid illiterate family, that is, among those same terms. Many druggists have the "who never had a chance"; in short, in a supply for their customers in as a when excusable ignorance is respon- interest of the public health and have sible for parents failing to call a phy- matter of accommodation, but we there sician. no right to ask them to do so as It is, Sunlight: As sunlight kills infectious is no opportunity for profit. germs, so the light of public intelli- therefore, the duty of the local health that gence transmitted through the publi- official (city or county) to see cation of facts (facts sometimes em- there is an available local supply on barrassing), gets rid of ignorance and hand. Call on your county or city carelessness and their fatal results. health officer for this antitoxin when The death rate from diphtheria in you need it. North Carolina must go down. The Four Sizes: The antitoxin is put up State Board of Health publicly accepts in four sizes: 1,000 units, 3,000 units, responsibility to reduce this death rate. 5,000 units, and 10,000 units. The last We have gone on record.—W. S. R. two sizes are used in treatment, it being 28 The Health Bulletin seldom advisable to use so small a dose officer had carelessly run down the as 3,000 units, and the 1,000 units pack- child with his automobile. ages are used as a prophylactic in case Diphtheria antitoxin is supplied al- of exposure. most free of charge by the laboratory Storage: Diphtheria antitoxin should of the State Board of Health, the charge be stored in an ice box. If this is im- being only 25 cents for sufficient to possible, a spring-house or other cool treat any case. The duty rests upon place may be used, care being taken to the county or town health officer to keep the packages dry. When first keep a supply on hand to meet calls filled the syringes contain 20 per cent that may be made. more antitoxin than the labels call for, Here is a list of the county and town and loss of potency is very slow if health officers who have purchased the properly stored. After expiration date antitoxin, together with the names of has been reached the antitoxin is still places where a number of individual good if 5 per cent of strength is de- physicians and drug stores have laid ducted for each year. The strength of in a supply. If the name of your county diphtheria antitoxin may be measured or town health officer is not listed you exactly, and we can assure you that should call his attention to the fact. you can rely on the full potency of City Health Officers: Dr. W. W. Stan- each syringe. cill, Raleigh; Dr. C. C. Hudson, Char- Prophylactic Doses: Immunizing lotte; Dr. J. T. Rieves, Greensboro; doses of antitoxin should be given in Dr. R. L. Carlton, Winston-Salem; Dr. cases of exposure. The immunity lasts C. V. Reynolds, Asheville. only a short time—from three to six County Health Officers: Dr. C. B. weeks. A more permanent immunity Smith, Toecane, Mitchell; Dr. J. E. may be obtained from a Toxin-Anti- Malone, Louisburg, Franklin; Dr. J. M. toxin mixture. Three injections are Sullivan, Hayesville, Clay; Dr. F. M. necessary, and therefore the protection Register, Jackson, Northampton; Dr. is not immediate, but when established C. E. Low, Wilmington, New Hanover; the immunity is believed to persist for Dr. Arch Cheatham, Durham, Durham; four or five years, and possibly longer. Dr. W. A. Bradsher, Roxboro, Person; Its use is especially advocated for chil- Dr. W. E. Warren, Williamston, Mar- dren under 5 years of age, and particu- tin; Dr. J. S. Mitchener, Kinston, larly for those in institutions. Lenoir; Dr. H. J. Tilson, Murphy, The State Laboratory of Hygiene Cherokee; Dr. P. B. Loftin, Beaufort, hopes soon to have Toxin-Antitoxin Carteret; Dr. L. J. Smith, Wilson, Wil- mixture for distribution, but definite son; Dr. K. E. Miller, Tarboro, Edge- announcement cannot be made at this combe; Dr. D. T. Watson, Southport, time.—^C. A. S. Brunswick; Dr. E. J. Bryson, Smoke- mont, Jackson; Dr. E. F. Long, Lexing- ton, Davidson; Dr. J. F. Jonas, Marion, IS TOUR HEALTH OFFICER McDowell; Dr. L. H. Coffey, Lenoir, LISTED HERE? Caldwell; Dr. J. W. Jones, Boone, Watauga; Dr. J. W. Rodwell, Mocks- If any child in North Carolina dies ville, Davie; Dr. G. S. Attmore, Stone- from diphtheria this winter because wall, Pamlico. there is not available a supply of diph- Physicians or Drug Stores vi the theria antitoxin to treat the case, then following Towns: Winton, Hertford; the death of that child can be charged Catawba, Catawba; Currituck, Curri- to the negligence of the county or town tuck; Albemarle, Stanly; Chapel Hill, health officer just as certainly as if that Orange; Palmerville, Stanly; Elm City, The Health Bulletin 29

Wilson; Bakersville, Mitchell; Maiden, The chief of the Bureau of Tubercu- Catawba; Clifton, Ashe; Pink Hill, losis of the State Board of Health, Lenoir; Pilot Mountain, Surry; Burl- Sanatorium, has been appointed Col- ington, Alamance; Hertford, Perqui- laborating Epidemiologist, United mans; Danbury, Stokes; W. Jefferson, States Public Health Service, and on Ashe; Mt. Olive, "Wayne; Troy, Mont- account of such appointment will be gomery; Greenville, Pitt; Advance, able to use franked envelopes in cor- Ashe; Ayden, Pitt; Cooleemee, Davie; respondence in regard to reporting Red Springs, Robeson; Canton, Hay- cases of tuberculosis, and will furnish wood; Clayton, Johnston; Coleraine, physicians franked envelopes in which Bertie; Knightdale, Wake; Statesville, they may send their reports to this Iredell; Maxton, Robeson; Marshall, office without postage. Recently we Madison; Trenton, Jones; Jacksonville, endeavored to send a supply of these Onslow; Gastonia, Gaston; Elkin, franked envelopes to every physician Surry; Goldsboro, Wayne; New Lon- in the State, also report cards. If you don, Stanly; Angier, Harnett; Salem- failed to get yours, or if you need more burg, Sampson; Aulander, Bertie; of either, write us. Woodland, Northampton; Raeford, Hoke; Oakboro, Stanly; Farmer, Ran- The physicians of North Carolina dolph; Candler, Buncombe; LaGraiige, cannot escape their responsibility in Lenoir; Stanfield, Stanly; White Rock, the fight against tuberculosis. He Madison. mans the outposts; he mans the listening posts; he is in the front line AMERICAN BED CROSS AND trenches; he makes the first contact BED CROSS SEALS with the enemy. The physicians in North Carolina can be counted on to The December campaign of the the last man in the fight against Ger- American Red Cross for new members many. Our people expect the same and the annual Red Cross Seal drive devotion to duty, the same loyalty, in have been combined and there will be the fight against the germs of tuber- no sale of Red Cross Seals this Decem- culosis, and their expectation will be ber, but every one who joins the Ameri- realized. can Red Cross will receive a packet containing a certain number of Red If you need a thing, you are paying Cross Seals and literature in regard to for it whether you buy it or not. If it the fight against tuberculosis. is a sanatorium our people need, it is The American Red Cross recognizes paid for today and every day that fol- our responsibility in, and the impor- lows in a definite money loss—it is paid tance of, taking the "germ" out of Ger- for today and every day that follows many; it also recognizes the great im- in sorrow, suffering, sickness, and portance of destroying the germ of death. And then it must be paid for tuberculosis. It is doing more now, over and over again with interest com- and will continue to do more and more, pounded daily by all future generations. in the fight against tuberculosis than It is far cheaper to pay for it NOW. ever before. It is far better to pay for it NOW. Further announcement will be made in the December issue, but let it be said that the annual membership fee The Returned Tuberculous Soldier is one dollar, and every man, woman, He offered his all for you; it is your and child in America ought to be a privilege to do your best for him. Could member.—L. B. McB. you conscientiously do less? PUBLIC HEALTli RND SANITATION

Edited by Dr. W. S. Rankin DIPHTHERIA

The Danger of Diphtheria

This disease, depending upon the way it is treated, is either one of the least or one of the most dangerous of all diseases. It is one of the least dangerous when promptly treated with antitoxin; it is one of the 7nost dangerous when the antitoxin treatment is incomplete, delayed, or not given. Before antitoxin was discovered the mortality from diphtheria was 81 deaths per hundred thousand of the population. Since the use of antitoxin In the treatment of diphtheria, the mortality has dropped to 21 deaths per hundred thousand of the population. This means that something like fifty to sixty thousand lives are saved every year in the United States through the prop'er use of antitoxin. Before the use of antitoxin, from 30 to 60 persons out of every hundred who contracted the disease died; since its use, only about 8 persons out of every hundred who contract the disease die. The fatality of the disease depends largely upon ichen the antitoxin is used. The following table illustrates this important point:

Cases Died Mortality

355 The Health Bulletin 31

"Convinced now of the essential Is the Antitoxin Treatment Dangerous? harmlessness of the serum, the ten- Dr. W. H. Park, one of our greatest everywhere has been to use dency authorities on the use of antitoxin, larger and larger doses, a practice says: "In 140,000 persons injected by which has been fully justified by the the New York City Health Department obtained. For a child over two results inspectors, there were two deaths due years old an initial dose for a severe to serum (antitoxin). About the same attack, including all laryngeal cases, proportion is reported from Boston." not be less than 7,000 or 8,000 should He further states that "about thirty units; repeat it in from six to eight deaths in all have been reported" from hours, provided no improvement is the use of antitoxin treatment. This Children under two years should seen. means that in the treatment with anti- receive from 5,000 to 6,000 units. Cases toxin of something like 160,000 cases of exceptional severity, in older chil- of diphtheria each year in the United dren, should receive from 10,000 to States there are from two to five deaths units, to be repeated in from six 15,000 from the use of antitoxin. On the other to eight hours if the progress of the hand, the evidence is conclusive that disease is unfavorable. Mild cases if the 150,000 cases were not treated should receive from 3.000 to 5,000 units with antitoxin, there would be from as an initial dose, a second being rarely 40,000 to 50.000 deaths from diphtheria, requried." whereas, just so many deaths are pre- Protect the Other Members of Tour vented through the use of this great Family remedy. While in the treatment of cases with antitoxin there is one Not everybody is susceptible to diph- 50,000 the antitoxin, there would theria. Only from 30 to 40 per cent death due to to 12,000 deaths as a of people will contract the disease when be from 10,000 direct result of the failure to use this exposed to it. There is a test known life-saving agent. as the Shick test by which may be great It is. therefore, clear that it is no less determined whether one is or is not criminal to attempt to treat diph- susceptible to diphtheria. This test than without antitoxin. The few consists of a hypodermic injection into theria following the use of antitoxin the skin, not xmcler the skin, of one or deaths usually been in persons who were two drops of a very dilute amount of have to asthmatic attacks, more es- diphtheria toxin. If the person so in- subject pecially persons whose asthma was jected is susceptible to the disease, a aggravated by coming in close very small red swelling about the size usually with horses. When treating of a dime appears about the site of the contact diphtheria, it is well for injection within twenty-four hours and asthmatics for the doctor to inject only from two to lasts for about a week. If, on the other three or from four to five drops of anti- hand, the person is immune to diph- wait few minutes to see theria no such reaction occurs. This toxin and a patient will react before giving test causes but very slight inconven- how the dose. ience. When a case of diphtheria oc- the full curs in a family it is therefore possible The Cause of Diphtheria for the physician, through the simple test above described, to determine Diphtheria i« due to a small germ which members of the family are liable that lives in the upper respiratory pas- to contract the disease and which mem- sages, usually in the nose and throat, bers are immune to the disease. Those but sometimes in the larynx or Adam's members of the family who are found apple. This germ is found in three to be susceptible to the disease should groups of people: (1) People with rec- immediately be given from 500 to 1.000 ognized cases of diphtheria; (2) people units of antitoxin, that is, an immuniz- with mild, unrecognizable cases of diph- ing or protective dose. In this way theria, who are spoken of as "missed they become protected from the disease cases"; (3) well people with infected for at least six weeks. Where the phy- throats, who are spoken of as "car- sician is not prepared to use the Shick riers." test, the only safe thing to do is to People with recognized cases of diph- assume that all members of the family theria have the following symptoms: in which there is a case of diphtheria a very sore throat, which is usually are liable to the disease and to give all accompanied by a white membrane on of them the immunizing dose of anti- the sides and back of the throat. The toxin. membrane is sometimes patchy and 32 The Health Bulletin may be very small in amount. It may rier," to a well person, generally be so located as to be invisible, and it through throat or nasal secretions. may be absent. With these local symp- This transference may take place in toms there is fever, rapid pulse, and one of the following ways: other symptoms indicating general con- (1) In acts of coughing and sneezing stitutional involvement. When there without holding a handkerchief or some is any doubt as to the nature of the other cover in front of the mouth and disease, a diagnosis is easily made by nose, when small particles of the secre- swabbing the throat with a small piece tions, so small as to be practically in- of cotton on the end of a wire, then visible, are thrown into the air, where wiping the cotton on a glass slide and they float for some time. Persons com- examining the exudate or phlegm under ing within three or four yards of an the microscope for the diphtheria germ. infected person who has coughed into People with mild, unrecognizable the air within the last minute or five in cases of diphtheria, or "missed cases," minutes are liable to breathe some are one of the most prolific sources of of the infection from the air. the disease. Such people suffer with (2) An infected person soils his very mild sore throats, no membrane hands with the secretions of his mouth being present, and with very slight gen- and nose, and by shaking hands with eral symptoms. They are not sick a well person infects the hands of that enough to send for a physician, and it person, who transfers the infection to does not occur to them that they may his mouth or nose, and so contracts the have diphtheria. They remain about disease. their business, freely mixing with the (3) An infected person may use general population, and serve to spread tableware, knives, forks, spoons, cups, and maintain epidemics even more than or plates, or pieces of food which a the recognized cases of the disease, who well person may later handle or use, are restricted in their movements by with the result that he becomes in- their more serious illness. It is esti- fected from the contaminated aricle. mated that in an epidemic of diphtheria One of the most public sources of this thjre is one "missed case" for every kind is the common dipper and water- recognized case of the disease. bucket found in many schoolrooms. Well persons with diphtheria infected Precautions During tlie Disease throats, or "carriers," like the second are prolific group, the "missed cases," 1. Faithfully carry out the rules fur- sources of the disease on account of nished by the quarantine officer. general public. their mingling with the 2. Separate the sick person from the In an epidemic of diphtheria that has other members of the family in as far 1 lasted for any length of time, about as such separation is practicable, and per cent of the population become "car- allow no one except those necessary riers." "Carriers" are usually persons for attendance upon the sick to be about who are or have been closely associated the sick. cases "missed cases" with recognized or 3. Supply the sick person with paper of the disease, or who themselves have napkins, rags, or handkerchiefs, and recovered from a known or an unsus- insist on the sick person holding these pected case of diphtheria. Frequently, rags, napkins, or handkerchiefs in front following a case of diphtheria in a of the mouth and nose when coughing family, one or more members of the or sneezing. "carriers" and re- same family become 4. See that the sick person has his main so for several months or perhaps own set of eating utensils, and that years. these, with all particles of unconsumed In this way secondary cases of diph- food, are thoroughly disinfected, be- theria occur in the family from time fore being used by another, with water to time, and the mistake is frequently that is boiling when it is poured over made that the room or house is sus- the utensils and food. pected of being permanently infected 5. Nurses and attendants upon the with the diphtheria germs, instead of sick must carefully wash their hands suspecting what is practically always with soap and water and then dip them the true explanation, that some mem- into a solution of carbolic acid, a table- ber of the family is a "carrier." spoonful of the acid to one pint of The germ of diphtheria is transferred water, before handling anything that from the recognized case of the dis- any other person touches. ease, the "missed case," or the "car- 6. All clothing or fabrics of any kind The Health Bulletin 33

should either be boiled or thoroughly COLDS soaked in a solution of carbolic acid in the strengrth of a tablespoonful of acid Colds are caught. How are they to a pint of water before being sent caught? What can be done to avoid away from the home, or before being catching cold? In answer to these used by other people. questions the State Board of Health Directions of tlie Nortli Carolina State says: All colds and indeed all diseases Board of Health for Householders of the breathing organs are largely on the Termination of the Disease due to air starvation. Benjamin Franklin noticed this truth and wrote 1. Where there is more than one living room in the home, have the con- as follows: valescent person take a warm bath, dry "I believe it is unnecessary to have thoroughly, put on the underclothing, colds, for I have observed that when I and leave the sick room, going into another room that has not been used treat myself to plenty of outdoor air I by the sick, there complete the dress. never catch cold. When I have caught It is best for the outer clothing not to cold, I noticed that one or two days be exposed to the air of the sick room. before its appearance I had eaten 2. The person acting as nurse should now put on an apron or outer dress, heartily and then sat around in a open all the windows and doors to the closed room with many others until sick room, remove all sheets, pillow- the air got bad and the room filled cases, curtains, and other cotton and linen fabrics that may contain infec- with tobacco smoke. I have also no- tious material, and place these things ticed that by staying much in the open at once in boiling water, to which air and lifting my bedroom windows should be added later the apron or outer garment worn by the nurse who high, that I get well i^uickly." cleans the room. The great man was correct in his 3. Remove all blankets, mattresses, observations. Overeating lessens re- pillows, carpets, and other unwashable sistance for a brief period while the materials and expose them as thoroughly as possible to the warm sun for abused stomach is trying to digest the at least two days. overload of garbage; and this abuse 4. The floor of the sick room or rooms of the body being followed by the sec- should now be thoroughly scrubbed ond abuse of not giving it air, with soap and water, or, if the floor is enough an oiled floor, revarnished or oiled. runs resistance down so low that the 5. After cleaning the floor, take a cold microbes, which are everywhere, cloth, wet it in the solution of carbolic get in their work. acid in the strength of a tablespoonful cf the acid to a pint of water, and wipe The sure remedy against colds is to down all woodwork, including mantel- eat moderately and breathe plenty of piece, wainscoting, furniture, and pure air. Of course, the skin, kid- floors. 6. The room, where living conditions neys and bowels must act correctly, will permit, should be kept open and for if they do not this, too, will re- well aired for two days before occupy- duce resistance and let the cold mic- ing again. Where the house is a one- robes grow in the other room or two-room house and the living nose and air space will not permit these precautions passages. to be carried out in full, the cleaning Every man is the architect of his should be done as thoroughly as cir- own colds. Bronchitis, pleurisy, pneu- cumstances will allow. monia, and tuberculosis are routes to early death, and they trail after colds. "A deal of health progress is blocked —Indiana Health Bulletin. because some men have their wish- bones where their backbones ought to Do not neglect the teeth during be." illness. a

Edited by Dr. B. E. Washburn

THE QUANTITY OF FOOD RE- or bulk and not by its fuel value. Some QUIRED BY THE BODY foods contain many calories of food- fuel value in a given bulk (i. e., are In discussing food requirements it concentrated), while others are bulky simplifies many complex questions to and contain but few calories in a given compare the body to a machine— bulk. An ounce of olive oil contains boiler and engine. The comparison is more calories (more food-fuel) than lettuce, justifiable and is a good one, for food three pounds of tomatoes, Olive oil is actually burned in the body by the string beans, or watermelon. aid of the air we breathe just as coal is a concentrated food while most vege- is burned in the boiler by the aid of tables are bulky foods. the air. The human body, in order to The quantity of food required varies perform physical and mental work, ex- with different individuals, and may pends heat and other energy, and it is vary in the same individual, depending food which supplies the material for upon his periods of work and rest and the generation of this heat. The body, upon the kind of work he does. An in addition to the work it does, must indoor worker needs only about half be kept at an almost constant tempera- the calories of food that is necessary ture, which is ordinarily above that of for an outdoor laborer. A farmer needs its surroundings. And, also, the body about one-third more fuel than the in- must constantly renew the varied ele- door clerk. The average woman takes ments (tissues) of which it is com- little exercise and needs about one- posed just as a machine must have third less fuel than the average man. worn and broken parts replaced by new Children need more calories in propor- ones. Food and air furnish the crude tion to their size and age than an adult. products for work, heat, and repair in Girls and boys of fourteen to seven- the body and in the machine. teen need as much or more than full- The diet must contain the essential grown adults. People vary in their fuel food elements so combined as to be needs just as different types of engines available for use by the body, either vary in their fuel needs. directly or after action by the body The ordinary male indoor worker secretions and tissues. The food prob- needs about 2,500 calories of food-fuel lem is to know the proper constituents per day. The larger the person or the of necessary food and how they should more muscular the work he does, the be combined in the daily ration, and more food he will require. Before de- to know the proper number of heat scribing individual body needs we will units necessary to maintain each in- consider how much it takes of some of dividual under given requirements. the common foods to make a given The food constituents and their rela- amount of food value—say, 100 calories. tion to th-e body needs were discussed In many cases the ordinary amount of in the October Bulletin. The present food served in our homes happens to article will consider the quantity of contain about 100 calories. The follow- each kind of food used by the body. ing list is from "How to Live," by The majority of the food we eat is Fisher and Fisk. "We find 100 calories used as body-fuel. For this reason food in a small lamb chop (weighing about (about 2 is measured in fuel-units, which are an ounce) ; in a large egg side-dish of baked called calories. Many people eat too ounces) ; in a small cubic much, while a few do not eat enough. beans (about 3 ounces) ; in IV2 in Mistakes of diet are often made by a inches of cheese (about an ounce) ; corn person measuring his food by its weight an ordinary side-dish of sweet ; ;

The Health Bulletin 35

(about 31/2 ounces); in one large-sized There is not enough food in Europe, potato (if baked, about 3 ounces; if yet the soldiers of the Allies must be boiled, about 4 ounces) ; in an ordi- maintained in full strength; their nary thick slice of bread (about l^/o wives and children at home must not the neutrals ounces) ; in one shredded wheat bis- face famine; friendly must finally, cuit (about an ounce) ; in a very large not be starved; and, our own lack dish of oatmeal (about 6 ounces) ; in a army in France must never a small piece of sponge-cake (about an needed ounce of food. is just one in all ounce) ; in a third of an ordinary piece There way which met. of pie (about 1% ounces) ; in three these requirements can be North teaspoonfuls of sugar (about 1 ounce) America must furnish the food. And in a dozen peanuts (about % of an we must furnish it from our savings ounce); in eight pecans (about % an because we have already sent our ounce) in four prunes (about 1 normal surplus. ounce) in a large banana (about 4 The available supply of food is less ounces) in half a cantaloupe (about 9 than ever before. Many million men ounces) in seven olives (about 1% have changed from sedentary workers ounces) in a very large orange (about to soldiers, and soldiers need more food. of are doing harder 10 ounces) ; in an ordinary pat of but- Millions women food. very ter (about y<^ an ounce) ; in a quarter of work and need more The are engaged a glass of cream (about 2 ounces) ; in fact that these people now a small glass of milk (about 5 ounces). largely in manual pursuits decreases "One reason why many people eat production and makes greater the need great quantities of food without realiz- of importing food. ing it, is the common delusion that Food is wasted if it is eaten when it many articles such as candy, fruits, is not needed as well as when it Is nuts, peanuts, and popcorn often eaten thrawn away. between meals, "do not count." An- Conservation is a moral issue. It is other common oversight is to overlook intemperance to waste food. accessories, such as butter and cream, Conservation means national saving which may contain more actual food of all resources. value than all the rest of a meal put If this democracy has not reached together. Ice-cream and other desserts such a stage of development that it has also have more food value than is usu- in its people the self-denial, voluntary ally realized. Nature counts every self-denial, willingness to sacrifice, to calory very carefully. If the number protect its own institutions and those of calories taken in exceeds the number of Europe from which our own were used by the body (or excreted unused), bred, then it deserves to go down and the excess accumulates in fat or tissue. take another form of civilization. Thus, if some 3,000 calories are taken We hold it in our power, and ours in each day and the calories used up or alone, to keep the wolf from the door excreted are only 2,800, then 200 must of the world. This duty is wider than be retained and accumulated in the war—it is as wide as our humanity. body." FIRST AID MEDICINE FOOD CONSERVATION IS A MORAL DUTY First Aid for Injuries First aid treatment of the common (From "The Day's Food in War and injuries is not nearly so difiicult as is Peace," issued by the United States sometimes supposed. One fact must al- Food Administration.) ways be remembered, however: any in- Our problem is to feed the Allies and jury in which the skin is pierced our own soldiers abroad by sending through, or, in other words, in which them as much food as we can of the there is a hole in the skin (slight

most concentrated nutritive value in scrapes and scratches may . be disre- the least shipping space. These foods garded), has the additional danger of are wheat, beef, pork, sugar, and fats. surgical infection and blood poisoning. Our solution is to eat less of these Whatever else we do, we must always and as little of all foods as will sup- try to prevent this. port health and strength. All saving Prevention of infection was first counts for victory. known some years after our Civil War, The situation has become critical. but since that time it has resulted in 36 The Health Bulletin

the other hand, the charred or the saving of hundreds of thousands On cooked body tissues in themselves form of lives more than were lost in that wall through which germs cannot war and all later wars down to the a lesson to be learned from present time. pass. The and scalds it The most important things to know this is that with burns aid is not necessary to take the very great in order to be able to render first in- care against the entrance of germs that service in cases of accidents and essential in a wound. All burns juries are the facts about shock and is which are very deep, covering a good its treatment. which shock is Shock deal of surface, or in severe, require the services of a phy- Every injury, except the most slight, sician. shock. In all burns your object will be to is accompanied by what is called protection from the When the ends of the nerves receive a stop the pain by paste made blow they carry the jar to the very deli- air. Good remedies are a called soda and water, carbolized cate brain, and the effect there is of baking grease like lard even shock. Perhaps some time you have vaseline, or any — You one of these substances on hit your finger with a hammer. cream. Put sit part, cover with a piece of feel very sick for a moment and the burned in place. down. A clammy sweat breaks out; cloth, and bandage or tie be used for the you are too weak to get up, and you Surgical gauze may necessary. Treat hardly know what is going on around cloth, but this is not you. This is shock. It is more marked shock. strong acids or alkalis, in a severe injury. Shocked people In burns from quickly as possible. For are often unconscious; they do not wash off as with baking soda in know or care what is happening around acids, neutralize soapsuds; for alkalis, use them; they lie prostrate and cold, with water or Afterwards weak pulse and shallow breathing. This vinegar or lemon juice. may grow worse and cause death. The treat like other burns. forget point is, that you must never that in any injury shock is likely to be present and must be treated. The treatment is to stimulate the body in every SUGGESTIONS FOR THE CARE OF way. Lay the patient flat on his back, THE TEETH so that the heart can easily pump blood into the brain. Cover warmly, placing When you get up in the morning or bricks around the body, hot bottles and just before going to bed at night if procurable. Be careful to have them brush your teeth with lukewarm water covered so that they will not cause burns. Rub both arms and legs toward and a good dental cream or powder. the body, but do not remove the cover- Your dentist can tell you of one hav- soon as a shocked ings to do so. As ing a pleasant taste that will make person can swallow, give him a half- teeth clean and leave your mouth teaspoonful of aromatic spirits of am- your monia in half a glass of water, then hot cool and sweet. tea or coffee. Keep the patient warm Do not brush the teeth straight recovery is com- and well covered until across. The outside of the upper teeth plete. Always send for a doctor unless should be brushed downward from the shock is very slight. Except in cases Clean of injuries accompanied by severe gums; the lower teeth upward. bleeding, shock should always be re- the inside of your teeth—next to your treated before the in- lieved or at least tongue—in the same way. The part jury is treated. of the teeth used for chewing food Burns and Scalds (the grinding surfaces) should be brushed in all directions. Burns are caused by dry heat and the dentist at least once every scalds by moist heat. With both, the Go to injury may be very shallow, skin-deep six months. Have him remove stains, bone. only, or very deep, down to the and fill cavities so that decay can no severe. Shock is often longer continue. The dentist's work Treatment.—Of course, when the skin will not hurt you so much if you go is burned through, the protection that it gives the body against germs is lost. twice a year. Edited by Dr. L. B. McBrayeb

THE TUBEECULOUS SOLDIER AND board or his advisory board on account THE REJECT of tuberculosis. Nor do the instructions to the local chapters of the Ameri- Arrangements have been made with can Red Cross place upon them any the American Red Cross, through its official responsibility for the care of Division of Civilian Relief, Mr. Joseph this reject, but what the Home Service C. Logan, director, whereby the Home committee cannot do officially the good Service committees of local chapters men and women who compose the shall visit and look into the needs of Home Service committee can do, inde- every soldier from North Carolina who pendently of their official connection is discharged and returned home on with the Home Service committee of account of tuberculosis. This Home the American Red Cross, i. e., as citi- Service committee will endeavor to get zens of the town or community they the discharged tuberculous soldier to can perform their moral duty and se- enter a sanatorium for treatment, or cure treatment for the rejected man by if he has doubts as to whether he has (a) from his own funds, (b) donations tuberculosis or not, to go to the State from town council or county board of Sanatorium or some other expert phy- commissioners (see law in regard to sician for examination. They will en- same passed by 1915 General Assem- deavor to take such care as may be bly), donations from churches, fra- necessary of the tuberculous soldier's ternal organizations, woman's clubs, family during the absence of the sol- Red Cross seals, etc., etc. And they can dier at a sanatorium. The Home Serv- by their visit give to the rejected man ice committees receive their instruc- proper literature and teach him the im- tions direct from Mr. Logan. portant things necessary in order that When the Government has sufficient he may not kill the other members of hospital beds to take care of its tuber- his family with the disease. culous soldiers, it will do it in its own institutions, but at the present it is The Soldier's Tuberculous Wife using the State Sanatorium to the limit soldier, on furlough, possible with the crowded condition A home a recently brought his wife to the State that is chronic there, and private sanatoria at Black Mountain, Henderson- Sanatorium. He had just thirty hours ville, or Asheville. in which to join his command in a near-by State. A sensible doctor had The Rejects advised him to bring his wife on down without consulting the superintendent, When the Home Service committee saying to the soldier, "I know they re- has caught up with the work incident quire that formal application be made to the discharged tuberculous soldier, and that the accepted applicant wait they will visit all the men who have his turn to be admitted, but I also know been rejected by local boards or district that the management has a heart and advisory boards on account of tubercu- is imbued with the true spirit of pa- losis, and endeavor to impress upon triotism, so go on down without delay." them the importance of taking treat- On account of the always crowded con- ment in a sanatorium. As mentioned dition, this soldier's wife was allowed above, the United States Government to sleep on a reclining chair until a assumes full responsibility for the care vacant bed could be had, and the sol- and treatment of discharged tubercu- dier, a private, made over to her an lous soldiers, but it does not assume allotment of fifteen dollars per month any responsibility for the treatment of which the Government duplicated, and the man who is rejected by his local the local chapter of the American Red 38 The Health Bulletin

Cross in her and his home county will suitable work, or to apply to public or provide the clothing and incidentals private charities." she will need while here. The soldier It is made the official duty of the was advised to go on back and fight local chapter of the American Red for his country and was assured that Cross to look after the soldier's tuber- his wife would have the very best of culous wife or sister for many reasons, care. one of which is that a soldier who has It is the official duty of the local a wife back home ill with tuberculosis chapter of the American Red Cross to cannot make a good soldier unless he take care of such cases as above recited, knows that she is receiving proper as the following quotation from their care and treatment, and it would inter- instructions by H. D. Gibson, general fere with the morale of our army; and manager of the Red Cross, to all di- again it would not be common fairness vision directors proves: to our soldier to take him away from "Whenever an individual chapter his sick wife and send him across the feels unable or unwilling financially water to fight the battles of democracy, to undertake home service, you are au- unless we assure him that his wife will thorized to state to the chapter con- receive proper care and treatment. cerned that its funds should be used Hence, the instructions quoted above so far as needed for the welfare of the to the local Red Cross chapters. families of soldiers and sailors in that BUT the rejected tuberculous regis- community, even if the result must be trant and the rejected registrant's wife the curtailing of work along other are left to civilian agencies—state gov- lines. The only Red Cross funds avail- ernments, county governments, city able for home service are those of the governments, state boards of health, chapter itself, whereas the surplus city and county health agencies, and funds of all chapters can be used if the constructive minded people of our necessary for general relief supplies. State, our counties, our cities, our com- "It should be made definitely certain munities. So far as the State govern- that a chapter with funds, no matter ment and the State Board of Health how limited, should not neglect its are concerned, they are confronted with home service obligations, because to do the urgent need and insistent demand so will likely cause the families of sol- for more room at their sanatorium. diers and sailors there to suffer priva- AMERICA EXPECTS EVERY MAN tion or to oblige them to sacrifice AND WOMAN TO DO THEIR DUTY health by reason of overwork, or un- TODAY.

INFLUENZA AND WHAT YOU SHOULD KNOW ABOUT IT

How and Where Influenza is Spread How to Keep From Taking Influenza

1. By careless spitting, coughing, 1. Keep away from crowds, especially sneezing, and using the same drinking indoor gatherings. vessel or towel others have used. The 2. Avoid people who cough, sneeze, disease germs are carried in the spittle and spit without holding a handker- and in the little drops of secretion from chief over the nose and mouth. the nose and throat. 3. Do not use common drinking cups 2. In crowds and public gatherings, or towels, and keep away from the soda churches, schools, picture shows, busi- fountain that does not supply indi- ness houses, fairs, circuses, trains, or in vidual cups and sterilized spoons. any other places where people congre- 4. Keep the bowels open. Snuff vase- gate. Soda fountains are especially dan- line up the nose three times a day. gerous if they do not supply individual Gargle mouth and throat and rinse out sanitary cups and sterilized spoons. nose with warm salt water, using a —

The Health Bulletin 39 level teaspoonful of salt to a glass of What to Do After Recoyering From warm water. Sleep and eat regularly. an Attack of Inflaenza These are very important. 1. Influenza is a treacherous disease. 5. Keep in the open air and sunshine If one s fortunate enough to escape as much as practicable and have good pneumonia during or immediately fol- ventilation in the home and office. Sleep lowing the attack, the lungs and res- with your windows open. piratory system are frequently so in- develops. 6. Wash your hands before eating, flamed that tuberculosis The and never put your unwashed hands in heart is overworked and needs rest. return to work or your mouth. Therefore, do not leave home until you have regained 7. Do not give the disease to others your strength, whether it is a week or when you sneeze or cough alwaj's bow a month. the head and cover both nose and 2. If complete recovery does not take mouth with handkerchief. place within two weeks, have your family physician carefully and thoroughly examine every vital organ and of Influenza, and to Symptoms What function of the body. Follow instruc- Do if Ton Take It tions the doctor may give you after such an examination. 1. In most cases a person taken with influenza feels sick rather suddenly. He What to Do After the Epidemic is feels weak, has pains in the eyes, ears, Over head or back, and may be sore all over.

Many patients feel dizzy, some vomit. 1. Secure the cooperation of your Most of the patients complain of feel- neighbors in petitioning your County ing chilly, and with this comes a fever Board of Health to establish a full- in which the temperature rises to 100 time health department in the county degrees to 104 degrees. In most cases to organize the people and teach disease prevention. Every one who has the pulse remains relatively slow. had influenza knows that prevention In appearance one is struck by the is better than cure. fact that the patient looks sick. His 2. If you live in a town, in addition eyes and the inner side of his eyelids to the above, see that your mayor and may be slightly bloodshot or congested. board of aldermen require soda foun- There may be running fiom the nose, tains to use nothing but individual and there may be some cough. These drinking cups, saucers, and sterilized signs of a cold may not be marked; spoons. Also, that moving picture nevertheless the patient looks and feels shows have thorough ventilation. very sick. A Last Word 2. If you have any of the above symptoms, go to bed at once and send for a 1. Do not become unduly alarmed doctor and follow his directions ex- during the epidemic—use judgment plicitly. and common sense. 2. Be sure and help those who cannot 3. If you cannot obtain a doctor at help themselves. If precautions are once, stay in bed with plenty of cover taken, it is not dangerous to care for to keep you warm, open all the win- the sick. During an influenza epi- dows and keep them open, take medi- demic the dangerous fellow is not the cine to open the bowels freely, and take sick-in-bed, but the one who goes about nourishing food, as milk, eggs, and coughing, sneezing, and spitting in a broth, every four hours. careless manner. 3. Influenza and La Grippe are the 4. Allow no one else to sleep in the same disease. same room. Protect others by sneez- 4. There are no vaccines or serums ing and coughing into cloths which can for influenza. be boiled or burned. 5. Don't waste your money on patent 5. Stay in bed until a doctor tells you medicines—they are dangerous. it is or, safe to get up; until you have 6. DON'T GIVE INFLUENZA TO been without fever for at least four OTHERS AND DO NOT LET OTHERS days. GITE IT TO TOU. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH M.D., J. Howell. Way, M.D., Pres., Waynesville Chas. O'H. Laughinqhouse, Richard H. Lewis, M.D., LL.D., Raleigh Greenville Edward J. Wood, M.D., . . Wilmington J. L. Ludlow, C.E., . . Winston-Salem Jacksonville Thomas E. Anderson, M.D., Statesville Cyrus Thompson, M.D., . . F. R. Harris, M.D., . . . Henderson E. C. Register, M.D., . . . Charlotte Official Staff and State Health Officer. W. S. Rankin, M.D., Secretary of the State Board of Health 0. A. Shore, M.D., Director of the State Laboratorj' of Hygiene. Warren H. Booker, C.E., Chief of the Bureau of Engineering and Education. L. B. McBrayer, M.D., Superintendent of the State Sanatorium. J. R. Gordon, M.D., Deputy State Registrar. G. M. Cooper, M.D., Chief of the Bureau of Medical Inspection of Schools. A. MoR. Crouch, M.D., Epidemiologist. B. E. Washburn, M.D., Director of County Health Work.

FREE PUBLIC HEALTH LITERATURE for The State Board of Health has a limited quantity of literature on health subjects or want free distribution. If you are interested in one or more of the following subjects, par- same sent to a friend, write to the State Board of Health for free literature on that ticular subject. Whooping-cough Clean-up Placards Malaria Hookworm Disease Spitting Placards Smallpox Public Health Laws Sanitary Privies Adenoids Tuberculosis Laws Residenial Sewage Measles Tuberculosis Disposal Plants German Measles Scarlet Fever Eyes Typhoid Fever Infantile Paralysis Flies Diphtheria Care of the Baby Colds Pellagra Fly Placards Teeth Constipation Typhoid Placards Cancer Indigestion Tuberculosis Placards SEX HYGIENE BULLETINS Set a—For Young Men Set D—For Parents A Reasonable Sex Life for Men. When and How to Tell the Children. Sexual Hygiene for Young Men. Venereal Diseases—A Sociologic Study. Vigorous Manhood. The Need for Sex Education. Smash the Line. (The case against the List of Reliable Pamphlets. restricted district.) Set E—For Girls and Young Women List of Reliable Pamphlets. Your Country Needs You. (Especially for Set B—For Public Officials and girls 11 years of age and over.) Business Men Note.— For girls under 11, see Public Health Measures in Relation to "When and How to Tell the Children" "Your Country Venereal Diseases. (Set D) ; portions of Venereal Diseases—A Sociological Study. Needs You" also may be read to younger Smash the Line. (The case against the girls. Girls 15 and over may be given restricted district.) "The Nation's Call to Young Women," The Need for Sex Education. at the discretion of the parent. A State-wide Program for Sex Education. The Nation's Call to Y'oung Women. List of Reliable Pamphlets. List of Reliable Pamphlets. Set C—For Boys Set F—For Teachers Vigorous Manhood. (Especially for boys The School Teacher and Sex Education. 12 years of age and over.) Sex Education in the Home and High Note.— For bovs under 12, see School. "When and How to Tell the Children" Venereal Diseases—A Sociologic Study. of "Vigorous Man- Smash the Line. (Set D) ; portions hood" also may be read to younger The Need for Sex Education. boys. Boys 15 years and over may be given Bulletin "A Reasonable Sex Life for Men" (see Set A), at the discretion of the parent. Sexual Hygiene for Young Men. List of Reliable Pamphlets. for Any of the above will be sent without charj :e. Please send for only those bulletins which vou have definite use. PuM5\edbH T/1E.JNI9RJ/1 CAS9LIA^A STATE. B

j Thi5 BulleliAwillbe 5eAl free to aryg citizgn of fhe State upoArequestl

Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, lS9Jf. Published monthly _ at the office of the Secretary of the Board, Raleigh, N. c'

\\A. iCEMBER, 1918 No. 6

<-;vk^^^^^ THE GOAL OF THE RED CROSS CHRISTMAS ROLL CALL LARGE MEMBERSHIP MEANS MORE TPIAN MONEY The aim and underlying purpose of tins campaign is to recruit under the banner of the Red Cross .every loyal American, no matter where he or she may live. The object of the BED CROSS CHRISTMAS ROLL CALL is to register in terms of active participation the spirit of a nation. The .'pirit in question is personified in Red Cross membership.

THE DATE—DECEMBER 16-23

Tlie week of December 16-23 has been set for the RED CROSS CHRISTMAS ROLL CALL. It seems peculiarly appropriate to have '.his ROLL CALL during the second Christmas season of the United States in the war—it should serve as a fitting climax to such an eventful twelve months. THE KEYNOTE

Universal Membership has been chosen as the keynote of the RED rUOSS CHRISTMAS ROLL CALL. This thought was expressed by I'rrsident Wilson when, on the occasion of his address last.^iay he said: -i summon you to the comradeship." In this appeal the President of 'c Red Cross, himself, has sounded the clarion call to every good Aii.erican to enroll as a member of the American Red Cross. The important thing for the reader to do is to see the Chairman of the.

' '.iiapaign Committee of his Local Chapter,^ become enrolled himself,

• 'ii volunteer ' his services for the week's campaign. ' : ! i$m^ mmisM PUBLI5AE:D SYTAL nOR.TA CAgQLiriA 5TATL BOA^D v^MEALTM I

Vol. xxxifi DECEMBER, 1918 No. 6

EDITORIAL

LIBRARIES AND PRIVIES and at only three schoolhouses was there a priv}/ of any description for See if you can recognize the county either sex ! The sorriest showing made which should be most concerned about by any county visited from Washington this little story. You will never know to Polk, or from Brunswick to Mitchell the man who made the remark which Whereupon another member of the con- caused it to be printed, so don't try to ference remarked with a great deal of guess; you might injure an innocent feeling, "Yes, but you found libraries." friend of the cause. This from a noted educator graphically It all happened in this way : The describes the mightiest obstacle to pub- writer was asked recently to take part lic health progress in North Carolina. in a little conferencie. The work of one Sixty libraries full of the records of or more public men in each county in Heroes of Ancient Mythology, and three the State was up for discussion. When privies, representing the most elemental the name of a certain county was men- step in the advance from savagery to tioned, a big rich county, whose school civilization. From the standpoint of system is well known in the State, the culture and refinement, to .say nothing chairman of the meeting suggested that of the dissemination of typhoid fever, the name of one of the school officials tuberculosis, hookworm, etc., had you of this county be passed over and an- ever pictured the spectacle of your other man be asked to perform the duty young lady teacher at the Bearskin in question. Pressed for a reason, the Creek High School having to lay down chairman stated that the school official her copy of "Evangeline" and wander was a supporter of the patent medicine around in the rain for half a mile interests. The writer concurred in the seeking a gallberry bush or a high rock chairman's observation for the follow- in order to answer a call of Nature. ing reason That is exactly the state of affairs in From April 15th to September 20th he more than 75 per cent of the public has visited twenty-eight Teachers' Insti- schools in North Carolina outside the tutes, representing thirty-seven coun- towns and villages. ties. At each meeting of teachers a not improve until our "hand primary" was held and a vote Conditions will and school patrons develop a taken on the question of "How many leaders "privy sense" along with a "library teachers taught the past year in a sense." school provided with a privy, either let us continue to build sanitary or otherwise, for both sexes"; By all means libraries until every school, of sixty teachers present at the insti- and equip large, in the State is the tute held in the county referred to small and of a good one. But for the above, all had taught in the county, possessor — —

The Health Bulletin 43

safety, let's :,,> of consistency and to the National Tuberculosis Associa- kc it two to one, "Two sanitary tion .$2,500,000, and the National Asso-

.-ts to one library" in every school. ciation w^ould make appropriations to teacher which she would .: vour lady State Associations, which in tuni would being first provided. make appropriations to State Associa- , iVr G. M. C. tions, which in turn would make appropriations to local associations. It was also decided that the Red Cross would KED CROSS CHRISTMAS ROLL CALL present to each new member and re- newal a packet containing 10 Red Cross As announced in the last Bulletix, Seals and a folder on the prevention re will be no Red Cross Seal sale of tuberculosis. organizations, s year. But. all our Now, let all Red Cross Seal workers, will join with the Red .U' and local, all persons interested in the fight universal enrollment of ...ss in its against tuberculosis,' all persons who arrange- ..iiibers in our state. A like are interested in seeing our boys "over state. , in every other lit exists there" have the attention that no or- recognizes riio American Red Cross ganization but the American Red Cross

• the fight against iinportJince of can give, all who are interested in emphatic way ..irulosis in the most seeing relief extended, in the rehabili- -ihlo, that is, by using its funds by tation of the European countries after • millions in France and other Euro- the war as no other organization can countries. It recognizes the im- .:n extend it, come up and pay your dollar rlaiioe of the Red Cross Seal Cam- and enroll as a member of the American fostered from its ,l-'ii which it has Red Cross and make this Christmas present time. .•l»ti(in to the enrollment universal in fact. -See the recognizes im- ( uir Government the campaign chairman of your chapter and .-::uK-e of the fight against tubercu- volunteer your services—also volunteer taking more care to ex- ;<. (a) by your dollar and be enrolled. Get the .li> uiborculosis men from the army idea Universal Enrollment. in world has .!i :iiiy other nation the L. B. McB.

;• . lic'iio; (b) by providing for all, in

• way or another, who are found A NEW NECESSITY FOR FOOD . .u-d with tuberculasis, having spent CONSERVATION '..aiis more than two million dollars

. .'ur own state in providing sanatoria The great Allied successes in France

; .- tlk'h- treatment. and Belgium will make it necessary for

I'lir (Jovernment also recognizes the the United States to supply a greater \tuw of the Red Cross Seal in the amount of food to Europe during the

!i.-ht :i?;ainst tuberculosis, but it was iiresent winter than ever before. Many

i,.it ilumght wise to have too many thousands of people have been rescued

.; ii>ai:,'iis, so after consultation be- from German bondage and these must

o'u (illicials of the National Tuber- be fed. Then, too, our army which has

. >is .Association, the American Red given the great Foch reserves and made

• -s and our Government at Wash- such brilliant successes possible has

~:i':i, including President Wilson, it more than two million men in France. > tli'oidcd to combine the Red Cross And these soldiers must be well fed d Campaign with the Red Cross in fact, they must have the best of ..ristmas Roll—December 15th to 25th everything it is possible to send them.

• .'I ml it was further decided that the In order to utilize shipping space to \:...;ican Red Cross would appropriate the best possible advantage we must '

44 The .Health Bulletin send concentrated food, especially greater and his interest in money slightly less, he would have sold you wheat and protein foods. To provide / 5,000 units of antitoxin every whit as/ for such an army and such this food effective as what he sold you—antitoxin/ a large civilian population, it is neces- the efficiency and strength of which! sary that we at home conserve as we was vouched for by both the State and\ Departments of Health for have never done before. In the past Federal — $1.95, and of this amount he would used too much protein food wo have have been allowed to retain 49 cents as for our good ; and at present we can a fair profit. The poor fellow just conserve and be patriotic and at the could not afford to lose the other §2.71. same time benefit our health. The It was too easy. You must not conclude that the drug- article on diet in the Personal Hygiene gist from whom you bought this ami- of the Section explains the details toxin is a represent;itive druggist. He problem. ^ B. E. W. is an exception. The druggists as a class are public-spirited, recognizing readily and discharging gladly those PROFITEERING IN VITAL responsibilities and duties relating to NECESSITIES public health that rest peculiarly upon druggists. To see that the public have or reliable diphtheria antitoxin within OVERCHARGING FOR ANTITOXIN easy financial reach of all, rich and poor alike, is one of their professional The following correspondence be- responsibilities that the majority of State tween certain parties and the druggists gladly admit. Board of Health with respect to the If the chairman of your board of price of diphtheria antitoxin is possi- county commissioners, who is also the chairman of your county board of bly of general interest and may assist health, was as alert to the public health diphtheria antitoxin more in making interests of the county as he ought to readily available: be, and as his official responsibilities demand that he should be, you would Secretary of Xorth Carolina State have gotten your antitoxin for 25 cents Board of Health. and would have saved $7.75. The Dear Sik:—I am writing in regard chairman of your board of county com- to price of antitoxin, ily six-year-old missioners is the dominant influence on daughter had diphtheria. We are in your county board of health. Your quarantine. In reading Bulletin No. county board of health selects the 107. I saw price of the u.OOO unit was county physician and county quarantine $1.9.5. I had to give eight dollars for officer. It is the duty of the county 5.000 units at our nearest drug store. physician and county quarantine officer Yanceyville, N. C. I want to know if to see that the state antitoxin, which there is any law to do anything with a is available to the public at 25 cents druggist for selling it at this price. per package regardless of the size of If there is anything I can do, please the package (the charge of 25 cents write me at once. being made to cover the wrapper, the Respectfully, boxing, and the syringe in which the antitoxin is contained), is (1) placed in suitable, convenient depositories in My de.\r Madam : —Your recent letter the county, and (2) that the people of is one that interests me very much, the county are made aware of the and but for- the unusual pressure of facilities for securing this antitoxin. work incident to the eiudemic, would If the county physician is as interested have received an immediate reply. in looking after the people's health as You paid the druggist .?S for a pack- he should be. he will find ways and age of 5,000 units of diphtheria anti- means for transforming his interest toxin. That $S was divided between into practical uses. But do not blame the manufacturer and the druggist, the the county physician if this is not done. manufacturer receiving 60 per cent, or You cannot vote for or against the

ifri.SO, and the druggist receiving 40 county physician ; he does not hold an

per cent, or $.3.20. If the interest of elective office ; he is appointed bj^ the the druggist in people was slightly county board of health. On the other The Health Bulletin 45

/ hand, 3'ou do vote for the chairman of enclosing a copy of this letter as a of your board of county commissioners j supplementary reply to yours. (who is the chairman of your county Very truly yours, of health) board ; you can hold him W. S. Rankin, Secretary. ^ responsible at the polls. Very truly yours, TUBERCULOSIS W. S. Rankin, COMMISSION TO ITALY FINANCED BY THE T^ Ttr o -o Secretary. Dr. W. S. Raxkix. AxMERICAN RED CROSS Raleigh, X. C. At the request of the Italian Govern- Peak Doctor:—I am sending here- ment, a commission on tuberculosis with a wrapper from a package of under the American Red Cross, is being antitoxin, and would lilve to know if sent to Italy to undertake work in cor^ the dealers have a right to sell this nection with the various Italian organi- product at a price higher than that zations in the field of prevention placed by the of manufacturers. tuberculosis for educational, The manufacturers' dispensary price and that and sanatorium methods. of one of our dealers are both on the Dr. Wm. Charles White, of Pitts- wrapper. It seems to me that it is a burgh, is director of this commission- case of proiu^ering, which should be Dr. R. H. Bickett, Jr., of Cleveland, is looked into if there is any way to get assistant director. Miss Mary S. Gard- at these fellows. ner, of Providence, R. I., goes with the Will you please give me your opinion commission in charge of the various of the matter, and greatly oblige nursing problems presented by the Yours very truly, eme gencies of the country at war Miss Foley, of Chicago, may later go as Dear Doctob:—Your letter of Octo- assistant chief to Miss Gardner. ber 31st. with the enclosed wrapper It is understood that the American Red of a 5,000 unit package of diphtheria Cross has appropriated a million two .hundred antitoxin from the Biological Labora- thousand dollars as a first appropriation tories of Parke, Davis & Company, is for this tuberculosis work in received. I note that on the package Italy. the manufacturer fixes and prints the retail price at 92. I also note on the TUBERCULOSIS VERSUS WAR opposite side of the package the re- Dr. Livingston Farrand, who has just tailer's price of $.3. If the retailer had returned to France to continue the sold this antitoxin for $2 he would fight against tuberculosis, made the have made a profit of 50 cents and statement that tuberculosis has killed roturued to the manufacturer $1.50. In as many people during the four years selling the package of antitoxin for $3 of war as have been killed in battle. 1..' made his legitimate profit of 50 cents Like the Germans, it is no respecter an additional profit of .?1, so that of persons—it kills the baby at the ^3 received was divided equally, mother's breast; it kills the mother '» each, between the druggist and with the baby at her breast. Dr. Far- manufacturer. rand says if the people of America \.

:. . moral right to capitalize ithe confi- would be assured and the cost in :.ec or the ignorance or the necessity money and in sacrifice would be infi- of ids customer by charging him such nitely less. a price for antitoxin. There is no Dr. Farrand is the head of the community in Xorth Carolina with a American Tuberculosis Commission to imblic conscience, with a public concep- France and has one million dollars at tion of right and wrong, so stunted or his disposal and as much more as he stupid as not to be as disagreeable, if can use. The Commission is financed I focused on this fellow, as is the sun- by the Rockefeller Foundation. Mr. lli^ht to a bat. Warren H. Booker, formerly Chief of I have dealt so fully _ with the cost the Bureau of Education and Engineer- lif antitoxin in a letter to another cor- ing, and Editor of this Bulletin, is tospondeut that I am taking the liberty with Dr. Farrand. pUnLIC KEALin AND S^^^MITATION

' " 7$ ) W

Edited by Dr. W. S. RANKIN SYPHILIS

(Also Called Lues and the Pox)

The Cause of Syphilis cent of all syphilis, the chancre mark- ing the site of infection appeai-s about Syphilis is caused by a small germ the mouth or in the mouth, demon- called the treponema pallidum or the strating infection by either (a) acts of spirochaeta pallida. The serm is not kissing, or (b) the use of a drinking of a vegetable nature as are most dis- glass or a dipper infected shortly be- ease germs, but of an animal nature. fore by the saliva of a syphilitic person. It is about 1-3000 of an inch in length Right'here it may be well to note that and is spiral shaped. a drinking glass or dipj^er has been The treponema or spirochaeta are shown to remain infectious thirty min- always present in the lesions or sores utes after being used by a syphilitic of syphilis, and are found nowhere person. The remainder of tlie ten per else in nature. If a discharge from cent of extra-genital syphilis, or about the sore or a part of the diseased flesh five per cent of all syphilis, is divided: is inoculated into a monkey, the disease (a) Cases of syphilis contracted bv is reproduced and the germ may be physicians and nurses in handling the recovered from the diseased parts of disease or in examining oy operatin;; the monkey. on persons with known or unknown The treponema dies rapidly when syphilis; (b) cases of syphilis con- dried, or when exposed to only slight tracted by wet nurses who nurse babies changes in temperature. In this respect with unsuspected inherited syphilis: it resembles the germ that causes (c) cases of syphilis contracted b.v gonorrhea, being restricted in its life being shaved by a barber whose razor cycle to conditions that are almost or brush becomes infected from a syph- limited to the human body. ilitic patron; (d) cases contracted by persons wlio are vaccinated with vac- Mode of Infection cine taken from the arm of a syphilitic the treponema requir- On account of person. As vaccine is now made of moisture, the germ of ing warmth and lymph from the calf instead of pus neither syphilis cannot be air borne, from the sore of some person's arm. be transmitted by can the infection syphilis is practically never conveyed unless the interval be- infected things, in this way. tween the contamination of the article and the transference of the infected Symptoms of Syphilis material to a susceptible person is very short. There is no disease that presents in The rule in syphilis, as in venereal its symptoms so many and such varied diseases generally, is infection by direct appearances as syphilis. This fact ha^ personal contact. Ninety per cent of been well expressed by some authority the initial sores in syphilis are genital on the science of disease in the sayin? in location, and as the initial sore al- that he who knows syphilis knows all ways occurs at the point of infection, pathology, meaning, of course, that the the evidence is absolute that nine out disease may resemble in its appearance of every ten cases of syphilis are con- any other disease. It may be so mild tracted through sexual intercourse. as to .go unsuspected throu.gh a louc There remains, therefore, about ten life, or unsuspected until some suddei: per cent of syphilis that is not genital. snap in the vital machinery—an aiw- Of this ten per cent of extra-genital plexy Or ruptured blood vessel—reveals syphilis, in half of it, or about hve per and terminates its work. On the other The Health Bulletin 47

h.iiul. it may come with all the acute Eruptions, perhaps the most charac- soverity and outbursts of symptoms teristic symptom of secondary syphilis, ihat mark the onset of a malignant usually follow clo.se upon the glandular ,Mse of smallpox. For these reasons it enlargement and the fever. Syphilitic will 1)0 best to describe a typical case eruptions, like the other symptoms of

,,f syphilis and then to call attention the disease, vary in profusion, in loca-

;,. the more important variations in the tion, and in form, but as a rule they I'lisease picture. In a typical case of occur upon the chest, the abdomen, the s.viihilis. running its natural course un- front of the arms, and the face, not livated or imperfectly treated, the infrequently appearing in the palms of symptoms of the disease are divided the hands and the sole of the feet. into three stages, the primary, the sec- The most characteristic eruption is ,,;;,l:iry, and the tertiary stages. made uj) of little round or oVal spots, The Primary Stage or Chancre.— reddish brown in color and without Within from fifteen to forty-two days, elevation—an eruption tliat may be ii

11:11 iy heals. syphilis, but about 30 per cent of all The Secoiularij Stage of Si/phiUs.— the work of the skin specialists has to Mr. Uiiig of the lymph glands or the for- do with syphilitic eruptions. :,,aiion of kernels in that portion of the Anemia, that is, paleness due to the l..,i!y nearest the chancre characterizes destruction of the red blood corpuscles

;!ii' beginning of tlie secondary stage. by the syphilitic poison, is associated

Ill u'fiiital chancre, the glands first in- with the al)ovo symptoms. The amount \oivcd are those of the groins. In of blood destruction, or anemia, varies .•\iia-genital chancre, those about the considerably in different cases. The :.,c.iirh or lips, the first glands to be- complexion of the syphilitic is muddy

...iiic enlarged are those in the neck. and pasty.

|"!n' enlargement of the lymph glands Mucous patches constitute one of the

.,. ,s not long remain localized or re- most characteristic symptoms of the -.iiicU'd. but rapidly extends to the secondary stage of syphilis. The mu- y;:,jih glands of the entire body. This cous patches are not only important as .irgement of the lymph glands (the a symptom of syphilis, but are far more

yiiii»li glands are the filter system of important as tlte infectious lesions of

;i.i' body) is coincident with and indi- syphilis. The mucous patches are small

• ati's the transition of the local syphil- wart-like, fiat-topped, grayish-white ele-

.'..r infection, the chancre, to a consti- vations occurring on the mucous mem-

; iticiiial disease or an infection of the brane of the lips, of the mouth and .;.;;ro body with the syphilitic germ. . tongue, and on moist or damp portions I'cvcr in variable amount, usually of the skin, especially the skin in the :aii:;iiig from one to two degrees, ac- genital regions. The germs of syphilis .uilianies the enlai'gement of the abound in all skin eruptions of the dis- yniiih glands. The fever of syphilis ease, but so long as the skin remains

::.:iy ho vory irregular, like tiiat which unbroken, the germs are not set free '•urs with late consumption or with and from such sores the disease can- 'l.'^i'l poisoning; it may be continuous not be contracted, but the moist mud-ous ..;ii hut slight interruption, rarely fall- patch with its sodden, oozing top per-

-• .syphilitic germ to pass out . III normal, like the fever that goes mits the

•. ;th typhoid; or, again, it may be re- upon the surface of the skin and from suscepti- •...iucnt, falling at regular periods to this infectious surface to any it comes in con- : -niiiil and then rising again, resemb- ble person with which

'.:.u' ill this way the fever that is asso- tact. in the ...U'd with malaria. Bone pains, usually occurring ;

48 The IIjealth Bulletin

shins, the colhir bones, and the fore- It may be located in the urethra or head, are, in many cases of syphilis, genital canal, and not visible. All of annoying symptoms. the symptoms that mark the typical JJye and ear affections, interfering secondary stage of syphilis may be so vei-y greatly with the function of these slight as not to be recognized. The special senses, are important markings gumma may be small, may be few in of the secondary stage of the disease. number, and may miss vital locations. The Ternary Stage.—After syphilis While, therefore, it is important to re- has lasted from eighteen months to two member the typical disease picture in and one-half years, the syphilitic is syphUis, it is equally important for one prone to suffer from gumma. The to remember the atypical, the unusual gumma is a small tumor varying in ways in which this disease makes its size from a pea to an egg, hard, gray- appearance. ish-white when opened. It may be Course of Syphilis located almost anywhere in the body. The symptoms resulting from gumma The course of syphilis depends ahao- or gummas (a person may have a num- lutely upon its treatment. On the one ber of gummas at the same time) de- hand, sj'philis may be quickly and com- pend naturally upon the location and pletely subdued and cured, and on the the size of the gumma. A gumma lo- other hand the disease may last from cated in the skin after it has developed five to ten or twenty years before the to some size may break down into a death of its victim, and in this time ragged, ugly, offensive ulcer. Located Involve friends, wife and children. The in the bones, particularly the bones of difference depends altogether on the the face, a gumma may produce marked promptness with which the syphilitic defoi-mities, as, for example, the de- applies for treatment and the faithful- struction of the bones of the nose or ness with which he carries it out.' We the bones of the hard palate, causing shall now describe the course of syphilis the falling in of the nose, or, where properly treated. with the palate is destroyed, interfering Syphilis Properly Treated.—Syphilis natural swallowing and with the voice. treated in the early primary stage, vital If the gumma is located in more shortlj' after the appearance of the organs, as in the heart, or brain, or chancre, and, therefore, before the spinal cord, the gravity of the disease germs invade the entire body, offers the is very great, and not infrequently golden opportunity in dealing with this death results. Along with the gumma disease. One hundred per cent of such of which marks the tertiary stage patients are curable. After the pri- to syphilis, the skin eruptions tend mary stage is passed, and after the character. become more ulcerative in secondary stage is begun, that is, after Atypical Syvhilis.—As we have al- the germs have invaded the entire sys- ready indicated, probably the most im- tem, possibly not more than 90 per cent portant thing for one to remember of the cases are curable. In the first about the a])pearance of syphilis is the six months of this disease, treatment extraordinary variation from the ordi- delayed days means cure delayed

nary course of the disease. A person months ; moreover, the longer the treat- may go through life and never know ment is delayed, the less the probability that he has syphilis, unless it is dis- of a complete cure. But treatment

covered by a blood test made in the must not only be given promptly ; it course of a general examination. An- must be given effectively and be per- other person with syphilis may come sistently carried out by the patient, down with all the acute symptoms of a otherwise the fact that the disease is case of smallpox and may even be sent curable does not mean that it will be to a smallpox hospital. Another case cured. of syphilis may resemble tuberculosis Here is the treatment of a person another, malaria; another, a brain tu- who, immediately after discovering the liver, mor ; another, a cancer of the chancre, went to a physician for treat-

and so on in accordance with the statement and was cured : The patient ap- ment made above that this disease may plied to a well known, reputable phy- resemble almost any other disease. The sician, not a druggist nor an advertis- initial lesion of syphilis, or the chancre, ing quack, within five days after ob- may be so slight or may be so located serving the chancre. The physician as not to be discovex'ed by the victim. made a microscopic examination of the The chance does not always ulcerate. secretion or the discharge from the : The Health Bulletin 49 sore nud found the serms of syphilis. treatment for eight weeks, when he He also took a specimon of the blood again reported to the physician for a and sent it to the laboratory of hygiene second course of treatment similar to for the Wasserman tost, that is, a test the first. After the second round, he for the presence of syphilis. The phy- was again allowed to rest ten or twelve sician was very painstaking; in his ex- weeks without treatment, when a third amination, explaining to the patient course of treatment was administered. that a diagnosis of no syphilis when Alter the thrc^o courses of treatment, syphilis might be present meant possi- six or eight Liood tests (Wasserman bly the loss of the opportunity to cure, reactions), taken at intervals of from and certainly longer treatment, greater three to six months apart, failed to inconvenience, and heavier expense; show any evidence of the disease, and whereas, the diagnosis of syphilis meant the physician pronounced the case a long course of treatment whicli, if cured. syphilis were not present, would be Syphilis Improperly Treated.—This unnecessary ; hence the thoroughness means either delayed treatment or in- of the physician's examination. terrupted treatment. On making a positive diagnosis of Delayed Treatment means the loss of syphilis, the physician gave the patient the golden opportunity for curing the three doses of salvarsan (arsphenamin) disease. It means failure to start the five days apart, and then five doses of treatment while the infection is re- salvarsan (arsphenamin) seven days stricted to the initial lesion, or chancre. apart. Tlie arsphenamin was injected It means waiting before taking the into the patient's vein, and while the treatment until the germs have broken operation was a matter of some little through the local barrier and distrib- surgical detail, it caused the patient but uted themselves throughout every nook little discomfort and inconvenience. and coi-ner of the body. Delayed treat- Tlie physician giving the salvarsan had ment means the sacrificing of the taken special training in the adminis- chances of a 100 per cent for, at most, tration of the drug. Right here it is a 90 per cent cure. The longer the necessary to say that the majority of delay in giving the treatment, the jiliysieians who attempt to treat syph- greater the uncertainty of cure. Not

ilis do not know how to use salvarsan onlj^ is there this uncertainty about a and cannot use it, and no person with complete cure, but the length of the syphilis should trust themselves to such treatment, and the inconvenience of the a physician for treatment. There is tx'eatment, and the cost of the treat- no authority in medicine tliat does not ment is multiplied many fold. hold that salvarsan in the treatment The causes of delayed treatment are of syphilis is an absolute essential. (1) The syphilitic is i.guorant of the Along with the salvarsan, the physi- meaning of prompt and efficient treat-

fian told the patient that it would be ment of this disease ; (2) he goes to the necessary for him to use inunctions of wrong man for treatment—to an ad- niorcurial ointment, and that, prefera- vertising cjuack, to some druggist who iily. the inunctions should be given by gives him some mercurial ointment and the physician himself, unless the pa- some pills, or to some doctor who does tient would take the necessary pains little more than the druggist, who is ;ind thoroughly rub in the ointment, not familiar with the modern treat- i'he physician also stated to the patient ment of the disease and does not use that he could use instead of the mer- salvarsan; (3) as in gonorrhea, the eiirial ointment, if it was more con- victim of syphilis hesitates to confide in venient to the patient, a hypodermic some reliable, trustworthy physician I'f mercury, one injection a week for the fact of his infection, and, for tem- eiuht weeks. On inquiry, the patient porary secrecy, throws away the op- was told that no preparation of mer- portunity of permanent cure; (4) the eury taken by the mouth would cure syphilitic does not himself know that syiihilis; that the most that could be he is infected with syphilis, either not expected of mercury given by the knowing the appearance or meaning of iiioulh was a relief or suppression of a chancre, or, possibly, where the chan- the symptoms of the disease, and not cre is* small and located in the urethra, a cure. not i-ecognizing the mark of the disease. .\fter the above treatment, which Interrupted Treatment is responsible lasted for eight or nine weeks, the for the statement of one of the authori- patient was allowed to go without ties on syphilis to the effect that "al- 50 The Health Bulletin most half of all sypliilitics eventually even decades, with outcroppings of succumb as a result of their infection." symptoms followed by another resort tc-

The two principal causes for inter- incomplete treatment ; then, again, the rupted treatment are, in the !• ;or of disease clears up and withdraws itself their importance, (1) i.ijnorance of the into the vitals away from the observa- true nature of the disease, and (2) real tion and the senses of its victims, only or supposed lack of funds. Patients to reappear and withdraw again and with interrupted treatment fail to dis- again as the patient alternately forgets tin.ijuish between symi^toms and dis- and recalls his treatment. Some of ea.se; they think that disap])earance of these people, years alter the chancre, symptoms means disappearance of the are found with aneurysms of the ar- disease; they take treatment until all teries, particularly of the large trunk the evidences or symptoms of the dis- artery leaving the heart, which has ease have disai)peared, and perhajis resulted from damage to the ve.ssol have been absent for sometime, then, walls by the .syphilitic germ. Aloni,' contrary to the advice of all authorities with the dilatation or tumors of the and to the urging of their physician vessels, which tend to become larger (if they have the right kind of physi- and larger until rupture and dentli, cian), they fail to come back for regu- there is usually a degeneration of the lar treatment and observation. arteries in different parts of the body, Concerning this incomplete treatment resulting in arterio-sclerosis or hi.i;h with the disappearance of symptoms. blood pressure. According to the fig-

Doctor Stokes, one of the great author- ures recently given by i )octor Osier, " ten out of twelve aneuiisms are ities on syphilis, says : . . . symp- syph- tomatic methods whisk the outward ilitic, and three out of every ten cases evidences temporarily out of sight, cre- of arterio-sclerosis are syphilitic. Doc- ate a false sense of security, and leave tor Osier also gives figures indicating the disease to proceed quietly below that 1-11 of the organic diseases of the the surface, to the undoing of its vic- heart (valvular diseases) have their tim. Such patients get an entirely cause in incompletely treated syphilis. false idea of their condition, and may Another person who has not faithfully refuse to believe that they are not followed his treatment finds, after ten really cured, or may have no occasion or hfteen years, or even later, that ho to wonder whether they are or not until is gradually developing locomotor they are beyond help. Every statement ataxia. From one to three per cent of that can be made about the danger of syphilitics develop this disease. The syphilis to the public health applies best medical opinion holds that practi- with full force to the symptomatically cally all locomotor ataxia is syphilitic treated early case. Trifling relapses, in origin. Still another syphilitic, who highly contagious sores in the mouth, has not persisted in his treatment, or elsewhere, are not prevented by sooner or later, perhaps years after his symptomatic treatment and pass un- initial lesion, at a time, perhaps, when noticed the more readily because the he has forgotten or at a time when his patient feels himself secure in what family is maturing, begins to act queer, has been dune for him. In the lirst makes foolish investments, loses his Ave years of an inefficiently treated in- fortune, and a few months later is fection, and sometimes longer, this dan- pronounced to have a form of insanity ger is a very near and terrible one, to known as general paresis. Practically which thousands fall victims every every case of general paresis has a year, and among them, perhaps, some sj'philitic origin, and not less than ton of your friends and mine. Dangerous per cent of all insanity is of this type. syphilis is i-rfectly treated syphilis, One realizes the importance of general and at .'i:..' i-.ent it may confront us paresis as an economic problem on in our drawi;,g rooms, in the swimming reflecting on the expenditure of .?5T0,- 000 a year by the State of North Caro- pool, across the counter of the store, or [ in the milkman, the waitress, the bar- Una for the treatment of her insane ' ber. It confronts thousands of wives in three State institutions. If 1-10 of this ai. 1 children in the person of half-cured insanity is traceable to syphilis, fathers, infected nurse-maids, and oth- the di-sease costs North Carolina in this ers intimately associated with their one item alone (and all of our insanity personal life." is not in our asylums) $57,000 a year. Persons with incomplete treatment go Still others develop complications due along through a course of years, or to gummas, that is, the lumor-like '

The Health Bulletin 51

•Towths which ch:\racterize the third per cent, are living but syphilitic ; and syphilis. re- sta.i^e of The symptoms 33, or 10 per cent are living and free from the gumma or gummas de- sulting of syphilis. So that we may say that pend upon the location of the gumma in this series only 10 per cent escaped and its size. Gummas located in the brain, or the spinal cord, or the heart, infection." The experience quoted is produce rapid and grave symptoms, in line with the experience of others whereas those located in the skin, or generally. Thus we see that in syphilis the muscles, or the hone, or the liver, race produce symptoms that are not so deterioration and race suicide find grave. one of their most important factors. Another, and perliaps tlic most im- "Hereditary syphilitic children are portant group of uncured syphilitics, most important if measured hy their filled with the spirochetea, the germs of potentiality for harm, is the incomplete the disease. They are in every tissue or interrupted treated syphilitic who and organ ; the child is literally riddled marries, infects his wife, and becomes with them. In spite of this it may the parent of children with inherited syphilis, a form of the disease of such for a time seem well. The typical frequency and far-reaching importance syiihilitic child, however, is thin, weak treatment under a sepa- ;is to deserve and wasted. Syphilis hastens old age rate heading. even in the strong. It turns the young Hereditary Syphilis child into an old man or woman at Hereditary sypliilis occurs in the birth. The skin is wrinkled, the flesh cliiUlren of syphilitic parents. The flabby. The face is that of an old man is always syphilitic, perhaps mother —weazened, pinched, pathetic, with ninety-nine times in a hundred acquir- watery, bleary eyes, and snuffling nose. ing innocent infection from the syphilitic father. The mother often says that all the The effect on the product of concep- baby's troubles started with a bad cold. infection the tion of syphilitic- through The disease attacks the throat, and mother depends upon the stage of the turns the normal robust cry of a healthy development of the unborn child when infected. The sooner after conception infant into a feeble squawk. The belly that infection takes place, the less the may become enormously distended from likelihood of the child's being born. enlargement of the internal organs, and Infection shortly after conception is the rest of the child dwindle to a usually followed by abortion, by which skeleton. eruptions are only a part is meant the interruption of pregnancy The within the first three months. Infec- of the picture and may be absent, but ilim of the iutra-uterine child some- when they occur, are quite characteris- what later is usually followed by mis- tic, as a rule, especially about the earriage, by wliicli is meant the interruption of pregnancy within the second mouth and buttocks, and do not usually three months. Still later infection of resemble the commoner skin complaints the intra-uterine child is usually fol- of infants." liiwwl by premature delivery, by which description does not apply is meant the interruption of pregnancy The above (luring the last three mouths, but prior to syphilitic children that are infected to the expiration of the ninth month late in pragnaucy with a mild form of of pregnancy. Still later infections of the disease. Such children are born the intra-uterine child, or milder in- and there is no fect ions, may permit the child to be apparently normal, horn with either the marks of syphilis suspicion of the disease in many cases • nn it, or to be born apparently well until about the age of puberity, from y to show the outcroppings of the the twelfth to the lifteenth year, when Mjise later in life. \'ecder reports 331 pregnancies in syphilitic manifestations make their

I syphilitic families ; 131, or 40 per appearance, particular in the form of

.r, died before term ; 51, or 15 per a disease of the eye known as inter- ;ir. died after birth, making a total stitial keratitis. ..irtality of 55 per cent; 116, or 35 Edited by Dr. B. E. WASHBURN

THE DIET FOR EFFICIENCY not be repaired as fast as it wears out, and a person who continues to eat such In opcratius an en.^ine the amount a diet for a long time will waste away of work that can be done depends upon and die. It is also possible for a per- the quality and amount of the fuel son to starve on a diet which does not burned. The engineer can measure the contain a sufficient amount of proteins. exact amount of work that his engine It has been proven that protein foods can do on a given quantity of fuel. A (especially meats) are not necessary ton of hard coal will cause the engine for muscular work, but that such en- to do a certain amount of work. The ergy is derived from the fats and carbo- same amount of soft or bituminous coal hydrates, the starch and the sugar of will not do as much, because it gives the food. Fats and carbohydrates, off less heat; and since the fuel value which are the fuel foods, do not form of a ton of wood is still less, the work muscle, bone, nerve and sinew. They done will be still less. The same thing are burned up in the body and only is true in the body. It can be deter- supply heat and energy. They may, mined just how much heat is liberated however, be stored up for future use, when a certain kind of food is eaten just as fuel for an engine may be stored (burned) and, consequently, the amount for future use. of work that it enables the body to Again, it is not necessary to eat perform. In other words, we can de- much fat in order to be fat. The body termine how many heat units or cal- is able to manufacture fat out of carbo- ories are furnished by an ounce of fat, hydrates (starch foods and sugar). It an ounce of sugar, starch, or protein. has been found that the fat which a The thing we are concerned with is cow' gives out in her milk far exceed in the of fat that she eats in her how best . to 'maintain the body a amount condition of health and strength—to food. An experiment made with some establish the highest degree of efficiency young pigs showed that they stored up —with the least expenditure of energy. more than four times as much fat as When unnecessary (too much) food is was given to them in their food. In eaten there is a loss of energy to the the same way some of the carbohy- body in handling and getting rid of drate food is stored, in the form of the surplus. There is an unnecessary glycogen or "animal starch," in the "wear and tear" on the digestive and liver and muscles. In this respect the eliminative organs, and the excess liver seems to act as a kind of savings which is useless may prove injurious. bank or place of deposit for some of The ideal diet is the smallest amount the fuel not needed for immediate use, of food that will keep the body in a dealing it out as it is needed in the state of continual health; the diet that form of sugar. will give the maximum of energy for Proteins also may be used by the the minimum of food. body food for fuel, but this occurs only In previous articles we considered in case of necessity. People who live the fact that food has two important in cold climates, in places where there uses—to repair the body tissues and has been a coal famine in the midst to furnish heat and energy. The mate- of a severe winter, have sometimes had rial for'tjuilding and repairing the body to burn up their furniture for fuel. is furnished by the proteins in the When that was exhausted they have food. If protein food is not supplied been known to tear down a part of the in sufficient quantities the body will house and burn it. It was better to ,

The Health Bulletin mutilate the house than to perish with The ideal diet consists of just enough cold. In like manner, when a person protein (meat) food to build and re- is deprived of food, the body first draws pair the body and no more. Carbo- on its reserve fuel and burns up its hydrates (starchy and sweet foods) store of fat. "When this is used up and fats should be used altogether for some of the flesh also has to be con- fuel and heat. Such a diet prevents the sumed in order to maintain enough heat accumulation of wastes in the body to keep the body alive. In such cases with the attendant poisoning they pro- proteins, the building material of the duce. body, are used for fuel. But ordinarily are not so used. tiiey FIRST AID I.IEDICINE Another case in which the body is burn protein is when an n!,liged to Fever.—Fever may be due to a num- excess of protein food is eaten. We ber of different causes, but, whatever in tlie liave noted the ways which body the cause may be, it is a danger signal regulate supply of fuel is able to the that something is quite wrong. This foods (starch and sugar) to meet its does not mean that one need become self-regulating needs, just as a furnace panic-stricken if a case of fever has controls the supply of coal to the fire. to be cared for. This would not be r.ut for the protein food there is no wise, and yet the possible gravity of such provision. The protein absorbed fever must not be overlooked. into the blood and not needed for im- The skin of a person with fever will mediate use must be burned up in order probably feel hot to the hands, the j> get it out of the body. So if the eyes will be very bright or perhaps liodv does not need the protein for very dull, and the patient may be repairs it is a bad form of fuel as it delirious or excited, or in a stupor. leaves behind a residue (called "clink- It is always a good plan to take the ers," in the engine) which must be temperature in every case of illness. disposed of. Fats and carbohydrates This is done with the clinical ther- used for fuel food leave no ashes. They mometer, which is like the ordinary lire changed into carbonic acid gas thermometer except that it is self- :iiid water, both of which are easily registering. That is to say, the top ••liininated, the carbonic acid gas being of the mercury or quicksilver in the exhaled through the lungs and the tube remains in place after a person's water j»asses off through the kidneys teniperature has been taken, so that up.d the skin. With protein foods, as tlie height of the temperature may we bine seen, the story is quite differ- easily be read. ent. These become oxidized or burned To take the temperature, shake down !nit yield substances that are not ready the mercury to 95 degrees Fahrenheit •'•v elimination by the kidneys until or below. This is done by holding the ihev have been chemically changed by thermometer bulb downward in one ;!ie liver. These substances, frequently hand and striking the hand sharply -iMiken of as tissue toxins (poisons), against the other. This will jar the ::i:iy circulate through the body and column of the mercury so that it will l.HVO an injurious effect. When present fall. You had better have your doctor

in large amounts they dull the brain show you how • to do this. Wash the i-A'A irritate the nerves and may even thermometer in clean cold water, shak- l«e tissues deposited in the and cause ing off the clinging drop. Put it in the hardening of the arteries and prema- patient's mouth, under the ton.gue, with luiv old age. the lips closed tightly. Leave it for five You can see that a sufficient amount "minutes, after which it can be removed

f protein is absolutely necessary to and read. Wash the thermometer in •.\w body, but that a great excess is clean, cold water before putting it back

V' ry likely to prove . harmful. The in its case. Remember that in fever '\tra work thrown upon the liver and the temperature is always higher at kalueys may result in serious injury to night, pei'haps by two or three degrees,

'..'•.eso organs because of the formation so that a high morning temperature is .' poisonous waste substances. The more serious than the same tempera- !"'«ly cannot burn protein as completely ture at night. . :!' it does starch, sugar, and fat, and The normal temperature is OSA de- .l.''se later should be the foods used to grees Fahrenheit. From that point to ^'il>ply heat and fuel, body warmth and 100 degrees at night is slight fever; werking energy. from 100 degrees Fahrenheit to 102 54 The Health Bulletin degrees Fahrenhpit is moderate fever, ing till the weather becomes settled in and from 102 degrees to lOG degrees the spring. high fever. Still higher temperatures In order to break up a cold it is well are very uncommon. Children are to take a hot bath at night and get nmc^i more liable to fever from slight into bed immediately. In order to than are their elders. In any cause free perspiration an extra blanket . fever the place for the sick should be init on the bed and a large

.i is in bed, if possible in a quiet, glass of hot lemonade drunk after get- ilark room. The patient should be ting into bed. Castor oil or a Seidlitz lightly covered. He may be bathed in powder should be taken, just as in cool water. The food should be very fever ; and as in fever, the food should light simple milk simple ; milk or a little milk toast will be very and — and be all that is required. Plenty of cool toast. As long as fever is present the water is necessary. The best medicine person sick witli a cold should not be is a good dose of castor oil or a Seidlitz allowed to get out of bed. If the fever powder. Don't think of giving any of keeps up, if the cough is severe, or if the patent medicines for fever. Most there is much difficulty in breathing, a such remedies contain dangerous coal- doctor's services should be secured, for tar products whicli weaken the heart. there may be danger of pneumonia, In high fever a doctor is needed at tuberculosis, measles, or other diseases. once. This is also true in moderate Any one with a cold had best be kept fever, if it does not fall in the morn- in one room continually, as moving ing or goes up again on the second from room to room with changes of night. Slight fever, if persistent, may temperature is likely to make the cold indicate something dangerously wrong. worse. Continued cough, with fever A word of warning should be said and loss of weight, vei'y likely shows in regard to the use of the clinical the beginning of tuberculosis. No de- thermometer. It is a good tool if proi> lay should be permitted to occur in erly used, and a poor one if used obtaining a physician's advice. Tuber- without intelligence. Probably no doc- culosis is curable in the early stages. tor is without patients who are regiilar Cough medicines may be readily pur- thermometer cranks. Such people take chased, but that does not make them their own or other people's tempera- any less dangerous. Most of them ture at all hours of the day or night, der'>''nd for their quieting effect upon the and make themselves and every one cough on some preparation of opium. around them miserable if they discover They are among the commonest causes the slightest rise of temperature. The of the opium or morphine habit. Snuffs best way is to take the. temperature in and other preparations for cold in the every case of illness, and then to call head too often contain cocaine and in the doctor if there is a considerable using them one risks forming a habit rise of temperature, or if the tempera- worse, if possible, than the opium habit. ture remains elevated for a couple of Sore Throat.—Of course this often days. Afterwards be guided by the exists together with' a cold, or it may doctor's advice. The subject is too occur separately. The treatment is the complicated for any general rules. same as for a cold. In addition, a Golds and Coughs.—Probably the or- chlorate of potash tablet may be al- dinary cold is the commonest sickness. lowed to dissolve slowly in the mouth Colds may be prevented by not sitting every three hours. It will soothe the in a di-aft, especially when heated by throat. A sore throat, witli great weak-

exercise ; by changing wet clothing or ness or high fever, may mean diph- shoes as soon as possible and taking a theria or some other severe infection.

hot bath ; by wearing suflicient cloth- These, of course, require a doctor's

ing in cold weather ; and by not chang- care.

25c. ANYWHERE IN NORTH CAROLINA, THE PRICE OF DIPHTHERIA ANTITOXIN. IF YOU ARE CHARGED MORE THAN THIS FOR ANTITOXIN, WRITE THE STATE BOARD OF HEALTH FOR AN EXPLANATION Wff^m

îf'-f t^rcî' wii'S^'îaF^

Edited by Dr. G. M. COOPER

FREE DENTAL CLINICS was given to children between six and twelve years of age, and in some of the sections worked, The State Board of Health Institutes restricted entirely to children under ten years old. Free Traveling Dental Service for The idea is two-fold, to teach the iiural School Children very small children practical care of the teeth, getting One (lay, about five years ago, the them to form the habit of regular visits writer was finishing the examination to the dentist; and, second, by filling of the thirty children in a small one- or other treatment, preserve teacher school, when a motner of four the child's teeth until past puberity .liildren present, ranging in age from when they will be able to realize the importance of dental «; to 1-i years, and every one seriously care. The actual needing dental treatment, made this treatment given was of course limited in cla.ss asiial remark: "If the county thinks to simple necessity, but included permanent it necessary to have a doctor examine "white" fillings in permanent Miir cliildren for defects, then why is teeth decayed, cleaning, extracting and careful treat- it not more important for it (the ment of cunnty) to send a doctor and a temporary teeth when possible. dentist Emphasis around to give the necessary treatment, was given on cleaning the teeth, use of the brush, and teaching . specially for us who are not able to the child and his liave it done otherwise." parent something of the care of the teeth. Close Questioning of that woman re- First vealed the fact that her husband w^as Step After ^Medical Inspection working at a sawmill at ?50 per mouth, The plan as developed is simply an •he nearest dentist was Wilmington or integral part of the follow-up work of t'iinton, each more tban thirty miles medical inspection of .school children. -listaiice. The dental work necessary One of the two chief objects of medical woiihl have cost for the four children inspection of schools is to find the .;! least twenty-live dollars. defective children and have them treat- 'I'lieu and there the writer conceived ed. This plan is logical and from the l:is lir.st vision of a traveling dental standpoint of the dentists is strictly -rvice for rural school children. By ethical. The plan, before beginning, rural, meaning those far from a dentist had the endorsement of the North Car- .;!;d actually living in the country as olina Dental Society in the language u<- mean country here in North Caro- of the following resolution introduced saa. where a village of a hundred is by Dr. J. Martin Fleming. President ri.'ht nuich town. of the State Board of Dental Examin- on July 10th, 1918, after many ers, at the regular meeting of State ;'."i;ths of work on details and plans, Society at Wrightsville, June 20, 1918: ii'l with considerable misgivings, this Resolution. Resolved that the •v. irk was actually begun by the State North Carolina Dental Society l"-.'.inl of Health. heartily endorse the plan of the T!iis article is a resume of results State Board of Health, as outlined •'•hieved in this first effort covering by Dr. Cooper, and that we pledge ' arieen weeks in all, and until the him the loyal support of this • a.ies were stopped in Wilson County Society. • :i account of the appearance of an This resolution was unanimously • i'ldeniic of influenza. adopted by the Society. ^York Educational Of about four hundred dentists in North Carolina, about three hundred 'Hie prime object of the work is, of and forty are members in good stand- >"urse, educational. The preference ing of their State Society. 56 TxiK Health Bulletin-

Six Dentists Employed treatment would have cost in private olKces. Five dentists were employed for tlieir G. Nine-tenths of the patients were whole time, beginning July 10th, and very young children whom most den- in Guilford County a local dentist was tists do not like to treat; and at least employed for three days of eacli weelc. 90 per cent of them had never visited Each dentist was provided witli a port- a dentist before. able outflt, including a McConnell fold- ing chair. The Guilford County dentist 7. Equipment of the very best qual- was instructed to do everything neces- ity, including the best Ritter chairs sary for cacli cliild reporting, exactly and electric engines, is already on the groui.d for as lie would in his own office ; the same a permanent free infirmary instructions were given to the dentist in Salisbury and Kinston, and funds doing the Erlanger Mill work at Lex- in hand for the same for Winston- ington, whose manager generously paid Salem. These infirmaries will be open one-half the expenses, the State Board to city and county school children un- of Health paying the other half. That der twelve years of age. accounts for the expense per capita, S. The funds for providing this work below, being greater for Guilford noted for Guilford and Caldwell counties and Erlanger. In the other worli, the were obtained by the counties paying: emphasis was placed on the educational half the cost and the State Board of of the large feature, and on account Health the other half. attendance, only one permanent tooth was filled for each child in many cases, 9. The cost in the remaining seven the child being referred to local private counties was divided between the dentists for balance of work. Dentists county, the State Board of Health, and in several towns have reported being the International Health Board. almost swamped with demands for children's work following the public clinics. Conclusions

1. A careful record of each of these Number Children Treated and Cost six thousand children revealed the fact Per Child that at least 75 per cent of them had No. Children decay in one or more six-year, or per- County Treated Cost Each manent, molars. Robeson 1,421 .30 cents 2. Very few children or their parents Forsvth 742 34 cents were discovered who knew that the Lenoir 3S9 .3S cents six-year molars are permanent teeth. Davidson 9SG 52 cents Many of the parents wanted to argue Caldwell 4.57 59 cents the contrary to the dentists. Nash 665 62 cents 3. The way to do the work is by sala- Northampton 563 S3 cents ried young dentists of the highest WiLson 334 __ cents type and training, employed, paid, and di- Erlanger Mills (Lex- rected by the State Board of Health. ington) :- 152 85 cents Guilford 362 $1.10 4. The time to do the work is while .the schools are in session. 1. 212 dispensaries were held. 5. The place to do the work is at the 2. 6,071 children received free treat- schoolhouse. ment. 6. Everything necessary should \«- 3. More than 100 lectures on oral done for all the child's hygiene were given. teeth, exce; gold fillings, treating of diseased pui^.-, 4. Total cost (estimat- about $3,100 etc. ing cost of Wilson County work, which was interi'upted and no bills paid to 7. All of the above can be provided date). for every child in every school district in the State every year at cost not 5. Discounting the educational' fea- a ture of the clinics entirely, and basing exceeding one dollar each. tlie cost on a most conservative esti- 8. One of the most necessary requi- mate comparing with local dentists in sites for the success of such work is a each locality, the work cost about 27 whole-time health officer and a well per cent of«-what the same class of organized health department. NOTICE TO READER,— When you finish reading this magazine place a one-cent stamp on this notice, hand same to any postal employee and it will be placed in the hands of our soldiers or sailors atthe front. NO WRAPPING— NO ADDRESS.

Published bn TAZ.^°Knn CAROLINA STME.DPARDs^Amum

Bulletin, will 3er\t free to orwj citizen Thi5 be of iihe 5tateup6Areque5t. |

Entered as second-claat matter at Postogice at Raleigh, N. 0., under Act of July 16, 1894. Published monthly at the office of the Secretary of the Board, Raleigh, N. G.

Vol. xxxtil JANUARY, 1919 No. 7 EDITORIAL

ALLEGORICALLT SPEAKING henzollern, is on his last legs and the jig is about up with the Huns. Let Now there are some folks who do me think! War is in disrepute not believe in prophets and visions, and I fear we have had too much of it. much they read in the papers, and An earthquake! Phew! Too some things they see with their own tame after what has passed since 1914. eyes. Then, there are others who Let me think! have imagination and the gift of vision, who understand the drift of life "Yes! I have it! Why didn't I think and recognize what is true and what of it sooner? An epidemic. But, what is false. If you belong to the first class disease? Curse science—smallpox, yel- you are advised to pass on to the next low fever, and my other standbys have article if your time is of any value. If been put out of business. What will it you belong to the second class you are be? There hasn't been a successful invited to read. epidemic since—let me look at my

It was 1918, and it was Hell, and it notebook—since 1889-1890. It was in- was the Devil! Let's make it plain. fluenza then. Spread by swapping It was His Satanic Majesty with the spit. Times have changed. It might cloven hoofs and the spiked tail, not a not work now. Let me see! We now hunnish impersonation or a food have soda fountains and dirty, un- grafter or a rent raiser, but the real washed glasses. Excellent! And travel

old boy himself. And it was the Hell is congested—everybody wants to go we were told about in the days of our somewhere else—and trains are act youth, with fire and brimstone and properly ventilated and are usually seven times hotter, etc.—the bad place dirty. Fine! Then there are picture itself. The date needs no explanation. shows and theatres—and a sneeze The Devil was in a dilemma and was means something in these places. I faced by a kind of paradox. He was believe to my soul (if I had one) that mad as hell because things had be- another epidemic would succeed! We'll come quiet as hell and there were try it, anyway." prospects that he would have to work Six months had passed and his Sa- like hell to start something new. Af- tanic IMajesty was reviewing his work. ter resting for four years he hated tu The epidemic had started in Spain and

work like the devil (he was) but then spread over Europe. But, it could "something must be done," he solilo- not be considered a great success. The quized. "My chief aide, old Bill Ho- medical corps of the armies combatted The Health Bllletix

manity. Of course precautions were it and required isolation of patients, soda fountains caused face masks to be worn by all enforced—delinquent cups; persons going into crowds, and had were required to use individual churches, made a vaccine to use as a prophylac- picture shows, theatres, schools, and all public gatherings were tic. And, the same precautions were enforced among the civil population. closed and forbidden; the people were spit is swap- So, while the epidemic had been bad it taught the ways by which had not been serious and the Devil was ped, and the disease is spread, and worried. And, to add to his worries, were taught to keep out of crowds. successful Bill Hohenzollern and the Huns were Cooperation was great and blazed into being defeated. It was too much for and the spirit of service there the Old Boy and he scratched his head full flame and never before had and yawned and said "Oh, Hell!" existed such a feeling of brotherhood. Something must be done and that at In fact, people had begun to say that once. He thought of Shylock's in- the epidemic had been worth all it had satiable greed and inhumanity and cost since it created sympathy and un- called him into consultation. It didn't derstanding and dissolved class dis- take Shylock long to suggest that the tinctions. epidemic would succeed in America. Now, this wasn't at all to the liking "Why in America the folks don't know of the Devil. And Bill and his Huns what war is and have never faced real were still getting it in the neck! To disaster. They can't meet an emer- ease his mind he decided to call old gency and great harm can be done be- Shylock and give him a good kick and fore they can organize. And Ameri- at least tell him how little he valued cans just dote on personal liberty, his judgment in the matter of epidem- which they have fostered so much ics. But Shylock spoke very confi-

that it has run to seed in many dently and demanded another trial. places. And they do love the money! He said, "Didn't I say the Americans Take the influenza there. They won't do love the money? Let me touch consent to restrictions which cause a their pocketbooks and you will see of loss of money. what fibre is their love of humanity their spirit of local community Shylock was entrusted with the job, and service. Watch results until New but it was not the success it was ex- assented. pected to be. The war had taught the Year's!" The Devil lesson of cooperation, and the people It was New Year's and Satan was soon organized. The suffering was waiting for Shylock. He was in ex- great and the toll of lives was unprec- cellent spirits. Of course Bill had had that had edented, but it was checked too soon. hell knocked out of him, but The strong quickly banded themselves been expected. The second epidemic together and took care of the weak, was accomplishing great results. The the rich contributed to the care of the people were no longer organized to was "busi- poor, and all were proud to realize control the disease; there what they could do and had done. The ness as usual." picture shows and full blast, spirit of service had gone abroad over theatres were running at the land; men and women had volun- stores and streets were crowded, trains open, teered to nurse the sick, soup kitchens were congested, churches were had been established and the victims and no community precautions were had been fed, emergency hospitals had being observed. The Devil was happy been organized to care for the helpless, and was wondering how Shylock had and business houses had closed and brought about such delectable results. was their owners had joined in serving hu- At last Shylock arrived and The Health Bulletin greeted with unusual cordiality. He racy, organizations like these control began to tell in detail of how children boards of health and tie the hands of had been especially attacked, and of health officials. Business as usual soon how many had died or been crippled became the slogan and of course if for life, of the way in which strong stores were crowded there could be no men had been stricken at their posts, excuse for placing the ban on other of the increased numbers of orphans things and picture shows and theatres and widows, of the prospects of a fu- opened." ture increase in tuberculosis, and of "That can all be seen," said the the acuteness of present suffering. The Devil, "but weren't the people afraid Devil inquired how such results had to go into crowded stores and shows? been accomplished. "They were at first while the news- warning "The Americans do love the money papers carried headlines I stopped this and their pocketbooks have been against crowds. But going into the touched," answered Shylock. kind of thing from papers." "But why didn't business continue "How?" during the first epidemic?" "Why, I had at least one large store "Times were dull then, but there is in each town to see the newspapers holid-ay trade now and profits are and threaten to withdraw all advertis- grester. Also, during the first epi- ing if such warnings continued to be demic the disease was new. But now, printed. This stopped it in short or- like tuberculosis, it has become com- der." mon and is not so much feared." ex- "Shylock, you are a wonder," said plained Shylock. His Satanic Majesty; "you shall be re- "Tell me some of the definite meth- warded. Retire." ods you used," said Satan. "One moment, Your Majesty." said Shylock thought for a moment and Shylock, "Let me but tell you of the then replied: way patent medicine concerns took "Take North Carolina, for example; money from poor people so they could results were as good there as any- not buy food or fuel. That was great! where. I got the schools and churches And of the way educated men and they were excellent to claim that women helped by going into crowds places to spread health propaganda and street cars when they had sus- and this took their minds off of in- picious colds. Do you know, the more fluenza. Some even claimed that dis- intelligent they looked the less con- eases can't be caught in churches! science they seemed to have? And I There are certainly lots of wise men must tell about women taking children know mighty little about the way ." who and babies with them when shop— spit is swapped! That is one of the "Enough," cried the Devil, "I am sat- greatest secrets of our success." isfied. Be gone!" "How did you manage to keep the stores and places of business open," Now there are some folks that do was asked. not believe much that they read or "Easy, dead easy! I made a few hear, and some things that they see leading merchants realize how much with their own eyes. But there are a money they were losing and this made few of us who have gone into homes them forget how many children were where influenza has hit hard. And we dying and how many people were suf- have seen whole families stricken at fering. Then they were quick to call one time- with no one to give the barest on their chambers of commerce and comfort or aid; we have seen fathers business associations and, in a democ- and mothers taken, and orphans sent The Health Bulletin

cannot secure out into the world with a helpless named above. If you present and a hopeless future. We diphtheria antitoxin made by the State who have seen these things and have Laboratory of Hygiene—and this anti- quality done our little bit to aid and comfort toxin is standardized and the have sometimes felt inspired when we is equal to any produced in the United could give a measure .of relief and have States—the fault is that your county not arrange- felt that our efforts were worth while. commissioners have made And when we would fail to comfort or ments to save this money to the citi- save we could not help but sympathize zens of your county. and express regret. The State Board of Health wishes And these phases of suffering hu- also to call the attention of the people manity make us doubt that dollars to the fact that the antitoxin produced should be considered of more value and distributed as described above, than human lives. B. E. W. does not mean that the doctor attending the case of diphtheria and using his "THE THIRD GREAT PLAGUE" the antitoxin should not receive usual fee for such services. In former The two cuts appearing on pages 5 with diphtheria had to pic- times a family and 6 of this Bulletin, and showing pay from $5 up for diphtheria anti- tures of the germs causing syphilis and toxin, in addition to the fees of the gonorrhea, were prepared and loaned to visiting doctor. At present, if your the North Carolina State Board of commissioners are progressive, you can Health by W. B. Saunders & Company, receive the antitoxin for 25 cents, no Philadelphia, Pa. For this kindness matter how large a dose is used. But we wish to express our appreciation, this in no way relieves you of the and, not as a matter of reciprocity, but com- charge made by the visiting doctor. in the interest of our readers, to B. E. W. mend to those who may be interested in a very complete and authoritative GROWING IN POPULARITY book on syphilis, the book published by W. B., Saunders & Company entitled Medical inspection of school chil- "The Third Great Plague," written by dren is growing in popularity. See if Clinic. Dr. John H. Stokes of the Mayo it cannot be provided in your county. S. R. The book sells for $1.50. W. Even if it does nothing but lead to better care of the children's teeth it itself. As an exchange FREE DIPTHERIA ANTITOXIN will pay for well says: The State Board of Health is again "Many times when the child is ap- calling attention to the fact that the parently well, it may be nursing an ill Laboratory of Hygiene is making and spot that, if left to run its distributing diphtheria antitoxin free or a weak course, may do much harm and prove of cost. The only charge is for the to him in his ma- container in which the antitoxin is a serious handicap inspection of the distributed and this charge is very, turity. Medical parents an op- very small, being 25 cents for each schools will give the their chil- package of antitoxin whether it con- portunity to know just how health, tains a small or a large number of dren stand as regards their units. Progressive counties in the and when they know they can proceed state are arranging for the antitoxin with the treatment and care that is to be distributed by the health officer, necessary for normal and healthy de- county physician, or some public- velopment of mind and body."—Pro- spirited drug store at the small price gressive Farmer. '

' ' ' I I I .r"^"^^ PUBLIC HEALTH RND SANITATION

Edited by Dr. W. S. Rankin

GONOERHEA The Mode of Infection

(CJap, Gleet, Chordee) As the gonococcus cannot live through the changes in temperature and drying incident to air transmis- The Cause of the Disease sion, airborne infection is obviously impossible; moreover, infection by con- Gonorrhea is due to a small germ taminated things, such as eating uten- called the gonococcus. These germs sils, drinking cups, seats of commodes, are about 1/25,000 of an inch in di- towels, etc., is extremely infrequent ameter; are biscuit-shaped, and occur for the same reason. It is possible in pairs. The flat surfaces of the bis- for a person to contract the disease cuit-shaped germs are turned together. from infected things, but the time be- Figure 1 shows some pus from a per- tween the contamination of the thing son with gonorrhea as it appears un- and the transmission of the infectious der the microscope. Six pus cells, agent to the new victim must be very rounded shadows, with three or four short; certainly not more than one round or ovoid bodies (nuclei) in them case of gonorrhea out of every hun- may be seen, and scattered about in dred cases of the disease is contracted infected these cells are numerous pairs of from things. gonococci. The danger is not from thinfis, but pei-sons. In infectious The gonococcus is present in every persons, that is, persons with case of gonorrhea. If the pus contain- gonorrhea (either acute or chronic latent ing the germs is experimentally placed and gleet), the infectious practically In the urethra of a well person (this germs, speaking, has been done), the inoculated person reach the surface of the body from which promptly develops a typical case of the they may be conveyed to others only at one point, namely, the open- disease. The gonococcus is found no- ings of the urinary where in nature except in those suffer- and genital ducts ing from the disease. or canals. It is. therefore, perfectly clear that the disease is contracted The gonococcus cannot live in a dry through sexual intercourse and almost state, nor can it withstand even slight solely in that way. variations in temperature. The germ All professional prostitutes are in- belongs to a small group of disease fected with gonorrhea, and most of producers that are almost dependent them are infective most of the time. upon conditions peculiar to the human The majority, the big body. majority, of loose men and loose girls are infected. One may "take a chance" and escape, but every year 2.000.000 new witnesses testify to the danger of exposure.

Symptoms of Gonorrhea Within from twelve hours to one week, usually within from twenty-four to forty-eight hours, after becoming infected, there is a burning and painful sensation on urinating. There is frequency of urination. There is a profuse discharge of thick, creamy pus from the urinary canal or urethra. The disease in its early and acute form is much more pronounced and Gonococci in urethral pus. more painful in men than in women. —

6 Tjie Health Bulletin

With the above local symptoms, there regard gonorrhea as even a more ser- are usually slight constitutional symp- ious disease than syphilis. Because of toms; a slight fever running from 99 shame, the desire to hide his disease, head- to 100 degrees, perhaps slight the victim (1) postpones consulting a and general ache, a loss of appetite trustworthy medical advisor, and (2) malaise. declines to go to bed for a week or Course of Gonorrhea ten days for fear the family may sus- Prompt and modern scientific treat- pect the true nature of his trouble. In ment would limit, perhaps, ninety-five this way, prompt treatment and scien- the out of every one hundred cases of gon- tific treatment are sacrificed and orrhea to a course of from five to eight patient becomes concerned with

Fig. 2. The germ of syphilis (Spirochaeta pallida) by dark field illumina- tion in the secretions from a syphilitic wart (condyloma). The living spiral organism highly magnified. Tlie bright circles are red blood cells.

weeks. This means that a person with The Complications of Gonorrhea gonorrhea should NOT (1) treat him- dire self; (2) rely upon a druggist for General: In both numbers and treatment, and (3) use patent medi- effects, the complications of this dis- cines. ease are surpassed by those of few the There are tico factors that cause other diseases. In the beginning, gonorrhea to be one of the most ser- disease is limited to an infection of the canal or ious of all diseases: One of these fac- front part of the urinary promptly tors is ignorance, and the other is urethra, but when not shame. Because of ignorance, the vic- treated, extends backward and to tim believes the "bad cold lie" that deeper parts, and from an infection infection of gonorrhea is no worse than a bad of the urinary tract to an glands. With cold. He does not know that among the genital tract and the well-informed there are many who this deepening of the field of infection, The Health Bulletin

there is also a widening of the infec- occurs in many other conditions be- tious area, the gonococci burrowing sides gonorrhea. into the deeper parts of the canal and Pus Tubes: The gonorrheal infec- surrounding tissue. This extension tion frequently extends from the womb and deepening of the infection, the or uterus to the Fallopian tubes or cost of delay and imperfect treatment, oviducts, causing a swelling and an occurs in from 40 to 80 per cent of all inflammation and an accumulation of cases of the disease. It is apparent, the pus within the lumen of the tubes. therefore, that the tendency of gon- The tubes become dilated, large, orrhea to chronicity is pronounced. rounded like a walnut or an egg, and Stricture: Ninety- five per cent of intensely painful, often necessitating strictures result from gonorrhea. Gon- an operation and the removal of the ab- orrhea causes stricture by causing in- scess. Of course, this disease of the flammation and, frequently, ulceration tubes results in female sterility, proof the urethra which, on healing by vided, however, that both tubes are scar tissue, results in a narrowing of affected. Recalling here what has been the canal or stricture. Stricture is one said under the heading of epididimitis of the most frequent and one of the as to the effect of gonorrhea in causing most annoying diseases of men. It male sterility, it is evident that this necessitates the mechanical dilatation disease profoundly influences the birth of the urethra by sound, and the arti- rate, being one of the larger factors ficial withdrawing of the urine by in sterile marriages. catheter. In interfering with the func- Peritonitis: If the pustule should infre- tion of the bladder, stricture not burst and the pus be discharged, it is quently lays the foundation for cystitis emptied into the peritoneal cavity with or inflammation of the bladder which, the result that an acute, very grave, the by extension upward, may involve not infrequently fatal peritonitis re- in an acute bright's disease. kidney sults. This complication, with one or Epididimitis occurs in from 10 to 20 two exceptions, is the gravest of all per cent of all cases of gonorrhea. the complications of the disease. Epididimitis is an inflammation of the Gonorrheal Rheumatism: Two or part of the testicle, and when it upper three per cent of persons with gonor- affects both glands, usually results in rhea develop this complication. Gon- male sterility. orrheal rheumatism is caused by a Diseases of Women: Gonori-hea is limited number of gonococci breaking perhaps the most important single through the walls of the urethra and cause of diseases of women. In the genital canals and getting into the women, gonorrhea is not usually char- lymph vessels and into the general acterized by such acute symptoms as circulation. In the general circula- in men, but the tendency of the disease tion, the gonococci tend to settle out to extend and to become chronic is per- in places least resistant to them. These haps greater. places are the joints. Gonorrheal Cystitis in women is a common com- rheumatism usually affects only one plication, in fact, almost one of the or two joints, in this way, differing constant complications of gonorrheal from regular rheumatism or articula,r infection of women. Cystitis shows it- rheumatism that involves many joints. self in frequency of urination with Gonorrheal infection of the joints is much burning pain on the passage of one of the most difficult diseases to the urine. The urine voided is small treat that is known, and usually fol- in amount, and cloudy from a large lows a prolonged, chronic course, is amount of pus mixed with it. very painful, and not infrequently re- Metritis and Endometritis is an in- sults in a permanent stiffening of tha flammation of the womb or uterus, or joints. Doctor Osier was accustomed »the lining of the uterus, respectively. to point out to his students the in- This results from the extension of the tractable nature of gonorrheal rheu- gonorrheal infection upward. It is as- matism by telling them that when they sociated with the discharge of a large located, one of their first patients amount of white mucoid material from would be a case of gonorrheal rheuma- which this disease gets its popular tism who had made the rounds of all name, "whites"; however, it is im- the doctors and without results; more- portant to remember that inflamma- over. Doctor Osier suggested that the tion of the womb, characterized by the young doctor send word to the patient above discharge, that is, the "whites," that he was out of town. 8 The Health Bulletin

Gonorrheal Septiceviia or Blood HEALTH MADE CONTAGIOUS AT Poisoning: This is the gravest compli- SCHOOLS cation of gonorrhea, but, fortunately, one of the more infrequent complica- The health movement in our public tions, perhaps not occurring more than schools has been transformed during in every two or three hundred once the past decade from a purely negative cases. Gonorrheal blood poisoning re- having as an object the sults from the invasion of the general movement, circulation by a large quantity of gon- avoidance of disease, to a splendidly ococci. The difference, then, between positive movement, having as its aim gonorrheal rheumatism and gonorrheal the development of vitality. "We de- blood poisoning is in the numbers of schools gonococci that break through the local sire for the youth of the future barriers. Gonorrheal blood poisoning in which health, instead of disease, majority of or septicemia is, in the will be contagious, in which the play- cases, rapidly fatal. Where it is not ground will be as important as the fatal, it nearly always leaves the pa- air, tient with serious valvular diseases of book, and where pure water, pure the heart. and abundant sunshine will be rights, Optha'mia Neo7iatorum is an infec- and not privileges. In these schools new born child tion of the eyes of the the physical, the mental, and the moral with gonococci as the child passes will be developed together, and not through the birth canal of the mother, will live not only who is infected with gonorrhea. About separately; the child 25 per cent of all blindness is a re- in healthy surroundings, but in sur- neonatorum, and 80 sult of opthalmia roundings where he will acquire hab- per cent of all blindness following its of health which will be lifelong. birth is a result of this disease. Gon- orrheal opthalmia may be eaaily prevented by dropping one or two drops into the of a solution of silver nitrate It is not the man who works with immediately following birth. In eyes his muscles and sweats profusely who North Carolina this is required by law, really suffers from the heat. It is the and the State Board of Health furnishes to all doctors and midwives a man who has been loafing around try- silver nitrate solution in appropriate ing to keep cool, who has filled his for use; moreover, any doctor form blood with all kinds of toxins which his who fails to use this precaution is, if skin and liver would only be too glad the baby delivered by him develops gonorrheal opthalmia, subject to suit to excrete if he would work enough by the parents, and there i? no jury, to give them a chance. Active ex- neglect could be proved, where this ercise to a reasonable extent is just as that would not award heavy damages. useful a means of health on a hot day Perhaps the saddest sight that one as on a cold one. sees in all the world is a blind child that has lost its sight from gonorrhea. No greater punishment can be visited upon any man than to be continually Don't worry about getting sick. If presence of his sight- reminded by the you have been vaccinated against less, groping child of the terrible price smallpox, inoculated against typhoid, it is paying day by day throughout its life to expatiate his sin. all the malaria germs in your system killed, and are eating plain, easily digested food, you are likely to be all Green stuff in the form of salad right. Of course, you want to keep every day will to some extent elimi- away from mumps, measles, and scar- nate the bad effects of indulgence in let fever, and to wear comfortable meat. The fresher this green stuff, clothing. Much of summer's discom- the the better. More people ought to learn fort lies with ourselves rather than about the mine of health to be found weather. If you don't believe it, just comfortable and see. in a kitchen garden. make yourself Edited by Dr. B. E. Washburn

WEIGHT AND HEALTH AS Women: 4 ft. Sin 112 5 ft. 5 in . 134 RELATED TO DIET 4 ft. 9 in . 114 5 ft. 6 in 138 4 ft. 10 in 116 5 ft. 7 in 142 Weight and healtli are very import- 4 ft. 11 in.... 118 5 ft. Sin 146 5 ft. in 120 5 ft. 9 in ant factors in considering a diet for 150 5 ft. 1 in 122 5 ft. 10 in 154 efficiency. If we do not eat enough 5 ft. 2 in 124 5 ft. 11 in 157 5 ft. 3 in 127 the various body organs will 6 ft. in 161 be starved 5 ft. 4 in 131 and will not be able to properly per- Lightweight is not a disadvantage form their function and ill health may if one is otherwise in good health, es- be the result. On the other hand over- pecially after age 30. eating may cause dire results and is Overweight is always a disadvantage often of greater danger than not to and should be avoided, especially by eat enough. If too much food is taken those approaching middle life. Keep the digestive organs will be overtaxed your weight about the average figure for age 30, and and made to take care of a quantity of do not let it creep up as you become older. food that is not needed. This entails The death-rate among those 50 to 80 a waste of energy in digestion and is lbs. overweight at middle life, is nearly very harmful. If, in repairing a house, double that of those slightly under- a great deal more material than is weight at that age. Some allowance needed is brought into the house, it must be made for type, a heavy-framed will be in the way of the workmen and individual carrying naturally more they will have to spend their energy weight than one slender and light- in moving it out of their way. When framed. more food is taken into the body than Overweight and the Death-Rate is needed it is just like so much rub- bish which must be cared for. There The fact that the man of average are a number of things which lead to weight is. after age 40, actually over- the bad habit of over-eating. These weight and that the average individual are eating too fast, drinking too much at that age is above the best weight is at meals, and eating too great a variety shown by life insurance experience. of food at one meal. For example, a man of 5 feet 7 inches to 5 feet 10 inches in height, age 45 to The following tables and comments 49, 10 pounds underweight, would have adopted from "Food: Fuel for the a 4 per cent lower mortality than the Human Engine." by E. L. Fisk, show man of exactly average weight for that the important relationship existing be- age and height. tween bodily weight and health and Overweights at that age and height the influence of diet on these: show the following extra mortality as compared to those 10 pounds under the Table of Heights and Weights at average weight: Age 30. Pounds Men: 5 ft. Oin 126 5 ft. 9 in 156 5 ft. 1 in 128 5 ft. 10 in 161 5 ft. 2 in 130 5 ft. 11 in 166 5 ft. 3 in 133 6 ft. in 172 5 ft. 4 in 136 6 ft. 1 in 178 5 ft. 5 in 140 6 ft. 2 in 184 5 ft. 6 in 144 6 ft. 3 in 190 5 ft. 7 in 148 6 ft. 4 in 196 5ft. Sin 152 6 ft. 5 in 201 10 The Health Bllletix

This shows that the burden of extra EATING TO LITE WELL mortality borne by the heavy-weight No one can have health who eats too with gain in regularly increases much. At the same age and height, weight. No one can have health who eats 50 pounds underweight shows a death- too often. rate equal to the actual death-rate have health who eats among insured lives generally and No one can only 6 per cent in excess of the death- when tired, hurried, worried, anxious, rate among those of average weight. or excited. Thirty-five pounds underweight at that No one can have health who rises age shows a lower mortality than late, gulps down a hearty breakfast, those of average weight. among swallows a sandwich and a glass of milk for dinner, and tops off the whole Table Showing Influence of performance with a late supper. Underweight When you have eaten do not wonder

Ages: 45 to 49. if it will agree with you. When you Height: 5 ft. 7 in. to 5 ft. 10 in. begin to wonder, trouble begins. If

you fear it, do not eat it; if you eat it, (Height and weight taken with coat and vest off, and in shoes.) do not fear it. Under Be cheerful at your meals. A sour Arernge will give you a sour Weight countenance weight, 5 lbs..-3% lower death-rate than average stomach. 10 lbs...4% lower death-rate than average weight, 15 lbs...5% lower death-iate than aveia?e weight, 20 lbs...5% lower death-rate than average weight, weight, 25 lbs.. .4% lower death-rate than average to hold weight, Milk bottles should be used 30 lbs.. .3% lower aeath-rate than average 35 lbs.. .2% lower death-rate than average weight. milk and for nothing else. As soon as 401bs...O Mortalitv of average weight, weight, it should be rinsed 45 lbs.. -3% highei death-rate than average the bottle is empty than average weight. 50 lbs...6% higher death-rate in luke-warm water until clean; it It must be remembered that these should then be scalded and set bottom insurance figures are taken from life upwards to drain. where the individuals have sources Sanitary regulations should prohibit been subjected to careful medical ex- bottles amination. This shows that no matter the return to the milk man of how careful the medical examination, which have not been cleaned. it has been impossible to select a favorable class of mature overweights to select a while it has been possible The Chinese plan of paying doctors relatively favorable class of mature is correct in principle, and in this re- underweights. It should also be remembered that these figures relate to gard we occidentals have the cart be- groups adverse factors. That is. these fore the horse. In China the doctor presented no other departure from the is paid for keeping his patients well, normal than their variation in weight. and his pay stops when they get sick. This is the practical application of our Keep away from persons who tell universally admitted adage that "An afraid of "catch- you that they are not ounce of prevention is worth a pound communicable diseases. They are ing" of cure." We generally entertain the as the person who in the same class delusion that we may continue to in- rocks the boat. dulge our appetites and passions until disease appears, and then oust the few tablets or pills. It is so much easier to prevent fires disease with a delusion we and accidents than to repair damages. When we rise out of this be- The habit of Safety First will avoid will resort to prevention, and not both. fore. -

Edited by Dr. Geo. M. Coopek.

SAFEGIARDI>G THE HEALTH OF concentrated—and very properly, too— OUR SCHOOL CHILDREN on the care of infants, among whom the largest number of deaths occur. By Emmett Holt, M.D. The milk stations, for example, follow the child during its first two years. York Times (Reprinted from the New They have done remarkable work. and Bulletin of the Child Health Or- They have been a large factor in reduc- ganization.) ing: infant mortality in this city from All studies that have been made in 288 in each 1,000 of infants bom thirty this country indicate that large num- years ago to 89 in the same number bers of children, especially in the born last year. This has meant or- crowded cities, are physically far be- ganization, cooperation, and wide- low par. How much this condition af- spread publicity. It has been a cam- fects the health and vigor of our peo- paign of education. ple was revealed in the selective draft. But the army of more than twenty The defective physical condition of millions of school children has as yet young men of draft age was largely received very scant consideration.- due to neglect of proper supervision Proper medical examination of school and guidance during their period of children exists in only a small number gro^\1th. If the defects disclosed by of states and in but a few of the larger the examining physicians had been re- cities. In the greater part of the coun- cognized early in school life it would try there are no such examinations, have been possible, in a large measure, even in the most superficial form, and to correct them. where they do exist, for the most part, One thing is conspicuous in the re- they are very inadequate, often consults of our studies and observations, sisting merely of one examination at and that is the superior physical con- the beginning and another at the end dition of the children of the better- of school life. EVEN THESE EX- cared-for classes, those who are favored AMINATIONS IN MOST INSTANCES with improved conditions of life. ARE ONLY CASUAL. THEY ARE PROPER FEEDING. FRESH AIR. MADE. FOR EXAMPLE, WITHOUT AND OUTDOOR EXERCISE HAVE REMOVING THE CLOTHING OF THE MADE THE PRESENT GENERA- CHILD FOR A PROPER EXAMINA- TION OF CHILDREN OF THE WELL- TION OF HEART AND LUNGS. TO DO CLASSES. TALLER, HEAV- An important economic point is the IER, AND STRONGER THAN THEIR necessity for what is known as reedu- PARENTS. This is a matter of com- cation of backward children in the mon observation. Children of other schools, or the repeating of grades. classes, however, especially in the large This is a great waste of efficiency and cities, do not show the same improve- entails an enormous expense. The ment. The knowledge of child culture necessity for reeducation is probably has not yet filtered down to the masses. due to the health of the child more The war has created a situation than to any other cause. A child's which makes the condition of these brain cannot be expected to do good children even worse than in peace work if the stomach is empty, any times. The higher cost of food, par- more than you can expect an engine ticularly of milk, which has led many to run without gasoline. families to forego its use entirely, is The conditions above outlined have chiefly responsible for this condition led to the formation of the Child today. Health Organization. The business of A great deal has been done, of keeping the school children in good course, in the last thirty years for the physical repair has not been generally better health of children, but the ef- thought of as a public duty. Too much forts of most of the boards of health stress in medical work in the schools and the welfare agencies have been has been placed on the detection of de- 12 The Health Bulletin

its motto, "Health in Edu- fects, such as adenoids and the con- pressed by dition of the tonsils and teeth. This cation. Education in Health." work is important, of course, but there INSTRUCTION IN HEALTH seem to be even more essential and SHOULD BE THE MOST VITAL fundamental questions to consider, PART OF EVERY CHILD'S EDUCA- which affect especially the influences TION, AND IT NECESSARILY MUST growth of chil- nutrition. The normal BE GIVEN EARLY, WHILE THE dren has been ignored, or at least has IS AT THE RECEPTIVE AGE. very little thought of. CHILD been will Few attempts have been made to Not only that, but this instruction compan- arouse the interest of the child him- spread from the child to his to what He will begin self in health matters or to see ions and into his home. only parents, which degree he could be stimulated, not at once to educate his health, but One of the chief to take an interest in his is most important. well and foreign-born people has to have the ambition to be troubles of our selecting of the proper strong. been in the it has been found The response of a group of children American foods, and following is difficult to reach them and teach them. to an appeal like the In many cases where children are un- astonishing: . country condition is not due "Every child owes it to his der-nourished, the body as strong to poverty, but to ignorance. Parents to make and keep his how to feed their boys and well as possible. must be taught soldiers "Uncle Sam does not want and girls the foods that are suitable be- who must ride in the ambulance for their ages and necessities of or weak. child must also ba cnuse thev are delicate tired, growth, and the who can foods. What he" wants is soldiers taught to eat these for their measurement of weight march in the ranks and fight The initial strong, noint. so country He needs an army of and heieht gives a starting can do child during capable boys and girls who that the progrpss of the He does period in growth may be their part at this great time. the school be a bur- noted and emphasized. A SET OF not want any boy or girl to MEASURING ROD den, but to carry one, and he needs SCALES AND A child." SHOULD BE IN EVERY SCHOOL. every CHILD'S The present extent of health activi- AND A NOTATION OF THE because it does not PROGRESS IN HEALTH SHOULD ties is inadequate, FART OF HIS include this emphasis on teaching good BE KEPT AS A addition to the detec- SCHOOL RECORD, GOING WITH health habits in HUM FROM GRADE TO GRADE AND tion of disease. TO SCHOOL. In the few isolated instances where FROM SCHOOL The problem of combating malnutri- the experiment has been tried, the re- tion in children is a serious one now sponse of the children to this effort at has been a revelation. confronting the country. It is a men- health education The The demonstration conducted by the ace to our future citizenship. beginning to suspect, if not to Child Health Organization at the Con- nation is even more essential to its servation Food Show was one of these realize, that than progress in science, instances. When it becomes known to permanence politics, or industry is the health of the child that he is below the normal peonle. especiallv of its children. or average weight for height and age, its HEALTH and he realizes that unless he is gain- THIS NATIONAL ASSET— be consid- —IS. AT PRESENT, THE MOST IN ing normally he can never NATIONAL ered for athletic honors of any kind in DANGER OF ALL OUR his school or group, a powerful argu- RESOURCES. ment has been found. Instead of rules The Child Health Organization is taking as one of its principal lines of hygiene being a set of prohibitions, up present become rules for his guidance to of activity measures by which they The aim help him improve his physical status. conditions may be combated. classes In the past the mistake has been in is to bring together in special instruction in each school the effort to impose rules for health, for health nutrition is most instead of arousing the child's own in- those children whose and give them interest and cooperation. There have markedly deficient, cooperation of been too many "dont's" and not enough dividual attention. The sought in every "do's." The fundamental idea which parents in this work is of the children the Child Health Organization is en- way. Observation even weekly, deavoring to encourage is well ex- should be monthly, or The Health Bulletin 13

exactly as is the practice with the in- If the physical status of the child is fants at the milk stations. known, he can be directed to the An important agency in overcoming proper channels on entering industry malnutrition among school children is and placed in the occupation he is best the supplying in the schools of one or fitted for. The character of his in- more hot meals each day. This prac- struction in the manual training school tice is now well recognized abroad as a can be determined in the same way. means of improving the health of chil- IT SHOULD BE POSSIBLE TO CAN- dren. In New York City there are already over fifty schools where the CEL THE WORKING PERMIT OP school luncheon has been introduced. THE CHILD WHEN HIS JOB IS The child Health Organization aims to FOUND TO BE UNSUITABLE TO develop this important work In most HIS HEALTH. of the schools only the noonday lunch- An effort to awaken the child's in- eon is furnished. This is a hot. well- terest in his health is made by argu- balanced meal, such as a healthy child ments like the following: at school requires, and it is supplied at a price which barely covers the cost "Think of your body as an engine. It of the food. Service and equipment really is one, for it produces heat and are provided by the municipality in power like a gasoline or steam engine. some places, and in others by private If we note how the engineer cares for philanthropy. One special argument his engine to get the most work out of for this luncheon in the war period is it with the least expense for fuel and the employment at the present time of with the least wear and tear on the en- so many women in industry. Mothers, so employed and away from home, can- gine, we may perhaps learn some- not prepare the midday meal for the thing from him. children. There is usually left for the "Our bodies are much more deli- child only the choice between the cately made than any engine or ma- school luncheon and the pushcart. chine that was ever invented by man, The idea dominating the school but many of the same rules hold re- luncheon in the past has been chiefly garding it. The engine must have the philanthropic—to supply the growing right kind of food. Food is the fuel child with one good meal each day. of the body, and is actually burned up Its value for this purpose cannot be in the body to keep us warm and to overestimated. But quite as important produce the strength we use up in is its educational value. Instead of work or play. But the food for the offering a menu for the child to select body must do something more than from, as its fancy dictates, each meal this. The bodies of children must served becomes an object lesson in nu- grow, and they grow very fast at the trition values, and he learns to eat the school age. They often double in size proper kinds of food required for between the seventh and fourteenth growth and nutrition. years. It is very necessary, then, that the The interest aroused in the child by food selected should supply all that these meals is most surprising. In a is needed to enable the body to grow few weeks he takes an interest in the right—and IT IS JUST AS EASY TO number of calories his food furnishes GROW RIGHT AS TO GROW WRONG. and how a proper meal is made up. "We know what kind of fuel is best The education of the child means the for the body, just as we know what education of the parent. Just as the kind is best for engines and automo- groups of girls known as the Little biles. You would think that, when peo- Mothers have been able to teach their ple knew what is best and also what own mothers what is good for the is cheapest, they would, if they could, babies, at the same time learning les- get it, not buy any other. So they sons which it will be impossible for would if they were wise and would them to forget, so these school lunch- stop to think; but many people are eons, properly prepared, will leave a wise about other matters and very ig- lasting impression. norant about the food that is best for Since the health of the child in in- their bodies." dustry has for some time been an inti- When once ideas like these are tho- mate concern of the National Child La- roughly impressed upon the child's bor Committee, it seemed wise to act mind, he is in a receptive mood for with that body. health instruction of every kind. Infant Hygiene

Edited by Mrs. Kate Brew Vaughn.

MOTHERS AND BABIES year, and on account of its being cool weather, and to that alone, I attribute the fact that she ornaments and lends How the State Board of Health Can fragrance throiigh her presence to my Help 3Iothers Kaise Their home today and glorifies the Father in doing. Babies so Twin boys came next, and the prob- Recognizing the large number of lem of supplementary feeding came up. mothers and children who are dying For a time I was compelled to use a each year of preventable causes, and patent food for this, and lack of knowl- endeavoring to reduce this number edge (or maybe it was common sense) and at the same time assist in every gave me much trouble—the food was way possible the mothers of North too rich and a number of ills resulted, Carolina, the State Board of Health painful to babies and entailing extra has given me the Bureau of Infant labor on myself. An excellent friend, Hygiene as a medium through which in the person of my physician, put a to meet you. I rather think I was ap- book on infant feeding in my hands pointed to this position because of my and made me realize that all the love love and sympathy for children and in the world would not take the place mothers, and, because I am the mother of common sense and knowledge of of five well-grown children. basic facts. With the two children, Looking back over my early mother- who followed to make up my five, there was as little trouble as could be hood, I feel that the first baby was so were breast-fed for experimented with that she lived in expected. They ten months, properly fed after being spite of me, rather than because of weaned, and, aside from measles and me. I had sufficient love to have whooping cough, which, because the sacrificed anything for her, but I had babies were healthy, appeared in the little or no knowledge of "mothercraft" mildest possible form, they have not and so, was dependent upon neighbors been ill. and servants for the knowledge of those things upon which her well being There are many things about the ba- depended. I knew a little of music, art. bies and about the expectant mother's literature; could make pretty salads condition on which the mother would and very good deserts, but all of these often like to have advice. Sometimes accomplishments were rather super- there is an older friend to whom she fluous in the care and feeding of a can apply for this knowledge, or possi- little human being. Fortunately, I was bly her physician is the sort to whom well myself and was able to nurse her she can go for information of what, until she was ten months of age, and to her, seems important, but which she it was at this time that my greatest fears may seem trivial to the physi- trouble began, for I had no idea that cian. Oftentimes, the mother would there was a science connected with like to tell someone of what she is do- the feeding of a baby, but was rather ing for the babies in order to have of the opinion that God took those chil- them confirm her judgment, or maybe dren who died as an ornament to His it would please her to tell someone, Throne and because He loved them too who is vastly intei-ested, about the new well to leave them o n earth. The teeth, and ask whether or not her baby weaning took place in the fall of the is the proper weight for age, or possi- The Health Bulletin 15 bly she would like to apply for sym- TEMPEB AND CHILDREN pathetic understanding of her position By Samuel G. Dixon, M.D., LL.D., Commis- only. sioner of Health of Pennsylvania The expectant mother feels a deli- 7^ UR bodies are our gardens, to cacy often in discussing her condition, which our wills are gardeners." or she may be at some distance from ^1 '^" Physical, mental and moral her physician; or it may be for eco- health depend upon self-control nomic reasons she does not employ and a physician; but there are many things the cultivation of this in children is of on which she wants advice. If it is greater importance than any other sin- her first experience, maybe she would gle virtue. like to know the approximate date of Who has not observed the discipli- the baby's birth, or it may be the neces- nary efforts of parents with a feeling sary articles of clothing or toilet for that they could improve upon the the little one about which she wants meth- to be advised. Frequently when wean- ods employed and the results obtained? ing the baby, young mothers would The casual observer usually decides like the physician tell to go to and that parents are more often to blame him all aboilt the disposition, habits for the faults of their offspring than of eating and sleeping, etc.. of the baby, and get recipes and means for the children themselves. Like begets feeding "his lordship." But busy doc- like, and the loss of self-control by the tors do not have time for all of this, father and too frequently the conscientious and mother is almost certain to little woman depends upon the advice be reflected in the child. of her next-door neighbor, whose chil- With children of a high-strung and dren, like my own first baby, lived in spite of, and not because of mother. nervous temperament, the display of Aside from my own practical knowl- passion and the loss of self-control is edge, I have had ten years of technical to be expected. To teach a child to and teaching training in dietetics and mothercraft. and to this the State govern itself and to control these gusts Board of Health has added the advice of temper is worthy of the most of Dr. Aldert Smedes Root, whose forte careful study, persistent and kind ef- is the care of babies and who enjoys a big clientele of "Well Babies," as well fort. as treating sick babies. To permit a child to give way to pas- I want to do for you I should what sion during the early years of its life love to have had done for me twenty is apt, years ago. I want to be the friend to when the strain of the real bur- whom you will write for advice before dens of life are added in later years, the baby comes and after the baby to end in a nervous or mental break- comes, and until is he sent out from down. you on that first personal and individual experience of "going to school." All students of nervous diseases are The State Board of Health has a aware of the possibility of the inherit- large and wonderfully equipped corps ance of mental defects present in the of specialists in its employ, and any parents. No one factor is of greater question put to me in the interest of aid in equipping a child to battle with the mother or the child will be answered by them in case it is outside hereditary tendencies of this character my domain. I should like to get a than its education in self-control. It friendly letter telling of ex- me your is of the greatest aid in the establish- pectancy of a new "responsibility" and ment of mental equilibrium and the whatever you write shall certainly be strictly confidential and will receive an maintenance of a sane pose. Knowl- answer to the best of my ability. edge, morality, and a healthy, temper- in the Yours name of ate physical existence are the fruits better motherhood, Kate Brew Vaughn, derived from the cultivation of this Director. virtue. 11,749 BABIES UNDER FIVE YEARS OF AGE DIE IN NORTH CAROLINA EVERY YEAR

This Is One-Third Of All The Deaths Occurring In The State.

2,626 Of these babies under two years of age die of diarrheal diseases. 2,046 Under one month of age, die of congenital diseases. 3,153 Are stillborn.

557 Mothers die of diseases incidental to childbirth.

THESE DEATHS FOR THE MOST PART ARE DUE TO THE MOTHER'S NOT KNOWING THE PROPER METHODS OF CARING FOR HERSELF PREVIOUS TO THE BIRTH OF BABY, AND OF ITS CARE AND FEEDING AFTER ITS BIRTH.

To reduce the number of baby deaths in the State, the State Board of Health has created a Bureau of Infant Hygiene and employed as Director, Mrs. Kate Brew Taughn, who is herself a practical mother, and who, in addition to this experience, lias had technical training in 3Iothercraft and >utrition. Associated with Mrs. Yaughn is Dr. Aldert Smedes Root, who is recognized as one of the best baby specialists in the countrj.

Mrs. Vaughn desires to meet the mothers of the State personally or through correspondence that she may advise them regarding: PRENATAL HYGIENE (Confidential Letters). CHILD CARE. ARTIFICIAL FEEDING. FEEDING OF CHILD AFTER WEANING. FEEDING CHILD OF PRE-SCHOOL AGE.

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BUREAU OF INFANT HYGIENE STATE BOARD OF HEALTH — ?2X/ )

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ErUerea an iiecona-cum» matter at Postoffiee at Raleigh, N. 0., under Act of July 16, 1894, Published monthly at the office of the Secretary of the Board, Raleigh, JV. O.

Vol. XXXlf / FEBRUARY, 1919 No. 8

36. Death Rate Per 1000 Living Among White Males

CENSUS OF 1910

43 ^ il A€ES l!2 20 30 40 50 60 WHY BE AN OLD MAN AT FORTY?

The above cut shows that more than twice as many men die at forty as die at twenty. Anyone with a modicum of common sense knows that this is not as it should be. A man should be in his prime at forty, and some are at fifty; but, according to the above cut, the mass of men are in their prime at twelve. At this early age their vitality begins to wane and defects accumulate, so that by the time they are twenty and thirty years old, they are old men. This is largely because of neglect of the human body, failure to have it looked over for physical defects and weaknesses, and failure to have these remedied or removed.

Isn't it worth while to take a little more care of how you live and stay young at least until you are twenty? There are no physical reasons why men should grow old and die at forty. Adapted from "Flow to Live." TABLE OF CONTENTS

PAGE

3 1. Big Opportunities for the State 4 2. No Al Nation With C3 Men 5 3. Lloyd George on Health 7 4. Health Work in North Carolina, 1917-1918 12 5. Save the Babies by Prenatal Care 16 6. Facts About Public Health Nursing

FREE PUBLIC HEALTH LITERATURE The State Board of Health has a limited quantity of literature on health subjects for free distribution. If you are interested in one or more of the following subjects, or want same sent to a friend, write to the State Board of Health for free literature on that particular subject. Whooping-cough Clean-up Placards Smallpox Hookworm Disease Spitting Placards Adenoids Public Health L.^ws Sanitary Priyies Measles Tuberculosis Laws Residential Sewage German Measles Tuberculosis Disposal Plants Typhoid Fever Scarlet Fever Eyes Diphtheria iNF.-kNTiLE Paralysis Flies Pellagra Care of the Baby Colds Constipation Ply Placards Teeth Indigestion Typhoid Placards Cancer Tuberculosis Placards Malaria SEX HYGIENE BULLETINS Set a—For Young Men Set D—For Parents A Reasonable Sex Life for Men. When and How to Tell the Children. Sexual Hygiene for Young Men. Venereal Diseases—A Sociologic Study. Vigorous Manhood. The Need for Sex Education. the Line. (The case against the re- Smash List of Reliable Pamphlets. stricted district.) List of Reliable Pamphlets. Set E—For Girls and Young Women Officials and Set B—For Public Your Country Needs Business Men You. (Especially for girls 11 years of age and over.) Public Health Measures in Relation to Ve- nereal Diseases. Note.—For girls under 11, see "When Venereal Diseases A Sociologic Study. and How to Tell the Children" (Set D) — ; Smash the Line. (The case against the re- portions of "Your Country Needs You" stricted District.) also may be read to younger girls. Girls The Need for Sex Education. 15 and over may be given "The Nation's A State-Wide Program for Sex Education. Call to Young Women" at the discretion List of Reliable Pamphlets. of the parent.

Set C—For Boys The Nation's Call to Young Women. Vigorous Manhood. (Especially for boys 12 List of Reliable Pamphlets. years of age and over.) Note.—^For bovs under 12, see "When Set P—For Teachers

Tell the Children" (Set D) ; and How to Tlie School Teacher and Sex Education. "Vigorous Manhood" also may portions of Sex Education in the Home and High be read to younger boys. Boys 15 years School. and over may be given Bulletin "A Rea- Study. sonable Sex Life for Men" (see Set A), Venereal Diseases—A Sociologic at the discretion of the parent. Smash the Line. for Sex Education. Sexual Hygiene for Young Men. The Need List of Reliable Pamphlets. List of Reliable Pamphlets. only those bulletins for Any of the above will be sent without char; ;e. Please send for which vou have definite use.

EDWARDS « BROUGHTON PRINTING CO.. RALEIGH. N. C. ris?

m PUBL!5AE:D BYTAE, nOR.TA CAeOUNA 5TATL EPAIgD s>^MEALJM

Vol. XXXIV FEBRUARY, 1919 No. 8

EDITORIAL

BIG OPPORTUNITIES FOE THE that occurred in the State, were of STATE children of five years old and under; over 8,000 of the The Nation's manpower has just 11,749 deaths were been given a complete physical exami- of babies two years old and under. nation by Uncle Sam himself. Some- Shall the little children of the State thing like 10,000,000 men within the continue to die at this rate? healthiest age period, between twenty In a recent speech, Lloyd George, and thirty years, have been called from whose opinion has greater weight to- all classes and conditions of American day than any one man's in the world, life, and have been thoroughly exam- perhaps (with the single exception of ined under the direction of the Gov- Woodrow Wilson's) has sounded a ernment. This examination has re- solemn warning to his country regard- vealed perhaps the most significant of ing the dangers that await the State all facts relating to public health, to that neglects the health and physical wit, that 38 per cent of the men ex- welfare of its people. England's warn- amined were physically unfit for mili- ing is America's warning. This no- tary service. Can a nation or state table address appears on another page survive and prosper with 38 per cent of this Bulletin. Read it. There is of its population unfit for service? not a single statement of fact or opin- The diagram on the cover page of ion in it that Woodrow Wilson would this bulletin, which is also based upon not approve. the findings of the Government—the The account of the State of North Bureau of the Census—illustrates an- Carolina with her public health obli- other significant fact to those who gations and opportunities is given on think, to wit, that more than twice as pages 7 to 12 of this bulletin. The many people die at the age of forty as account is stated briefly and in busi- die at twenty. In other words, the ness form, giving first the total expen- vitality and physical endurance of the ditures, and second, the results, item average man has so depreciated that by item. Know what the State is get- at forty it is not half of what it was ting for the money it is spending on at twenty. Shall men continue to the health of its people. grow old and die at forty, when it is In the words of Lloyd George, "To their right and within their power to be thoroughly equipped to face any live to be sixty, seventy or eighty years emergency of either peace or war, the of age? State must take a more constant and Another significant fact to the more intelligent interest in the health thoughtful is that in North Carolina, and fitness of the people. You cannot out of 34,005 deaths last year, 11,749, maintain an Al nation with a C3 popu- or more than one-third of all the deaths lation." W. S. R. The Health Bulletin NO Al NATION WITH C3 MEN

Lloyd George Warns England of the Ruin to Follow Physical Neglect of the People—England's Warning Is America's Lesson.

war. One of the most notable addresses of have done great things in this We could have accomplished greater the war period is the health speech of if this country had been in a sound David Lloyd George, premier of Great condition. War, like sickness, lays Britain, in which he warns his coun- bare the weakness of the constitution. What has been ours? Let us talk quite of the ruin and decay that will in- try frankly. evitably follow neglect of the people's "We have had a ministry of national health and physical welfare. service set up in this country, and since then we have had the most care- Lloyd George's warning to Britain fully compiled statistics as to the Is America's opportunity to learn a health of the people, certainly between great lesson. The conditions that the ages of 18 and 42. That is the age of fitness and the age of strength. threaten her future greatness—condi- What has it revealed? and happi- tions affecting the health "You have the three grades—your ness of her people—are some of Ameri- Al, your B2, and your C3—and all I ca's greatest problems also. can tell you is this, that the results Lloyd George's speech in part fol- of these examinations are sufficiently startling—I do not mind using the lows: word appalling. I hardly dare to tell To Be Ready for Peace you what iL is in some parts of Lan- cashire. The number of B2 and C3 unseen hand casts "As soon as the men throughout the kingdom is pro- skies we the rainbow of peace on the digious, so much so that we have half is must be ready. And to be ready suspected the doctors. But there was must summarized in one counsel. We a reexamination, which did not make of the war. profit by the lessons very much difference, and I apologize it has taught us Is "The first lesson to the doctors here—for the first time. the immense importance of maintain- Nation. The ing the solidarity of the Human Material Wasted British empire has rendered a service to humanity the magnitude of which "What does it mean? When you this will appear greater and greater as look at it. it means this—that we have generation recedes into the past. It used our human material in this coun- helped to stop the onrush of barbarism try prodigally, foolishly, cruelly. I that was sweeping over Europe. It asked the minister of national service has held the unfenced highways of the how many men we could have put into world free for the armies of freedom the fighting ranks if the health of the to pass and repass. To permit such country had been properly looked af- an organization to fall to pieces after ter, and I was staggered at the reply. the war would be a crime against It was a considered reply. He said at civilization. least one million. If we had only had "The next great lesson of the war that number this war would have long is that if the State, if Britain, is to be ago ended triumphantly for us. thoroughly equipped to face any emer- "But here we are, combing out essen- gency of either peace or war the State tial industries—there are questions as must take a more constant and more to whether you should put miners back Intelligent interest in the health and or keep them in the army (a few tens is fitness of the people. If the empire of thousands) ; whether you should put to be equal to this task, the men and a few thousands more into munition women who make up the empire must works. And yet you had one million be equal to theirs. How does Britain men who, if the State had taken proper stand in the light of that test? We care of the fitness of the people, would The Health Bulletin liave been available for the war. And "Now the most important workshop the vigor and strength of the workers in this land is the home. And the of this country have been unsatisfac- quality of the steel in the national tory even in pursuits where all condi- fabric depends upon the home. If it is tions are favorable to the development unhealthy, ill-equipped, ill-supplied, ill- of a fine physique—agriculture. The managed, the quality becomes defective results in agriculture have been almost and it cannot bear the strain. as disappointing as in almost any other industry—a thoroughly healthy occu- Health Needs of the People pation of that kind. "Everywhere a virile race has been "What are the influences that make wasted by neglect and want of thought for the health of the people? The first for it. It is a danger to the State and is the houses in which the people live. to the empire. You cannot bring up a healthy people "And unless this lesson is learned, in unhealthy homes. Why. even those the war will have been in vain. Our who rear animals will tell you that. schooling has cost us dear, but if we The problem of housing in this coun- LLOYD GEORGE ON HEALTH

"War, like sickness, lays bare the "If the State had properly looked weakness of the constitution." after the fitness of the people, England would hare had 1,000,000 more fighting men at the front." "You cannot maintain an Al nation with a C3 population." "Ton cannot bring up a healthy people in unhealthy homes. The most "Care for the health of the people is important workshop in the land is the the secret of national efficiency." home."

"To be thoroughly equipped to face "Ton cannot plow the waste land any emergency of either peace or war, with writing paper, you cannot sweep the State must take a more constant away the slums with paint brushes, and more intelligent interest in the and you cannot bind the gaping health and fitness of the people." wounds of tlie people with red tape." make the best use of it I believe it will try is the most urgent that awaits be worth it all in the end, even in the treatment. We have talked about it, saving of human life. we have played with it for forty, fifty "Care for the health of the people is years, but it has never been really the secret of national efficiency. It is taken in hand. It has only been taken the secret of national recuperation. in hand in the way an untidy or slov- With our machinery we take the great- enly housewife takes up the cleaning est care. It is material. The way we of her house—just that part where the look after it if the steel is defective visitor can see. through badly ventilated or ill-con- "There has been too much of that structed furnaces or insufficient fuel! in our cities. The slums, the bad If the machine is inadequately oiled houses—they are out of sight. That or not looked after or overworked, if is not the way to deal with a problem repairs are not done in time and done which affects the strength of the Na- thoroughly—well, your machinery is tion. No government, no party has no use. had the courage to grapple with it in "I solemnly warn my fellow country- the way a good business man would men you cannot maintain an Al em- grapple with some sort of rottenness pire with a C3 population. which he discovered in his business, "And man is the most delicately con- and which was wasting his assets. He structed of all machines. It is bad would not trifle with it; he would business not to look after the men, have the thing thoroughly searched the women, and, if I may say so, above out and put right. That is what ought all the children. to be done. It is equally true of the —

The Health Bulletin

through whole field of public life. We have mighty struggle have not gone firmly in this had acts of parliament running into it all to reestablish more land, for which they have fought, the hundreds of sections; we have had dominion of slums; of wages that will regulations that would fill a library; not maintain, let alone che^r life; of the most attractive pic- we have had confusion and disorganization, which circulated, tures of model dwellings create waste, inefiiciency, misery and and we have had endless authorities. squalor. But you cannot plow the waste land "But to enable the Nation to bear with writing paper, you cannot sweep the gigantic burden of debt which the away slums with paint brushes, and war will impose upon it. and the still you cannot bind the gaping wounds of greater burden of recuperation and re- the people with red tape. That is our construction, we must see that the first problem. national resources are developed to the "The next is this: There ought to full, and that the State renders all be a more intelligent organization of assistance in its power for the attain- the forces which have specially in ment of that object. Comfort is the charge the health of the Nation surest preventive of anarchy, the best national, municipal, medical. We have conditions of production. If abundance enormous losses to make up. The is not there you cannot distribute it. crippled and the wounded must come That is an obvious truth which the first; but we must also think of the Bolsheviks seem to have overlooked. children who are to fill up the gap in The Bolsheviks began with distribu- the generation that is to come. tion and ended with distribution. Pro- "The State must see that they are duction did not concern them. That is built up into a strong, healthy and the surest road to national poverty, vigorous people. There is no surer and it is the Bolshevist method. way of strengthening the country than "The State must help, the State must that. promote, the State must encourage pro- "What more are we to do to improve duction; it must remove hindrances to the life of the people? Wages during production; it must insure that confi- the M'ar have been raised and we must dence and security which is essential see in the future that labor is requited to production. There must be no with wages that will sustain life in shrinking from national organization, full vigor. I am glad to see that in national production and national as- agriculture wages have gone up. There sistance. must be healthier conditions in the workshops. Many of them were ad- Storm Signals Appear mirable; many of them tolerable, many not tolerable. Bad health for the Na- "In my Welsh home we have an in- tion is bad business for all. variable method of ascertaining when the storm is coming. There is a light- The ^Nation's Hour house behind the western hills. When the weather is fair and settled you "There are times in the history of never see its light. But now and the world when nations take a great again it illumines the darkness, and leap forward into the light. This is you then know that the storm is com- such a time. There is a great river in ing. I have been scanning the hori- eastern Europe which, after meander- zon, and I can see fiashes on the sky ing sluggishly through hundreds of which indicate to me that there are leagues, finding a great barrier in its grave atmospheric disturbances in the road, concentrates the whole of its social and economic world. In the strength to break through—rushes natural world you cannot with think- along and then merges into a sunnier ing avert the storm. In the more ar- land and into more fertile plains. That tificial world of human society you is the story of the national life of this can, if you take heed in time, avert the country, before, during and after the hurricane. I give one advice to my war. It has taken a great rush for- countrymen, and I say it solemnly to ward, and when it emerges from the them—take heed in time. And if you rocks through which its torrents are do we shall enjoy settled weather for now struggling it will deploy into a the great harvest which is coming sunnier and a fairer land. when the fierce heat of summer which "The men who endure the discom- is beating upon us in this great war fort, the terror, the torture in this will be over and past." The Health Bulletin 7

HEALTH WORK IN NORTH CAROLINA, 1917-1918

An Account of What the State Has Spent on the Health of Its People, and What It Has Received.

By Dr. W. S. Rankin, Secretary-Treasurer, State Board of Health

We assume that the people of North Dlridends on Investments in Public Carolina are interested particularly in Health just two things with respect to the Item 1. The State Laboratory of work of the State Board of Health: Hygiene has examined annually for the (1) What the Board spends; (2) What last two years 8,652 microscopic speci- the Board gets for the expenditure. mens, which would have cost the peo- This statement, therefore, will deal, ple and the physicians of this State, if in as brief a manner as is consistent examined in other laboratories, a mini- with clearness, with the debit and mum of $1.50 per specimen, or a total credit side of the State's account with of $12,978. This $12,978 is one divi- public health. dend that is paid on the State's invest- Just one additional introductory ment of $86,991.13 in the health of her statement needs to be made—a state- people. ment in no sense intended a s an Item 2. The State Laboratory of apology but as simple justice to the Hygiene has examined annually for Board of Health. The work of the the last two years 2,100 samples of State Board of Health, during the last drinking water. These analyses, if biennium, has been seriously inter- made by other laboratories, would have fered with by two things: (1) The cost the State $5 a piece, or a total war; (2) The epidemic of influenza. of $10,500. This $10,500 is a second The war called for a mobilization of dividend paid on the State's invest- medical men and health officers. The ment of $86,991.13 in the health of her State Board of Health lost a number people. of its officers to the military service of Itein S. The State Laboratory of the country, and it was not only im- Hygiene has treated annually for the possible to replace our losses, but im- last two years 336 citizens of North possible to secure health officers for ex- Carolina who had been bitten by rabid tensions in the health work that would It would have cost these have been made but for the war. The animals. citizens a minimum of $15,000 to have epidemic of influenza necessitated the secured this treatment outside the cessation of much public health work State. This $15,000, then, may be re- for the reason that public health forces third dividend paid on the were concentrated on the epidemic. garded as a State's investment of $86,991.13 in the health of her people. Expenses of the State for Public Item 4. The State Laboratory of Health Hygiene has distributed annually for During the biennial period of 1917- the last two years 248.876 doses of ty- 1918, the annual income of the State phoid vaccine, 7,896 doses of whooping- Board of Health, including the Labora- cough vaccine, and 29,580 doses of tory but not the Sanatorium, has been smallpox vaccine, which vaccines, if $86,991.13. purchased at the ordinary retail price, 8 The Health Bulletin

would have cost a minimum of $100,- work in this State have amounted to 000. This $100,000 is, then, a fourth over $16,000. In short, Ave have been dlrldend paid on the State's invest- instrumental in securing from outside ment of $86,991.13 in the health of her sources, without cost to the State, dur- people. ing the last two years, $60,000 worth Item 5. The State Laboratory of of health work. Hygiene has distributed annually for Item 7. A silver nitrate solution the last two years 2,412 doses, or 12,- has been supplied to all the physicians 060,000 finits, of diphtheria antitoxin. and midwives of the State, with in- The antitoxin, distributed free of cost structions as to the law requiring the to the people in 1918, at the old retail application of this solution to the eyes price would have cost $12,060. The of all new-born children for the pre- antitoxin distributed in 1917, at about vention of gonorrheal ophthalmia, or one-fourth the previous retail price of blindness in the new-born. antitoxin, saved our people an addi- There occurs in North Carolina an- tional $9,000, making a total saving on nually about 100 cases of gonorrheal diphtheria antitoxin of $21,000 for the ophthalmia, or blindness in the new- last two years, or an annual saving of bom—a form of blindness that is pre- at least $10,000. But this by no means vented in 98 per cent of the births, represents the total amount saved un- where it otherwise would occur, by the der this item to the citizens of North use of the silver nitrate solution; in Carolina. Commercial manufacturers other words, there are 12^/^ cases of

cJf antitoxin, In order to sell their this preventable blindness for every product at all in North Carolina in 10.000 births. The State Epidemiolo- competition with the State's free anti- gist believes that he is conservative in toxin, have had to cut their original assuming that in at least half of the price to one-third of what it was. The births occurring in the State, 40,000 people are now paying only one-third births, the law requiring the applica- of what they otherwise would have to tion of silver nitrate is complied with. pay for the antitoxin of private manu- If this estimate is correct and if the facturers. The arrangement of the prophylactic is 98 per cent efficient in State Board of Health for supplying preventing blindness, 49 cases of blind- antitoxin to the people of North Caro- ness are prevented each year through lina saves our State not less than $20,- this law. Let us assume, however, 000 a year. This $20,000 is, then, a fifth that less than half of this amount of dividend paid on the State's investment blindness is prevented—20 cases. It of $86,991.13 in public health. costs the State of North Carolina $185 Item 6. The State Board of Health a year per blind child to give it an has interested the International Health education with the hope of making it Board and the United States Public self-supporting. It requires at least ten Health Service in opportunities for years at the Blind Institution for the successful public health work in North child to receive this education. This Carolina to the extent of obtaining would make a total cost to the State from these agencies, during the past for educating the blind child, as an ef- two years, a total appropriation of fort to make it self-supporting, ten $43,757.19. In addition to this direct times $185, or $1,850; for twenty blind appropriation, we have secured from children this would be $37,000. While the above agencies the loan of health estimates of the amount saved by this officials for work in North Carolina, law will vary with the individual without cost to the State, whose com- viewpoint, it will be admitted by all bined salaries during the time of their that this law is saving the State each —

The Health Bulletin

year many thousands of dollars, and less 628, or 211 lives from typhoid fever saving some of the State's citizens a during the year 1917. There were loss that is incalculable. saved 839 less 502, or 337 lives during

Item S. The Board of Health was the year 1918, or, during the two years, successful in securing the appointment there have been saved 548 lives from of all the officers—State and county typhoid fever. concerned with quarantine work in The fatality from typhoid fever is 10 North Carolina to the position of col- per cent; that is, 100 cases of the dis- laborating epidemiologist of the Fed- ease cause 10 deaths. A decrease of eral Government. While the Federal 548 deaths, therefore, was necessarily Government pays these officials only $1 associated with the prevention of per year in accordance with an act of 5,480 cases of the disease. Taking the Congress, the position of an official in estimates of the value of the average the Federal Government permits the life at the average age at death from State and county quarantine officers typhoid fever, made by political econ- to use the franking privilege which omists of national reputation and life t saves to the State and the counties not based upon the expectancy and ^ less than $5,000 a year postage. earning capacity, the 548 lives saved Item 9. Several years ago, the State were worth $4,000 each, a total of $2,- Board of Health was responsible for a 192,000 of vital conservation. change in the management of out- The prevention of 5,480 cases of ty- breaks of smallpox. The change ef- phoid fever associated with this sav-

fected was shifting the responsibility i n g f 548 lives also h a s a money of protecting the unvaccinated (the equivalent. The average case of ty- only susceptibles) from the community phoid fever lasts six weeks. The cost t t h e unvaccinated individual. I n of treating an average case of typhoid I making this change, the State Board fever, estimating the amount paid phy- of Health did away with a system of sicians, druggists, and nurses, and smallpox quarantine and isolation losses of salary or per diem on account which, according to reports from coun- of sickness, may be conservatively es- ties for the year preceding the change timated at $100 a case (usually esti- in the method of control, was costing mated at $200 each case), which the State $66,000. Smallpox is one of amounts to a total of $584,000 saved the least significant factors in the from sickness. State's death rate. As a result of the In this item it appears, therefore, change in the method of control, there that through the work of typhoid pre- has been, apparently, no increase in vention as organized, directed, and car- either cases or deaths. It appears, ried on by the Board, and through the therefore, that the Board of Health, Board's previous efforts, there is a through this policy of making the in- vital saving to the State of North Caro- dividual responsible for his suscepti- lina estimated at $2,740,000. bility to smallpox instead of his com- Item 11. The State law which re- munity, is saving the State annually quires that all plans and specifications something like $50,000. for waterworks and sewerage systems Item 10. In 1914, for the first time shall be submitted to and approved by in the history of the State, deaths from the State Board of Health, before be- all causes were accurately recorded. ing accepted by the municipalities for In that year there were 839 deaths which the plans and specifications are from typhoid fever; in 1915, 744; in designed, safeguards our towns and 1916, 700; in 1917, 628, and in 1918, cities against the work of cheap engi- 502. There were saved, therefore, 839 neers and contractors. To illustrate: 10 The Health Bulletin

A town in this State, before this law accordance with instructions and un- went into operation, let a contract for der the direction of the State Board of the installation of a public water sup- Health. It is officially recorded that ply. The water supply was found dan- 10,670 of these school children have gerous on account of its location and been treated. As a result of the above had to be moved. The location of the examinations and treatments, thou- school children of which water supply, had it been passed upon sands of other have no record have received much by the State Board of Health, would we treatment. never have been approved. To change needed and proper year, the location of the supply cost the Item IJf. During the first full town somewhere between $10,000 and 1918, of its existence, the Bureau of of $15,000. Many such losses have been Epidemiology of the State Board saved the municipalities of the State Health prescribed the method and su- quarantine of 29,785 cases by this law which requires that all pervised the plans and specifications for water sup- o f communicable diseases. As a against the unneces- plies and sewerage systems b e ex- further precaution amined and approved by the engineers sary spread of communicable diseases, patrons of of the State Board of Health before the teachers, pupils and being accepted by the towns and cities 3,598 public schools were notified, for which they are intended. through a well developed system, of Item 12. The State Board of Health the exisitence of communicable disease community, of the dan- in its direction of the management of in the school the influenza epidemic, believe;; and gers of the disease, its methods of claims that when the epidemic has spread, and the means for its control. passed and the records are available In this way, many thousands of cases comparisons with the other states will of contagions that would have occurred have show that the influenza cases and otherwise, causing many deaths, deaths per thousand population in been prevented. North Carolina compare favorably with Item 15. Probably the most im- the incidence of the disease elsewhere, portant, certainly the most funda- and that in attaining these results the mental, health law that any state may cost of handling the epidemic to this enact is a vital statistics law. The State was small, comparatively speak- vital statistics law of North Carolina ing. In the work of medical relief, requires the State to secure, and per- sixty-four communities were served manently preserve in a fire-proof vault, with seventy emergency doctors and a complete record of the two principal sixty-one emergency nurses at a total events in the life of each citizen—the cost to the State of $1,266,37. We birth and the death of the citizen. The claim now, leaving the verification of State holds that not one of its citizens the claim to the future, that in this is so humble that his coming and his work we saved many thousands of dol- going should not be taken ofiicial note lars to the State of North Carolina. of An annual average of 77,000 births Item 13. Over 160,000 school chil- and 34,000 deaths are registered, card dren have been given a preliminary indexed and classified by race, sex, age, physical examination by school teach- county, township, town or city, and by ers in accordance with instructions and cause of death. under the direction of the State Board For the individual, these records of Health. About 48,700 of these school mean that each child may be enabled children have been given a second or to keep track of its ancestors—father, complete physical examination by phy- mother, grandparents, great grandpar- sicians and specially trained nurses in ents, collateral kin. Each individual The Health Bulletin 11 will be enabled to prove his or her age culation in excess of 1,125,000; a total In the courts, his or her right to suf- of 12,816 letters have been written; frage, the right to marriage, the right motion pictures featuring health sub- to insurance, the right to enter various jects in an entertaining manner have Industries, the right to inheritance, been witnessed by approximately 58,298 etc. people; approximately 19,971 people For the State, this law means that have witnessed illustrated health lec- the number of deaths per thousand of tures; approximately 52,285 people the population occurring in North have witnessed special health exhibits. Carolina, or in any county or town- The value of the results attained by ship, or town or city of the State, shall these efforts is something that can- be known. It means that the number not be estimated in dollars and cents. of births per thousand of the popula- The value of any educational move- tion in the State, in the counties, in ment is an intangible quantity. The any part or subdivision of the State, Bible, the work of the ministers and shall be known; that by comparing the churches, the school system, the such figures with similar figures from press, all are vital agencies upon which the other states of the Union, the peo- no exact value can be placed, but of ple of this State, the people of other such tremendous importance that no states and of the world, may know, not sane person would argue for the sup- guess, what health conditions in North pression of any. In like manner the Carolina are. educational work along health lines

Best of all, this law has shown and cannot be valued exactly. It has car- caused to be published on the authority ried information and instruction to the of the United States Government, the people of the State, reaching directly fact that the State of North Carolina at least one-half of the population. is one of the healthiest in the Union. "Line upon line, precept upon precept," This is the meaning of our death rate the prevention of disease has been of 13.0 per thousand of the population preached, and the deaths from preven- per year, and our birth rate of 31.9 table diseases have been materially re- per thousand of the population per duced. year, as compared with the average Item 17. The State Board of Health, death rate of 13.9 and birth rate of by its educational activities, has fos- 24.8 of the registration states of the tered, strengthened, and directed an Union for the same year—the last year interest on the part of the counties in for which the figures are available. local health work so that today North Item 16. A continuous and exten- Carolina has sixteen counties, embrac- sive educational campaign has been ing a total population of 687,634. or waged against unhygienic and insani- 28% per cent of the population of the tary conditions in the homes and com- State, under whole-time county health munities of the State. This has been officers. No state in the Union has de- carried on in the following manner: veloped its county health work to a The Health Bulletin has been mailed like extent. to an average of 48.000 people monthly; Item 18. In nine of the sixteen specially prepared leaflets, pamphlets counties referred to in Item 17, the and placards have been distributed State Board of Health has had direc- upon request to an extent exceeding tion of the county health work for a 30,000 monthly, daily articles have period of fourteen months, and in that been supplied to the newspapers of the time the amount of work accomplished State for publication, these having is indicated in the following tabula- been used in publications having a cir- tion: 12 The Health Bulletin

1. 969 public health meetings were SATE THE BABIES held with a total attendance of 87,450. B¥ PRENATAL CABE 2. 815 health articles were published in the county papers. of Infants 3. 7,364 homes constructed sanitary Many of the Useless Deaths privies. Caused by Lack of Care 4. 20,834 people were examined for Before Birth hookworm disease, and 3,928 were treated. By Mes. Kate Brew Vaughn 5. 479 schools were visited by health When, from the time of the closing officers. of the gates of Paradise, the wrathful 6. 38,969 school children were examined by the teachers working un- edict of Jehovah thundered out after der the direction of the health officers. the fleeing form of the mother of us 7. 12,699 school children were ex- all: "In pain shalt thou bear thy chil- amined by the health officers, these dren," to the present, the woman has children being referred by the teachers. to the decree and 8. 6,171 defective children were bowed her head treated. borne the punishment, if such it can 9. 1,528 adults were given physical be termed, with grim fortitude and examinations by the health officers. heroism. But there have always been 10. 37.234 people were vaccinated against typhoid fever. some on whom this punishment has 11. 6,450 people were vaccinated fallen lightly, and it seems that the against smallpox. women of the freest, most primitive 12. 4,356 cases of infectious dis- life have, in a large measure, escaped eases were quarantined. the horror and the danger of child- Item 19. The executive office of the birth of the more civilized or sentitive con- State Board of Health rendered people. It is proverbial that the In- siderable assistance, possibly amount- dian woman keeps her place in the ing altogether to two months full time march until "her hour" has come, and service, to the Council of National De- shortly thereafter resumes it with her fense, the Surgeon General of the burden upon her back; the peasant Medical Aide to the Army, and the women of all countries living free and pro- Governor in the preparedness primitive lives neither dread nor evade gram of the country. maternity. Our own great grand- general Item 20. To indicate the mothers in a new country, beset with the State Board of business handled by hardships and stripped of all conven- official correspondence, Health, the iences and luxuries, brought into the years, amounted during the last two has world the men who built the ideals of letters and 104,- to a receipt 92,550 and supplied the material structure of 120 replies. This is equivalent to a this Nation, and this largely without daily correspondence of 126 letters re- the benefit of the medical profession, replies. This does not ceived, and 142 which had fewer members in the new preparation and mailing of include the country than the ministry; and this 110,704 multigraph letters. same woman found five days lost from her work all that could be spared to issue into existence a Washington or a All utensils with which milk comes Lincoln. It is to be noted that many than we in contact should be rinsed, washed more of those sturdy women and scalded every time they are used. would like to contemplate died of child- ills of con- When a baby is bottle-fed, every bed fever and the attendant time each feeding-bottle and nipple are finement. It was not unusual to lose the used they should be rinsed in luke- 25 per cent of the family before been at- warm water to Thich a small amount first year of their age had of boracic acid has been added, and tained. The succeeding generations then scalded. have found a declining birth-rate and The Health Bulletin 13 an Increasing dread on the part of the husband with the caved in ribs, women of the maternal experience. who could do no heavy labor. What Is There is in one of the northwestern the mysterious balance which inheres cities, a little Polish mid-wife who, in the constitution of some women and aside from stirring the men of her own not in others? Is it a matter of in- nationality to enlist in this war, has heritance or physical training or mus- performed a signal service for the cular and structural proportion and de- country of her adoption during the two velopment? What part does the life, years of war. She Is a pathetic little activity and training of the growing creature, weighing 95 pounds, born girl play In the determination of her thirty-five years ago in Russian-Poland subsequent maternal competency? and left, early, an orphan and at the What relation do dress, exercise and mercy of a pitiless neighborhood. She diet bear to this all important subject? was brought to America at the age of How far this maternal competency sixteen by a thrifty family who saw in may be furthered by proper care and her an excellent and an inexpensive medical advice is being demonstrated servant, on whose shoulders were in states emphasizing prenatal and in- placed burdens which should right- fant hygiene work. fully belong to a stevedore of husky Reports of the Department of Vital proportions. All her life she toiled Statistics of the State Board of Health, like a slave for a small recompense, show 74,795 births in 1917, of which and at twenty years of age she married 3,153 were still births. During the a "squatter" on a small farm. An acci- same year 11,749 children under five dent which caved in his ribs, made years of age died from all causes. hard work impossible for him. The Diarrheal diseases caused the deaths toil-hardened woman wrestled like a of 2,626 babies, 1,456 of whom were un- minature Titan with the cut-over der one year of age, and 1,170 were in ground, which was fertile enough af- their second year. Congenital debility, ter it had been gotten at through a net- lack of care, etc., were the cause of work of rocks and stumps, while the 2,046 deaths, most of which occurred husband whose ribs were crushed past during the first month of life. Four hard work, took care of the house and thousand six hundred and seventy-two children in her absence. The fact deaths of children under two years of which stands out most is not her suc- age from diseases largely preventable cessful farming, which in itself is a by proper education of the mother in bigger job than most men can accom- care and feeding. Three thousand one plish, but the fact that not content to hundred and fifty-three still born ba- have brought into this world eleven bies, many of whom might have been lusty infants of her own in the past saved by a reasonable knowledge of eighteen years, she has in her rural prenatal hygiene and the means for ob- community relieved the fears and taining such for herself by the mother. given physical comfort, In the absence It is true, of course, that pregnancy of a physician, to over an hundred and childbirth are usually normal pro- mothers and babies. cesses, but not always. Fortunately, It is told that one morning last most abnormalities and unusual con- April she not only delivered herself ditions give timely warning of their of two beautiful girls, twins, numbers occurrence and In many cases may oe 12 and 13 of her family, but she relieved by simple methods or lend washed and dressed them and after- themselves to treatfnent which should wards prepared breakfast for the bal- lead to a successful termination. In ance of the family, which embraced fonner times every woman who gave 14 The Health Bulletin

birth to a child or passed through a Assistance necessary to make con- miscarriage was exposed to great dan- finement safe, demands special train- ger of infection and child-bed fever, ing and should be looked upon as a but at present, thanks to the recogni- special branch of surgery. The best tion of the bacterial origin of the dis- surgeon available is called In to oper- ease, this danger can be practically ate for appendicitis or to set a fractured bone; a trained veterinarian is eliminated by the rigid observance of called in for valuable stock, but fre- surgical cleanliness and hygienic con- quently a woman, at the head of the ditions on the part of patient. It has whole machinery, is attended by a also been found that the most effective superstitious mid-wife who is none too method of combatting any of the com- clean. The financial value of a baby plications of pregnancy is by prevent- is $90. The economic value of a mother ing their occurrence altogether. Fail- between twenty and thirty years of age ing in this, to take in their ear- them is $4,100, to say nothing of the spirit- liest stages for treatment. ual and humane aspects of the case. Only of late and to a limited degree It has been proven that nursing serv- has it been realized that expert super- ice is invaluable in supplementing vision is necessary for every woman medical supervision during pregnancy, during pregnancy. If complications of and this is particularly true in the this period and of confinement are to country where the distance from the be prevented or cured, such supervi- physician makes it difficult to see him sion is necessary for the reduction of regularly. A nurse who has had special the maternal mortality rate. That training and experience in prenatal physicians should realize these facts work and who is especially equipped to is not enough; women and their hus- discern danger signs in pregnancy, will bands must realize them also, other- be of great help to the expectant wise, women will not consult their mother in the country and to her phy- physicians early or regularly during sician. pregnancy, nor will their husbands be Great possibilities are in store for willing to pay for this added service. those who apply themselves to the Every expectant mother in North problems of prenatal care as part of a Carolina is entitled to the advice of a campaign for reduction of infant mor- well trained physician, physical exami- tality. This will call for coordination nation, including pelvic measurement, of all factors and the unselfish appli- frequent examination of urine, and cation of means at command. The necessary dentistry. It is her right to material reduction of infant mortality expect ample nourishment, sufficient will be impossible unless the two rest and sleep, work and exercise mod- causes, congenital diseases and diar- erated to prevent fatigue, proper cloth- rheal diseases, are attacked from in- ing and the possibility of recreation. dividual or special standpoint. The The woman should have at least one later diseases can be taken up after week in bed after birth and should not the child is born. Information for resume her household work for at least this campaign is available through the a month following confinement, in or- birth registrations daily received at der that she may recuperate from the the office of the State Board of Health. strain and produce milk for her off- The former must be attacked before spring. If the mother resumes her the birth of the child. Information work at once, the energy from her food upon which the campaign is based will be expended in that labor, instead must come from individual sources. of into the breast milk for her baby. Ignorance is one of the main causes The Health Bulletin 15 of illness and death among babies and (2) Securing the cooperation of all is due either to the fact that parents physicians in availing themselves of do not want to learn or because, oppor- the service of the State Board ^f tunities for information have not been Health and the visiting nurse, where given them. Most mothers are anxious such obtain, so that mothers who come to be taught how to care for their under their supervision may be in- babies, how to keep them well through structed in hygiene of pregnancy and the hot summer, what to do before the referred to them in the event of unto- doctor comes in an emergency, such as ward signs or symptoms. croup or convulsions; how to nurse a (3) Securing the interest and co- sick child, or a mother and new born operation of commercial and philan- baby at home. These are all questions thropic organizations in establishing which most women are anxious to prenatal and infant health work. learn all they can, and the number (4) Securing the cooperation of who do not know because of lack of women's clubs, demonstration agents, opportunity is greater than the num- ministers, in incorporating this pro- ber who do not want to learn, or the paganda in their educational work. neglectful ones. We cannot compel (5) Securing the cooperation of the mothers to take the proper care of press. their babies and we cannot legislate In order that the principles of pre- this righteousness into them, but we vention may receive fullest application can gain their confidence and coopera- during pregnancy, it is advisable that tion, qualities which bring definite re- intelligent women should have some sults. knowledge of the reproductive pro- The success of prenatal and infant cesses in human beings. Prenatal care hygiene work depends upon: and its proper application includes (1) The cooperation of counties in care of the infant during the most crucial employing (a) Whole-time health oflB- period of its existence, the first cers whose duty it will be to examine month. and treat those whose condition in life While we are of the opinion that the prohibits the engagement of a family best form of educational propaganda physician and the means of securing is personal contact with the mother, proper instruction and advice in cases in the absence of sufficient means for of unusual character; (&) A visiting this, we feel that literature which will nurse who will visit, advise and assist reach them at stated Intervals may all mothers or expectant mothers, giv- awaken their interest or keep it alive ing particular attention to primiparous in case it has already been generated. women, to delicate children and babies We must set them thinking of the artificially fed; (c) Maintain an oflSce importance of prevention as compared available to the mothers and children with correction, and we must give of the county; (d) Hospitals accessi- them such corrective measures as is ble to all parts of the county by means possible. of good roads for complicated cases. With the world confiict ended glor- If the public could be taught that such iously, but at great cost in human life, service could be obtained, the mid-wife we can easily see that the fortune of a problem would adjust itself and hospi- nation is the healthy babies to take tals for maternity cases would increase the place of the men sacrificed to make in popularity by the force of the ex- this victory possible. With the hope cellent results of their service; (e) of giving this information and advice The licensing and intelligent local su- where it is needed, we have available pervision of mid-wives. for distribution free literature which 16 The Health Bulletin deals with the different phases of this of disease, and by providing adequate expectant period and the early years and equal care for all who need care. should be di- of a child's life. We will be glad to Ideally, a community with a sufficient send this information to you or your vided into districts nurses in each friends, and will be glad to have regis- number of public health all the people tered with us expectant mothers as district to care for foundation on early in their pregnancy as possible, within it. "The safest public health work may be so that each one may get the beneSt which any general nursing care of all of the advice we have to offer. built is the the sick of the community, irrespec- FACTS ABOUT PUBLIC HEALTH tive of class, age or type of disease." NURSING The Public Health Nurse Must be a graduate nurse of a recog- Dr. L. B. McBrayeb Contriliuted by nized hospital and should have taken additional training, either during or More Public Health Nurses are after her regular course, in public Needed health service. This additional train- public health nurses The demand for ing in properly supervised agencies greater than the which was already other than hospitals is necessary be- been increased by the war supply, has cause of the social and economic prob- by the recent epidemic of influenza, and lems she is forced to meet and the during which the public health nurse necessity of her cooperation with all has so fully proved her value, not only other public agencies. by care of the sick, but by the educa- of the Public Health Nurse tion of the community in preventive The Work measures. The social readjustments Includes care of mothers and babies, industrial nursing, of reconstruction will make the need school nursing, and the demand for public health nurs- tuberculosis nursing and medical social ing limitless. service nursing. The public health To supply this demand there must nurse may specialize in any one of be more courses established in hospi- these fields, but in small communities tals and universities for the additional usually serves in all capacities. by public health training needed The University of North Carolina These courses must include nurses. has recently added to its library books in other adequately super- field work and literature on public health nurs- agencies. Scholarships vised social ing which can be borrowed in the same be secured to enable young must way as other things from this library. this training. A sense women to take Those interested should address Dr. value of the work and a recogni- of L R. Wilson, Librarian, University of importance of the women tion of the North Carolina, Chapel Hill, N. C. who perform it must be developed in The State Red Cross Seal Commissiou mind in order that women the public has appropriated $1,000 to aid nurses of talent and intelligence may see the in North Carolina who will afterwards opportunity which this field offers do public health nursing in North them. Carolina in taking a course in public will The Aim of Public Health Nursing health nursing. The scholarships nor more than Is to maintain the health of a com- not be less than $50 munity by educating every member of $100. For further information ad- Ehrenfeld, State the community in the principles and dress Miss Rose M. Nursing, San- methods of hygiene, sanitation, the Director, Public Health spread of disease and the prevention atorium, N. C. NOTICE TO READER.—When you finish reading this maoazine place a one-cent stamp on this notice, hand same to any postal employee and it will be placed in the hands of our soldiers or sailors •tthe front. NO WRAPPING— NO ADDRESS. __

PublislyedbM TAZ. i^9Rm CAKPLU^A STATE. DPARDs^AmUn

This Bijleli A will be 5er\X free to oiNg citizeA of lihe State upoi\ request !

Entered as second-class matter at Postoffice at Raleigh, N. O., under Act of July 16, 1894 Published monthly at the office of the Secretary of the Board, Raleigh, N. 0.

Vol. XXXffI MARCH, 1919 No. 9

Advancement—improvement in conditions—is the order of things in a society of equals. —Lincoln.

RECOMMENDATIONS OF THE NORTH CAROLINA STATE BOARD OF HEALTH TO THE GENERAL ASSEMBLY OF 1919

One. That diseases and deaths caused by fecal infections

be decreased by making the more dangerously located insani-

tary privies sanitary.

Two. That adequate and proper treatment for public school

children suffering from physical defects be provided.

Three. That the State make provision for financial partici-

pation with the Federal Government, the counties, and other

agencies interested in the development of rural sanitation.

Four. That the State co-operate with the Federal Govern-

ment in its program for the prevention of venereal diseases. Lllll PUE)U5AE£> BY TAE, HORJA CAgOUhA 5TATE, BQMgP a^MEALTM ||[2J

Vol. XXXIV MARCH, 1919 No. 9

RECOMMENDATIONS OF THE NORTH CAROLINA STATE BOARD OF HEALTH TO GENERAL ASSEMBLY 1919

infants of age. While The First Recommendation under two years estimates hy different authorities give A general law should be enacted varying percentages of this disease as Tnaking it compulsory for the owner of due to fecal infections, it is a conserva- property on which a closet is located tive estimate to claim that '33 per cent within three hundred feet* of the of this disease is fecal in origin (some dwelling-house of any other person, to authorities would place this percentage maintain a sanitary closet in accord- as high as 80 or 90 per cent). If this ance with plans and specifications ap- be so, we must add to the typhoid and proved hy the State Board of Health. dysentery deaths and cases of sickness Such sanitary closets would prevent 875 deaths and 17,350 cases of sickness the undue spread of typhoid fever, from diarrheal diseases of infancy. Our hook-worm, intestinal tuberculosis, and account against fecal infections, then, other intestinal diseases. Besides many stands as follows: Deaths from ty- diseases are brought on by the absence phoid, 502; dysentery, 604; diarrheal of commodious, sanitary, and conven- diseases of infants, 875; total, 1,981. ient toilet facilities.—Governor's Mes- Cases of sickness, typhoid, 5,020; dys- sage to the General Assembly. entery, 12,080; diarrheal diseases of infants, 17,350; total, 34,450. The North Carolina State Board of Health recommends, First— There Are Three Routes of Fecal Infection THAT A STATE LAW PROVIDING FOR THE SANITARY CONSTRUC- Human excrement reaches its vic- TION AND MAINTENANCE OF SUCH tims hy three routes: Route I. Ex- PRIVIES AS BY REASON OF LOCA- crement is deposited on the ground or TION ARE ESPECIALLY DANGER- in an open privy and washed by rain OUS TO HEALTH AND LIFE, BE over or through the soil into a well or ENACTED. Considerations on which spring from which drinking water is this recommendation rests are as fol- obtained. Route II. Excrement in lows: minute and invisible amounts may soil the hands (it is the general rule to find, Deaths and Sickness fkom Fecal- the rare exception not to find, by suit- Borne DiSElASES able laboratory methods, intestinal bacteria on the hands of people), and be The swallowing of human excrement, passed in handshaking or in the hand- fecal infections, causes 2,000 deaths ling of eating utensils or food to a and 35,000 cases of sickness annually second person. This form of infection in North Carolina. is known as contact infection. Route There are 1,106 deaths and 17,080 III. Excrement is carried by flies from cases of sickness due to typhoid fever open, insanitary privies to kitchens and dysentery, diseases originating and dining-rooms, to food, and thereby SOLELY from fecal infections. There to its victims. are 2,626 deaths and 52,000 cases of sickness due to diarrheal diseases of *Meaning yards instead of feet. . —

The Health Bulletin

If the first route, or the water route, The fly increases and decreases with were largely responsible for our fecal- the rise and fall of the thermometer, borne diseases, we should expect to and typhoid fever as a type of fecal in- find that these diseases, as typified by fection comes and departs with the fly. typhoid, would be most prevalent dur- The evidence of the diagram, both the ing the heavy rainfall months, that is, positive evidence and the negative evi- during the winter and spring. If the dence, proves that the fly, armed with second route, or the contact route, were feces, is the principal cause of fecal in- most responsible for our fecal-borne fections in this State. diseases, we should expect to find these diseases evenly distributed over the Kill the Fly or Disarm Him twelve months, with a slight increase with the fly in their prevalence during the cold We must either do away infection, or weather, for human contact is about as the conveyor of fecal the fly the same throughout the year, being we must make it impossible for material, human slightly closer in cold weather when to get the infectious he does his people are driven indoors. If the third excrement, with which is far cheaper and route, or the fly route, were largely re- deadly work. It latter course sponsible for fecal-borne diseases, we simpler to follow the for the fly to should expect to find these diseases, to make it impossible excrement to typified by typhoid, most prevalent secure and carry human latter end may be attained when flies are most numerous. We food. This To make should expect these diseases to be low- by making privies sanitary. to construct it so est in the winter, begin to increase in a privy sanitary is privy containing April and May, and reach their maxi- that the part of the inaccessible to mum in August, and decline with the the excrement is (1) dangerous, through coming of the cold weather of fall and flies, and (2) not surface washings or winter. This is precisely what we do the possibilities of into wells, springs, or find. The following diagram shows percolation water. this conclusively: streams, to drinking

MONTHLY VARIATION IN TVPHOID DEATHS (N.C. average for 4 years)

High rate in summer and fall due largely +o flies cominq from open-back privies to unscreened houses. 138 "41

Sep. Oct. Nov. Dec. Jan. Feb. Mar Apr. May Jun. July Aug. —

The Health Bulletin

Some PEmtES Very Dangerous, Others those with populations of 20,000 and Far Less Dangerous more, have, with only one or two exceptions, adequately manned and fi- All insanitary open privies are or nanced health departments through not equally dangerous. The danger of which they have enforced proper privy any open or insanitary privy is in pro- regulations. The bill, therefore, ex- portion to the size of the population to empts the larger cities of the State which it is related either by the fly with adequately manned health depart- route or water route. An open, insani- ments from its provisions, unless some tary privy located in the average town of these cities desire to take advantage or city block is within 300 yards, that of this legislation. The majority of is, fly range, of from 16 to 20 homes city authorities will see in this legis- with a total population of from 90 to lation two distinct advantages: (1) 120 people; an open, insanitary privy Local privy regulation, as evidenced by located in the average rural section is its inadequacy, is regarded by munic- within 300 yards of only one home of ipal authorities as a political liability from 5 to 7 people. Actual figures bear and not a political asset. It is be- out this statement. In purely rural lieved, therefore, that the municipal sections of this State there is one case authorities of North Carolina will be of typhoid fever per thousand popula- pleased to have the State Board of tion a year, whereas in the unsewered Health (as far removed from political village, town, or suburban section action and reaction as it is possible to there are from five to six cases of ty- have an administrative body) assume phoid fever per thousand population a a responsibility that they regard as im- year. An open, insanitary privy lo- portant but, at the same time, dis- cated on the watershed of a public tinctly disagreeable; furthermore, the water supply is another dangerous State health authorities will have closet that by the water route (the pos- greater weight, will be less personal sibility of pollution washing into the and less objectionable with those con- public water supply) threatens the cerned in the construction and main- health and lives of many people in- tenance of privies than local inspectors. stead of only a few. There is another (2) The towns and cities of the State important difference in the potential will find in this legislation the ad- danger of the two types of privies vantage of saving to themselves the the country privy in infectious contact expense of the quarterly inspections of with one home and the urban privy or watersheds which they have been re- privy on the watershed in infectious quired to make. contact with many homes. The evil effects of the country privy are of a Served, Revenue, suicidal character, injuring only those Size of Population Inspection Force who use it and are responsible for it; but the evil effects of the town privy The bill that will be submitted for or unsafe privy on the watershed are the consideration of the General As- of a homicidal character, injuring those sembly embodying this recommenda- have no responsibility for it and who tion will relate to a total population of no control over it. The bill that will from 500,000 to 600,000 people that lae submitted to the General Assembly make use of from 75,000 to 80,000 pri- to meet this recommendation of the vies. The bill imposes an annual in- North Carolina State Board of Health spection or license tax of forty cents is directed against these two dangerous on the owner of each privy, and in this types of privies, against homicide by way supplies a fund of approximately feces. $30,000 a year for the execution of the law. With $30,000 a year, the State Advantages of State Over Local can be divided into ten sanitary dis- StJPERVISION tricts averaging ten counties each, and Local supervision has proved a fail- an intelligent sanitary inspector placed ure. It is true that a number of towns in charge of each district. The quali- and cities in the State have enforced fications of these inspectors will be both the construction and maintenance those of an intelligent policeman. Each of sanitary privies, but the percentage inspector will cost probably $125 per of the urban population of the State month, and will need $100 a month for living in these places is relatively traveling expenses. For getting about small. The larger cities of the State, in their district, the inspectors will use The Health Bulletin

motorcycles. In charge of the ten in- economic values; if the 6,300 cases of spectors will be a sanitary engineer sickness prevented would have cost our who, in addition to seeing that the in- people in doctors' bills, druggists' bills, spectors perform the work required of nursing, time lost from labor, $30 them in a satisfactory manner, will apiece, we shall have saved an addi- study, devise, and recommend suitable tional $189,000, or a total saving in types of closets for the different sec- human economic value of $554,000. tions of the State and for the different Shall the State withhold $30,000 an- conditions found among our people. nually in inspection taxes, or $500,000 in human economic values? Valuable By-Peoduct But we must not forget that life has another value than its economic value, A by-product of this law, almost of than its meat value, than the value of equal value to the regulation of privies, the horse, than the value of the sheep. will be its provision of an adequate "How much better is a man than a force of sanitary inspectors who will sheep." "The life is more than meat, not only see that privies are properly and the body is more than raiment?" constructed and maintained, but who The economic or meat value depends will make other inspections now re- upon the power of the flesh to act as a quired of the State Board of Health, transforming machine on the sun's and be useful in the enforcement of rays, absorbing the rays directly or in- existing public health laws, more espe- directly, and converting them into some cially the quarantine and vital statis- form of energy available for service. tics laws. The human body is more than a trans- Price and Purchase forming station for sun's rays; it is a shrine, it has the value of a holy temple In considering the cost of this meas- which lifts it to other and higher con- ure of safety, we have to think of both siderations than that of the money- the cost to the individual owner of the changers. privy and the cost to the State as a whole. The owner of the privy pays the State forty cents; the State in return protects him from the unsightli- The Second Recommendation ness, the offensive odors, and the fecal- Every child has a natural right to borne diseases of from six to eight in- or physical defect cor- sanitary privies within 300 yards of his have any mental medical home. Does he get the worth of his rected, if it be in the poioer of money? Will he be satisfied? or surgical skill. The incidental fact The State, in enacting the law, pro- that the parents may not he able to pay vides for the collection and expendi- for the necessary treatment in no way ture of $30,000 in inspection taxes an- affects the right of the child. The Gen- nually. The State, in failing to enact eral Assembly of 1917 made a whole- the law, provides for the unnecessary some start in this direction by the en- loss of at least 365 lives—one death actment of chapter 244, Public Laws of each day of the year—and the unneces- 1911, but the scope of that chapter sary occurrence of 6,300 cases of sick- should be greatly enlarged and the ap- ness. This estimate assumes that we propriation increased from ten to at prevent only 18 per cent of the deaths least fifty thousand dollars per annum. and sickness now due to fecal diseases We cannot claim to maintain an intel- —a censurably conservative estimate. ligent, much less a Christian civiliza- The issue, then, is this: Which shall tion, if a child be allowed to stagger the State yield, $30,000 in inspection through life under the handicap of a taxes or 36.5 lives and 6.300 cases of mental or physical infirmity for the sickness in human values? And what want of a feiv dollars. Indeed, it is an is the value of this human material? economical blunder for society to per- In the days of slavery it had a value; mit an adult to become a mental or it has not lost it. Juries, courts, give physical derelict for want of proper it a value now, based on earning ca- surgical or medical treatment. It is pacity and longevity. If the 365 lives cheaper to correct these infirmities saved are worth $1,000 each, we shall than to pay for the upkeep of these have saved $365,000 worth of human derelicts in charitable institutio7is. The Health Bulletin

The North Carolina State Board of to neglect these children means ever- Health recommends, Second— increasing demands on the department extra facilities to pro- PRO- of education for THAT A LAW BE ENACTED vide for grade repeaters, wasted school VIDING FOR THE EXAMINATION efforts, and a large per cent of adult AND TREATMENT OF DEFECTIVE illiterates arriving at maturity each SCHOOL CHILDREN. The considera- year. It means taxing the State's re- tions on which these recommendations sources more and more heavily to pro- rest are as follows: vide for the insane, the tubercular, the "North Carolina's greatest resource feeble-minded, and the indigent. is its child-life." Practically everybody Now, what is the most practical now admits that the first requisite for thing to be done in order to most in- the safety and prosperity of a State telligently cope with the problem? rests upon the physical fitness of its From an administrative standpoint citizens. Thirty-eight per cent of the alone, it would be impossible to under- young men between twenty-one and take a comprehensive plan for the ex- thirty-one years of age called out in amination and treatment of the chil- the draft of 1917 were physically unfit dren of all the State every year; there- to go to war on account of diseases and fore, the bill as presented to the Gen- conditions which could have been pre- eral Assembly provides for a program vented to a large extent if treated in to be rotated every three years, for the their earlier years. In one county present. The bill provides three dis- alone, of seven hundred young men extinct features: (1) for a preliminary amined, six hundred and seventy-eight, physical examination by the teacher; or all but twenty-two, had already lost (2) for a reexamination by an agent one or more of the first four permanent of the State Board of Health; and (3) teeth which a child "cuts" at six years provision for the treatment, special of age. Every, one of those teeth could and dental, of about 30,000 children have been saved by proper treatment each year. The special appropriation and care if done under fourteen years requested in the bill is |50,000 annu- of age. A defective child, neglected, ally. For that sum the following things grows into a liability to the commun- could be accomplished: First, the re- ity; if given proper care and assist- examination of all defective children ance at the right time, the same child first reported by the teachers; second, will become an asset to his community. the operation by the best specialists There are 803,257 children of school working through the club plan of age in North Carolina. Within the past about 6,000 children, the fitting of eye- four years the State Board of Health glasses by competent oculists of about has supervised the examination of 2,000 children; and third, the dental about 200,000 children. This work was treatment through public clinics of done by teachers, trained nurses, and about 22,000 children. This work, if physicians. Children of all classes, left to private arrangement, would ages, and conditions of both sexes and never be done for 90 per cent of these colors have been included. This work children; but if done for all would cost has been done in all parts of the State, at least $300,000. These figures are from counties as far west as Madison, based upon most conservative esti- Swain, and Macon to the eastern coun- mates. Thus, after totaling all the pos- ties of Currituck and Camden. Upon sible cost to the State and the counties, a most conservative opinion as to diag- 30,000 children will receive treatment, nosis, these records show that more a majority of whom would not other- than 80 per cent of the school children wise, at a saving of at least seventy-five need dental treatment; more than 10 cents out of each dollar. per cent have diseased throats; and more than 5 per cent have defective vision and hearing. This does not include the many cases of grosser The Third Recommendation tuberculosis, ma- troubles as incipient The North Carolina State Board of laria, hookworm, and serious under- Health recommends. Third— nourishment. Forty-five per cent of all school children who fail to pass be- THAT RURAL HEALTH WORK BE yond the seventh grade fail for physi- PROVIDED FOR BY AN APPROPRI- cal reasons either incident to them- ATION CONDITIONED UPON SUP- selves or their parents. For the State PLEMENTARY APPROPRIATIONS The Health Bulletin

FROM OTHER SOURCES, MORE ES- The relative importance of these crip- PECIALLY THE FEDERAL GOV- pling diseases is not properly appre- ERNMENT, IN THE PROPORTION ciated. They are prevalent because OF NOT LESS THAN $2 FOR EVERY they do not impose pain or discomfort of such intensity as to cause their vic- $1 EXPENDED BY THE STATE. This tims to react against them, to apply recommendation rests upon the follow- for and carry out effective treatment. ing considerations: Like small taxes gradually increased over long years, they take from the Considerations Beabing Upo.x theRel- people a total of vitality and efficiency ATm: Importance of Rural Health which if compared with our account against the killing diseases, tubercu- The fl7~st consideration is that in losis, typhoid fever, pneumonia, and North Carolina 90 per cent or 2,100,000 other acutely fatal diseases, would of a 2,400,000 population is rural. The cause this latter group of diseases of affords country, therefore, in this State more spectacular action to be regarded by far the larger opportunity and im- as of less relative importance. Our poses the heavier obligation for health more important vital losses—like our ^ work. financial losses, in driblets, pennies, P The' second consideration is that the nickels, dimes, and an occasional * rural people, as compared with the quarter—are in little drafts, long con- urban people, are less able both in tinued. knowledge and in per capita wealth to In conclusion, the need for rural safeguard their health and lives, and health work rests upon (1) the larger are, therefore, most in need of assist- size of the population involved; (2) ance. the relative lack of knowledge and The tM7-d consideration is based means among the rural people for deal- m upon the condition of rural health. ing with matters of sanitation and * While the Federal Government by its hygiene; (3) the lower vital stamina own methods of examination, applied of rural people probably produced by to something like 10,000,000 men drawn the greater prevalence of crippling dis- from all walks of American life and eases among them. from the healthiest age group—from 21 to 31 years of age—has pronounced Health of Rural People a Common 38 per cent of those examined physi- Interest to All Drtsions of Gov- cally unfit for military service, it has ernment found through the records of the oflBce of the Surgeon General that rural On the efficiency of the rural popu- people are more susceptible to infec- lation the production of food and tions and succumb more readily to in- clothes—the cost of living—depends; fections than urban people. therefore, conditions affecting rural The explanation of the lower ebb of life are a matter of profound interest, vitality of rural people as compared not only to the rural population but to with urban people probably lies in the the entire population; a matter of con- greater prevalence of the subacute, de- cern not only for the rural or county vitalizing, crippling diseases in the governments, but for the State and country. As such diseases may be men- Federal Governments as well. tioned malaria, almost entirely rural Already certain important and com- and affecting 10 per cent of our people; mon interests relating to rural welfare hookworm disease, also almost entirely have been recognized and provided for rural and affecting about 30 per cent of by a cooperative plan with financial the people; chronic constipation, affect- participation by the three branches of ing 20 per cent of the people; suppu- our Government, Federal, State, and rating gums, affecting 30 or 40 per cent County. The three common interests of the population; lacerated female so far recognized and cared for are: genital canals, affecting a large part (1) construction and maintenance of of the child-bearing population and roads; (2) farm-life demonstration more rural than urban; the common work; and (3) vocational education. physical defects of childhood, adenoids, The principles that have become es- tonsils, defective vision, and bad teeth, tablished in this country for dealing all astoundingly prevalent and more with these major common interests frequently encountered among rural are: (1) the financing jointly of the people than in the towns and cities. rural problem by the three govern- —

The Health Bulletin

ments concerned; (2) the expenditure The plan of rural health work on of the pooled funds on a plan of work which the joint funds will be expended approved by each of the financial paris to be approved by all three partici- ticipants. For example, in providing pating governments, county authori- for good roads, the Federal Govern- ties, the State Board of Health, and ment makes an appropriation which is the United States Public Health Serv- apportioned to the States on an equi- ice. This will serve to guarantee the table basis. Each State apportionment efficiency of the work. becomes available when the State ap- propriates a sum equal to that received Possibilities in Rural Health Work from the Federal Government, and the combined State and Federal fund is What can be done in rural health available for the counties that appro- work may now be stated in terms of priate definite supplementary sums. fact, not as prophecy or opinion. Nine The health of the rural people, con- counties in North Carolina, working ditioning the production of food and in cooperation with the State Board of clothes—the cost of living—is a com- Health and the International Health mon interest of transcendent impor- Board, following a standard plan of tance to all branches of the Govern- work on a budget of $6,000 each, have ment—Federal, State, and County been at work now for an average of and should be taken care of according fourteen months each. The health offi- to the established precedent and prac- cers in charge of the work in these tice of financial participation and gov- nine counties with only one or two ernmental cooperation in dealing with exceptions were men who had never common interests of major importance. had any special training or experience in public health administration. The Prospects for Federal Financial Par- following table shows the amount of ticipation IN Assisting in Rural work accomplished by the average Health Work county for the average month in the initial stages of county health work: Hon. A. S. Lever, Chairman of the Committee on Agriculture in the 1. 8 public lectures with an at- United States Congress, has just intro- tendance of 729 people. duced H. R. 14185, which recognizes 2. 7 newspaper health articles rural sanitation as a matter of com- published in the county mon interest to all three branches of papers. the Government, and makes a Federal 3. 61 rufal homes constructed sani- appropriation for meeting the Federal tary privies. obligation to rural health work. Mr. 4. 171 people examined for hook- Lever is one of the most constructive worm disease and 33 of these and influential leaders in Congress, and treated. has either initiated or taken a promi- 5. 4 schools visited by the health nent part in all legislation that has to officer. do with the common interests of our 6. 325 school children examined by governments in rural conditions. Prac- the teachers working under tically the entire Committee on Agri- the direction of the health culture has endorsed the bill. The officer. Committee on Rules has agreed to per- 7. 106 school children personally ex- mit the bill to come up for special hear- amined by the health officer. ing. Judging from reports, there 8. 51 of the children found defec- seems to be an overAvhelming sentitive by the health officer were ment in Congress for this legislation. treated. The prospects for the bill's becoming a 9. 32 adults given physical exami- law are exceedingly bright. nations by the health officer. If the bill passes. North Carolina 10. 310 people vaccinated against ty- will receive as her apportionment $36,- phoid fever, 399.33, conditioned upon the State's 11. 54 people vaccinated against making an appropriation for rural smallpox. health work of an equal amount, the 12. County quarantine work per- combined Federal and State fund then formed satisfactorily and in- being available for those counties that cluded the quarantining, ac- appropriate supplementary funds for cording to the State law, of rural health work. 43 cases of infectious diseases. The Health Bulletin

13. Medical attention was given State Board of Health, to examine the the county dependents who children (the teachers cooperating as were inmates of the county required by law) for the common de- home, the jail, and the chain- fects of childhood, and to arrange, gangs. through the organization of tonsil and adenoids clubs and free dental clinics law the If H. R. 14185 becomes a and (the latter to be financed by the State shall meet the State of North Carolina Board of Health), for the treatment Federal apportionment and make it of the defects found, either free of cost health the available for rural work, or at such a minimum cost as to be State Board of Health proposes the easily within the reach of the county employment jointly by the Federal, or parents. State, and County governments of a (5) By cooperation with the Bureau public health nurse working on a total of Infant Hygiene of the State Board budget of $3,000 a year, contributed of Health, and following a certain defi- each by the three participating $1,000 nite plan of standardized work for The budget will prob- governments. rural nurses, to carry out a county ably be expended as follows: unit of infant hygiene work embracing of mothers in regard Nurse's, salary $1,500.00 the instruction of pregnancy and the Nurse's traveling expenses... 720.00 to the hygiene their babies. Postage, stationery, and print- care and feeding of ing 250.00 Office equipment 250.00 Supplies for sick 180.00 Contingencies 100.00 The Fourth Recommendation Carolina State Board of With this budget the nurse may be ex- The North recommends. Fourth— pected to carry out in a satisfactory Health manner the following units of health THAT ADEQUATE PROVISION BE work: MADE FOR CO-OPERATING WITH (1) See that the State and county THE FEDERAL GOVERNMENT IN quarantine laws are properly carried THE PREVENTION OF VENEREAL out and that free antitoxin is made DISEASES. The considerations on easily available to the people of the which this recommendation rests are county. This is a matter of routine as follows: carefully worked out and supervised under the by the State Board of Health General Prevalence of Venereal quarantine law. provisions of the State DlSE^\SES (2) Through free vaccination dispensaries held on certain dates and at Before millions of men were called certain places, to vaccinate the people up for thorough physical examinations of the county who apply for vaccination by the Government, and the relative against (a) typhoid fever; (&) small- prevalence of various defects and dis- pox; (c) pneumonia; and (d) possibly eases were revealed by this general influenza. wholesale and thorough examination (3) To carry out a unit of tubercu- of our people, the only basis of opinion losis work consisting of (a) public as to the prevalence of venereal dis- lectures through the schools to both eases were the estimates furnished by children and parents on the subject specialists for this group of diseases. of tuberculosis. Many of these lectures The revelation of the draft boards and will be illustrated with lantern slides. of the medical department of the Army (&) To meet and advise with, and fur- and Navy, with respect to the physical nish, through cooperation already conditions prevailing among the peo- available through the State Sana- ple, and particularly the prevalence of torium, any persons having suspicions venereal diseases, have largely re- of tuberculosis a thoroughly modern placed estimates with actual figures. examination for the disease, and in this way facilitate the recognition of Milftary Prevalence tuberculosis in the early curable stages of the disease. General Gorgas, Surgeon General of (4) In cooperation with the Bureau the United States Army, says: "The of Medical Inspection of Schools of the army loses more days of service from 10 The Health Bulletin

Its men due to venereal diseases than Venereal Infection Per Thousand Men from any other cause. If the medical Year Rate department of the army had a choice U. S. Army 1909 196.99 presented to it, say if some man came U. S. Navy 1909 159.83 with a wand, and it was demonstrated Japanese Navy 1907 139.75 that with this wand every wounded British Navy 1908 122.49 man could be gotten back into the line British Army 1908 75.8 at the end of the second day, with his Russia 1906 62.7 1907 54.2 wound cured; and another course were Austria Japanese Army 1907 37.6 presented by which all venereal dis- France 1906 28.6 eases could be eradicated from the Prussian Army 1907 18.7 army, and our choice were given, per- of this mitting us to leave out all sentimental The diagram on page 11 reports made reasons, such as the moral effect upon bulletin, prepared from to the Surgeon General of the Army the community, and allowing us merely and published by the Surgeon Gen- to consider the good of the army, and eral of the Army, shows the preva- our ability to keep in the line the larg- lence of venereal diseases in the est and most efficient fighting force, I different subdivisions of our army, think there would be very little hesi- and in the army as a whole, compared tation on the part of our department with the prevalence of other communi- in choosing the eradication of venereal cable diseases. It will be noted that the diseases. We, in the course of the year, venereal disease rate is almost five should be able to keep more men in the times the rate of the other communi- trenches and have a more efficient force cable diseases named. by having ei'adicated venereal diseases Crv'iLiAN Prevalence than by eradicating wounds." The Council of National Defense The diagram above referred to fur- says: nishes most interesting and convincing prevalence "During the twelve weeks ending evidence as to the civilian of venereal diseases. For example, December 7, 1917, there were reported the diagram shows that in the army from 31 cantonments, 21,742 new cases group farthest removed from the peo- of venereal disease. The incapacita- ple, the Regular Army, there was less tion of these men involves not only venereal disease than in that army loss of time; in addition, it has cost group somewhat nearer the civilian the Government to keep them during population, namely, the National the period of hospital confinement Guard; that there was less venereal (which varies from one to eight weeks) disease in the National Guard than in more money than is required to main- that army gi'oup just from the ranks tain the entire command at Camp Dix of the people, representing all races, classes, the (the cantonment in New Jersey with industrial and social Na- tional Army. The evidence of the 20,859 men) plus an additional sum chart is that the nearer we come to the for medical treatment. civilian population the higher the rate "This is not all. Inevitably the dis- of venereal disease encountered. This is ease will relapse in hundreds of these in conformity with the evidence pre- cases, in many instances after the men sented to the Military Affairs Com- have been transported to France and mittee to the effect that 83 1/3 per presumably put into condition for serv- cent of the venereal diseases in the ice at the front, at a cost to the nation army were brought in as the drafted of probably $1,500 for each man." men came into camp, and only 16 2/3 Lieut. Col. William F. Snow, repre- per cent were contracted after the men senting the Office of the Surgeon Gen- came into the ranks. The evidence in- eral, before a committee of the United dicates that big as the venereal disease States Senate, said: "Over 80,000 cases problem is from a military standpoint, of venereal diseases have been recorded it is bigger as a civilian problem. in the United States Army between Sep- A representative of the United States tember, 1917, and June, 1918." Public Health Service estimates that The following official figures show there are annually 2,500,000 new cases the prevalence of venereal diseases in of venereal disease in the United different countries: States—about one person in forty be- The Health Bulletin 11 coming infected each year. The Coun- the first million enlisted men, that were venereal dis- cil of National Defense estimates that found to be infected with there are over 50,000 cases of venereal eases: disease in North Carolina. This figure 1. Florida 8.90 may be compared with the total num- 2. Alabama 8.70 ber of annual cases of tuberculosis. 3. Virginia 8.40 DIAGRAM Showing Prevalence of Venereal Diseases Compared with other communicable diseases

in the United States Army

Prepared from Reports made to the Surgeon General

88.0 13.4 12 The Health Bulletin

13. Missouri 3.50 family, and as a menace to the vitality, 14. Arizona 3.40 health, and physical progress of the 15. Louisiana 3.32 race, the venereal diseases are justly 16. Indiana 3.30 regarded as the greatest modern 17. Maryland 3.28 plagues. ..." 18. Ohio 3.24 Gonorrhea is responsible for 60 per 19. Delaware 2.78 cent of the surgical operations on 20. New Mexico 2.68 women. 21. Rhode Island 2.66 Gonorrhea is responsible for 50 per 22. Pennsylvania 2.60 cent of all sterility. 23. Illinois 2.44 Gonorrhea is responsible for from 25 24. Kansas 2.38 to 33 per cent of all blindness. 26. District of Columbia 2.14 Gonorrhea permanently maims one 26. Colorado 2.12 person in a hundred, and kills one per- 27. Maine 2.02 son in every two hundred. 28. Michigan 1.95 Syphilis as a cause of death ranks 29. Alaska 1.90 with tuberculosis; pneumonia, and 30. New York 1.82 cancer. 1.75 31. North Dakota Syphilis causes from 10 to 20 per 1.73 32. Arkansas cent of all insanity. Massachusetts 1.66 33. Syphilis, assuming that 10 per cent 1.63 34. Iowa of the insane in the three large State Connecticut 1.60 35. Hospitals in North Carolina are there Minnesota 1.57 36. as a result of this disease, costs North Jersey 1.55 37. New Carolina annually in appropriations for 38. Vermont 1.53 these three hospitals 1/10 of $570,000; 39. Nebraska 1.53 that is, $57,000. Of course, this does 1.40 40. Nevada not include the ravages and losses from Hampshire 1.22 41. New syphilis outside of the State insane 1.22 42. Wyoming asylums. 43. Wisconsin 1.21 1.15 44. California Federal Provisions for Dealing With 0.92 45. South Dakota the Venereial Diseiase Problem 46. Montana 0.89 47. Washington 0.86 The revelations of the Army with 48. Utah 0.79 respect to the prevalence of venereal 49. Idaho 0.76 diseases and the effects of these dis- 50. Oregon 0.59 eases have caused the Federal Govern- ment to recognize the venereal dis- The average per cent for the States ease problem as one of such vast im- is 2.82. North Carolina's percentage portance to the life of the Nation gen- is 3.9, that is, 39 men out of every 1,000 erally as to influence Congress to ap- drawn indiscriminately, except with re- propriate nearly $2,500,000 for dealing spect to age, from the men of North with the problem. One million dollars appropriation is Carolina, were infected with venereal of the apportioned among the States of the Union on a diseases. There were but nine States population basis. The first year's ap- with a higher* percentage of infection portionment, ending July 1, 1919, is to Carolina. States like Penn- than North be paid to the States without condi- sylvania, Illinois, Rhode Island, Louis- tion of financial cooperation, but after large iana, and Massachusetts, with July 1, 1919, the Federal apportion- urban population, showed a lower per ment of funds for this purpose to the cent of venereal diseases than rural States is conditioned upon the States North Carolina with almost a complete appropriating an equal amount. North absence of red-light districts. Carolina's full allotment, providing the General Assembly will appropriate an Some of the Important Effects of equal amount, is $23,988.61. The com- Venereal Diseases bined funds. State and Federal, are to be expended on a plan for combating Dr. M. J. Rosenau, Professor of Pre- venereal diseases that is approved by ventive Medicine and Hygiene, Har- the United States Public Health Serv- vard University, says: "As a danger ice and the North Carolina State Board to the public health, as a peril to the of Health. —

The Health Bulletin 13

Standard Plan foe Combating PROSTITUTION THE SOURCE OF VENEBE14X Diseases VENEREAL DISEASES The plan of work for dealing with [Prostitution bears to venereal dis- venereal diseases has been devised and eases the same relation that stagnant agreed upon by conferences between water bears to malaria. The best state- the OfBce of the Surgeon General of the ment on this subject that we have ever Army, the Surgeon General of the Pub- seen is taken from the book entitled lic Health Service, and State Boards of "Syphilis and Public Health," by Ed- ward B. Vedder, A.M., M.D., Lieutenant Health. This plan consists, briefly, of Colonel, Medical Corps, United States three parts: Army, and reproduced here by permis- 1. A general educational campaign sion of the publishers, Messrs. Lea & for informing the public of the preva- Febiger, Philadelphia, Pa. To those lence of venereal diseases, the dire ef- who cannot think of prostitution as fect of these diseases, their cause and one of the evils of North Carolina, we prevention. This educational work is would invite their attention to the to be carried out through (a) the pub- relative prevalence of venereal diseases lication of articles in the State Board among North Carolina men as indi- of Health Bulletin; (b) articles con- cated in the table shown on pages 11 tributed to the press; (c) the prepara- and 12 of this Bulletin. Editor.] tion distribution, and through appro- "The root of the venereal disease priate channels, of special pamphlets problem lies in prostitution. It would on the various phases of the sex prob- seem that pessimism or the habit of lem and venereal diseases; (d) courses looking only on the dark side of things of lectures by male lecturers to the receives its justification here, for pros- male colleges of the State and by fe- titution is a subject that appears to male lecturers to the girls' colleges and have no bright side. Nothing is more women's clubs; (e) the use of films, discouraging than the fact that after and en- more especially the excellent film pre- so many years of discussion deavor to deal with the problem we pared by the Army for educating the have made so little progress in practi- soldiers in regard to venereal diseases, cal methods of dealing with this ulcer entitled "Fit to Fight." of the body politic. The natural ten- 2. adequate provision for the Making dency is to turn from the discussion modern treatment of venereal diseases of such an unprofitable and disgusting by (a) furnishing free salvarsan or subject, but since prostitution is the arsphenamin, the remedy for syphilis, chief cause of the present prevalence to the people of the State; (&) organ- of syphilis, any work dealing with izing and partially financing dispen- syphilis and public health that omitted saries for the free treatment of ve- this subject would be incomplete. nereal diseases in the larger cities of While the discussion of prostitution the State, and after the per capita cost must necessarily be brief, an effort will suflicient facts to of treatment in the dispensaries is de- be made to present termined, to appoint physicians in the indicate the hopeful method of attack- various counties to treat venereal dis- ing this problem. prob- eases according to the method estab- "Prostitution is a sociological lished in the dispensary, paying these lem, and its eradication depends upon physicians per case the same amount the study of the conditions operating paid the dispensary per capita case. to produce it and the adoption of measures that will remove these causes. But 3. The suppression, so far as pos- venereal diseases are a present men- sible, of prostitution—open and clan- to society, and the sanitarian destine—through (a) the employment ace practical meas- of plainclothes men for securing evi- wishes to know what to dence suflQcient to convict the prosti- ures he may take at once in regard to limit the spread of these tute; (&) by legislation that will per- prostitution mit the holding of an infected prosti- diseases. These are two different tute until she shall be treated and phases of the subject that should be separately. cured of her infection. discussed The details of these recommenda- Prostitntion as a Sociological Problem tions will be brought before the Gen- eral Assembly in due time in the form "There is good reason to believe that of appropriate bills. sexual promiscuity Is as old as the hu- 14 The Health Bulletin man race, since anthropologists tell us education of a new race of men who that before the development of the will have the same standard of sexual family promiscuity was general, and purity for themselves as for the women our knowledge of the animals from they expect to marry. But it is well which the human race developed ap- to remember that such high ideals are pears to confirm this view. Therefore, only slowly realized, and that in the in promiscuity or, at least, polygamy is meantime we are compelled to live biologically a natural condition, and the world as it exists today. monogamy has developed as the result -Sociological Reform.—Since the of moral and economic considerations. raison d'etre of prostitution is to be But the latter have not as yet been found in the biological origin of the sufficient to entirely restrain man from race and the struggle between a per- his tendency to promiscuity, and this fectly natural appetite and moral and is the ultimate cause of prostitution. economic laws, it follows that any con- will "The origin of venereal diseases is ditions that make marriage easy shrouded in obscurity. Promiscuity proportionately reduce prostitution, among the animals is not productive of while those social conditions that make disease with the single exception of marriage difficult or defer the age of dourine, or so-called horse syphilis, marriage encourage prostitution. In marriage which is a trypanosome infection primitive communities where transmitted by sexual congress. But occurs at an early age prostitution is the com- it is useless to speculate upon the bio- almost unknown. When logical origin of venereal diseases. munity becomes more complex, as in Gonorrhea at least is known to have cities, the age of marriage is almost existed from early antiquity. Many always deferred. The man who derives have thought that syphilis was brought his living from the soil in a country back from America by the sailors with where land is easily obtainable may Columbus and thence spread over be economically independent and may earlier. Europe, but there is no proof that this marry at the age of twenty or intensive view is correct. In no case has un- In the city a long period of doubted syphilis been demonstrated in education becomes necessary before pre-Columbian bones, while, on the economic independence can be contrary, there is considerable evidence achieved, and the age at which mar- that syphilis was common in Europe riage is possible is deferred for from before the discovery of America but five to ten years. Reproduction is a was not distinguished as an indepen- physiological possibility at a very early dent disease, being confounded with age (puberty), and if governed solely leprosy and other diseases. Mercurial by physiological laws Avould normally inunctions were a popular form of occur not much later than eighteen treatment in Europe long before the years of age. The perpetuation of the time of Columbus, and it is difficult to species is not dependent on the whims understand to what their popularity of individuals, but is ensured by means instinct, the sex was due if syphilis w^as nonexistent. of a most imperious But while there are differences of appetite. This appetite is far stronger opinion on this point which can hardly in the male than in the female, and be regarded as settled, there are cer- hence we find that it is almost always tainly grounds for believing that sex- the male who seeks his mate. If this ual promiscuity with its accompani- instinct were promptly obeyed in a gen- ment of venereal disease has been with legitimate way, marriage would us since before the dawn of history. erally occur somewhere between eight- of age. But If sexual promiscuity ceased, gonor- een and twenty years rhea and syphilis would soon become physiology and sociological conditions extinct diseases. But since the human are not on speaking terms and make race has made so little moral progress their arrangements quite independent- are equally imperious in its long development through the ly, and as both exigent, prostitution is the natural ages it is hardly to be expected that and a sudden revolution in morals will oc- result. The demand on the part of cur during the present generation. the male creates the supply, and will "This does not mean that w^e should continue to do so until, as the result education to a higher moral plane not 'hitch our chariot to a star.' Ideals of economic conditions, the are our most precious asset, and it is or changed ceases. well to have clearly before us the ideal demand stated, and very gen- of a community free from vice, and the "It is frequently The Health Bulletin 15 erally believed, that women are driven rived directly from prostitution, and into prostitution because they are not the prevalence of these diseases among paid a living wage. This may occa- the single is a sure indication that it sionally be a cause of prostitution, but is the unmarried who turn to prostitu- it is a very minor cause, as shown by tion. The fact that the greatest inci- investigations into the previous occu- dence of venereal diseases is between pations of prostitutes. Stromberg the years of twenty-one to twenty-five found that out of 462 prostitutes there indicates that it is just during these was not a single case in which the years, when marriage should have oc- economic cause was the determining curred, that most of the exposures have factor. Welander in his studies of taken place. prostitutes in Stockholm found that 60 "Further evidence that the prostitute per cent of them were previously in draws her clientele chiefly from the un- domestic service and were in comfort- married may be found in statistics pre- able circumstances. Leonhard's ex- sented by Snow. During one year 369 amination of the records of 600 pros- new cases were classified in a Boston titutes in Diisseldorf failed to estab- dispensary for venereal diseases, with lish poverty as a reason for prostitu- the following result: those single tion. Kneeland found that at the Bed- under twenty-one years comprise 23.5 ford Reformatory out of 279 cases, per cent of all cases, single over twenty- economic conditions were thought to one years 65 per cent of all cases, so be responsible for the adoption of a that 88.5 per cent were single. The life of prostitution in only 19 cases. married under thirty years furnished "We see, therefore, that very few only 6 per cent and over thirty years prostitutes allege poverty as a com- 5.5 per cent, so that the total married pelling cause. A very large percentage cases were 11.5 per cent. In the same come from the ranks of domestics, who article it is shown that the source of may not be richly paid, and whose infection in 55.5 per cent of cases is hours of labor may be hard, but who the prostitute; that domestics, friends, are at least fed, clothed, and housed working women, and unknown sources and cannot have been driven into pros- were responsible for 42.4 per cent, and titution by destitution. There may be that only 1.5 per cent of the cases of a thousand contributing causes, includ- venereal disease were traceable to ing the fact that many girls who are adulterous relations with married mentally deficient or morally weak find this life an easier mode of support than legitimate occupations; but the more The State's Program of Treatment for essential cause is the demand on the Prostitutioii part of the male that his sexual appetite be satisfied, and as legitimate mar- The General Assembly of 1919 will prostitution, the riage is impossible, be asked to enact bills dealing Avith white slave traffic, and venereal disease prostitution, which will be submitted are the natural consequences. before this is read, that will put into "That prostitution is supported al- effect the following principles of most wholly by the unmarried is shown control: by the following figures compiled by Brandweiner: 1. Through funds contributed jointly Males by the Federal and State Governments, Widowed the employment of from two to three Disease Total Single Married or plainclothes men to detect, secure evi- Divorced dence, and bring prosecutions in magis- Chancroid ... 980 895 75 10 trates' courts against prostitutes. Gonorrhea ..1365 1179 162 24 2. Conviction of prostitution Syphilis 2264 1962 270 32 in a magistrate's court to give the State Board of Health the right to quaran- . Females Widowed tine, and to hold in quarantine, under Disease Total Single Married or a sufficient penalty, prostitutes who Divorced may reasonably be suspected to be in- Chancroid ... 941 906 29 6 fected with venereal diseases; as prac- Gonorrhea ...1670 1618 43 9 all prostitutes are infected, Syphilis 2900 2660 210 30 tically they will all be quarantined until examined "We have already seen that the great and found noninfectious. majority of venereal diseases are de- 3. To hold the prostitute under quar- 16 The Health Bulletin

antine until she has been treated and 5. By making the expense for detain- cured of her venereal disease infec- ing and treating a convicted prostitute tion; that is, until she is no longer a chargeable to the county permitting carrier, a source of the disease. the practice of prostitution to turn the 4. The expense of detaining, quaran- county law-enforcing oflBcers, to wit, tining, and treating a prostitute to be sheriff, deputy sheriffs, and municipal chargeable to the county in which the police, strongly against the practice of prostitution for which she is convicted prostitution in order to protect the was practiced. county from unnecessary expense.

EXPENDITURES OF MONEY BY THE RED CROSS AND OTHERS IN TUBERCULOSIS OVERSEAS

Contributed by Dr. L. B. McBbayer.

"// there is to be a Democratic equality of opportunity, there " must be an equal opportunity for health.

"So severe had been the privations of war among refugees of the battle area that tuberculosis had gained great headway. The fight against this scourge began immediately upon the arrival of tlie Red Cross in France. The disbursements up to July 1st this year (1918) were $2,117,327. "Seventy-six tuberculosis hospitals have been completed. "Requisitions for goods have been approved for 96 provisional hospitals containing 5,610 beds, all to be in operation by fall. "The appropriation for the current six months is $2,582,156.14." You will understand that this does not include money spent by the International Healtli Board. I suppose some mention ought to be made also of the Red Cross- work with children in France, which is so closely bound up with tlie tuberculosis work. I note that the same bulletin says up to July 1, 1918, $1,149,129 had been disbursed for the care of French cliildren,, and the appropriation for this work to January 1st next is $2,775,877. In addition, the International Health Board is spending one to two million a year in France. Mr. Warren H. Booker, who was with tlie State Board of Health, is now with the International Health Board in France, and is in charge of educational propaganda only. He has for his budget for this year $129,000. Four counties in Ohio (Wood, Hancock, Seneca, and Crawford) are spending $100,000 in sanatoria construction. The Council of National Defense is spending $100,000 at the State Sanatorium in West Virginia in erecting hospital beds for tuberculous soldiers. Marion County, Indiana, is appropriating $100,000 for additional buildings at their County Sanatorium. Washington City was selling bonds very recently in amount of $350,- 000 for additions to their Sanatorium. The American Red Cross has recently appropriated $50,000 for scholarships for nurses who desire to take the course in Public Health Nursing. c. mm PubHsêdbij T/\£.^9Km CAROLINA STATL DÂRD sÂOÛn 1 Thl5 Biile-tinwill be ênt free to oixg citizeA of the 5tate.up0i\ request j MnUrtd M «e«ond-ci«## rmUter at Postofice at Raleigh, N. O., under Aot of Juty 16 'l894 PublUh4d m^mthly at the office of the Secretary of the Board, Raleigh, N. O.' T©1. XXXit/ APRIL, 1919 No. 10

# -Mm..

\ y t

SPRING

See what Richard H. Tyson's mother says about him on page 11 —

PUBLIC HEALTti RND SANITATION

Edited by Dr. W. S. Rankin

MR. GANN PAYS $46.55 FOR $1.75 WORTH OF ANTITOXIN

Who Is to Blame—Somebody or Nobody

reputation The North Carolina State Board of Health has not very much of a that reputation. for not calling spades spades. We are trying here to maintain been made to this The following table is made up from 123 reports that have office recently by families that have had to use antitoxin:

Bought Name of Total ! Antitoxin Address Address Purchaser Cost from o S"3 o 3 Zpq 2;s

$18.00 Greensboro Drug Co.. Greensboro. 0.50 3€ A. S. Campbell Stokesdale.. .50 2< Herbert Fleming Ayden 13.00 King's Pharmacy 46.55 Greensboro Drug Co. Greensboro. 1.75 2( S. B. Gann Stokesdale.. Dees Drug Store Burgaw ,50 2'. Joe Newkirk. -- Burgaw 12.00 Woodard Drug Co... Selma .75 2^ C. A. Corbett Selma 18.00 10.00 Goldsboro Drug Co.. Goldsboro.. .50 2( J. L. Brock Goldsboro.. Co Canton .25 2( Mies Jarrett Canton 5.00 Martin Drug Martin Drug Co Canton .50 2( Mrs. W. C. Phillips. Canton 10.00 M. Shuford 1.50 2( H. L. Starnes Hickory 30.00 C. 2( Clinton - .50 Mrs. Etta Warren... Clinton 10.00 fSelma Drug Co Selma .75 George W. Pike Pine LeveL 8.90 1 \Woodard Drug Co. High Point .50 PhiUp Proctor Thomasville.. 9.00 ; Dr. McCain Mount Olive .75 Roland Millard Mount Olive.. 11.75 I Guy Rose. Walnut Cove... .75 ! Tuttle.... Oscar L. Gerry Walnut Cove. 9.00 Dr. R. G. 17.50 Troutman & Polk J. B. Stewart EastMonbo..

I Drug Co Troutman

by the From the preceding table it will be stances the antitoxin was made manufacturer and sold by the noted that Mr. A. S. Campbell bought same If somebody is respon- 20,000 units of antitoxin, which he same druggist. than it should have obtained for 50 cents, pay- sible for charging people more is necessary for them to pay, let that ing $18 for it, 36 times what it should out into the sunlight have cost him. Mr. S. B. Gann, of somebody come glasses are needed for Stokesdale, got his antitoxin cheaper, even if shaded but lost more money in doing so. Mr. comfort. Selma, who paid Gann paid $46.55 for $1.75 worth of Mr. C. A. Corbett, of worth of antitoxin, antitoxin, 26 prices for it. It is inter- $18 for 75 cents "If there is any way for me esting to note that in both of these in- writes: The Hkalth Bulletin to get a rebate on the above antitoxin, J. W. Halford, Lillington Allen, New London I would like to have it." Our reply Johnson, Winston-Salem cannot rebate to Mr. Corbett is that we H. M. Montgomery, Burlington him this time, but we hope to save him G. A. McLemore, Clayton the necessity of writing for the rebate Mimms, Winston-Salem Fearing, Elizabeth City next time. Z. W. T. Rainey, Badin parties interested in There are three A. F. Williams, Wilson the sale and price of diphtheria anti- Cobb, Goldsboro toxin—the seller, the user, and the J. N. Moore, Marshall G. A. Caton, Bridgeton State of North Carolina. D. R. Baird, Mars Hill wholesale and retail The sellers, A. P. Willis, Candler dealers, appear to be interested in sell- Phillips, High Point ing antitoxin for a price that will give A. B. Goodman, Lenoir Salemburg them what they have mistakenly re- Sikes, W. H. Smith, Goldsboro good profit. garded as a A. C. Jordan, Durham The user is concerned to get stand- Glen Long, Catawba ard, first-class, thoroughly reliable an- R. O. Dees, Greensboro M. M. White, Lenoir titoxin at the cheapest rate. The T. C. Matthews, Castalia antitoxins is tested by potency of all A. C. Whitaker. Julian the same test, which is a test easily J. A. Smith, Wilmington applied and thoroughly reliable in war- Geo. H. Ross, Durham Fisher, Jackson ranting conclusions. The same test of J. L. S. A. Saunders. Aulander is applied to the potency, therefore, T. C. Bullock. Autryville State brand of antitoxin as to all other W. T. Holt, McLeansville antitoxins. The doctors who are using Grady Stowe, Tobaccoville State antitoxin and saving" their pa- We submit that this list of the pro- trons the high and unnecessary charges fession represents a group of as first- for commercial brands represent the class physicians as will be found in very best physicians of the State. In the State. 123 reports from families who have In discussing the subject of diph- recently suffered from diphtheria and theria at the October meeting of the used antitoxin, the following physi- County Medical Society, Dr. Al- cians were in attendance and pre- Wake dert Root, specialist in the diseases scribed State antitoxin with excellent S. of children, made the following state- results: ment: "I have used the diphtheria Drs. R. B. Miller, Goldsboro antitoxin prepared by the State Board C. A. Efaird. Mount Airy of Health in all of my cases since it Chas. Peterson, Spruce Pine became available to the public, because W. A. Bradsher, Roxboro size H. G. Monk, Trenton in no single case, no matter the Wm. P. Holt, Duke of the dose, have I had the uncom- F. W. Avart, Wilmington fortable toxic symptoms (urticaria, W. A. Rogers. Franklin temperature reaction, etc.) which have W. I. Hill, Albemarle K. A. Price. Hickory arisen from the use of any of the other P. W. Schallert, Winston-Salem antitoxins upon the markets. Aside Greenville Henning Smith, from this, its potency is shown by the J. Clegg Hall, Albemarle prompt response to its use in these J. F. McKay. Buies Creek Asa Thurston, Taylorsville cases." G. A. Gentry, Person County The third party interested in the J. W. Jones, Winston-Salem price of antitoxin is the State of North E. Nobles, Greenville J. Carolina, which we are trying to repre- .J, C. Wilkins, Haw River The Health Bulletin sent. The State wants its people to have and the kind of health work you have antitoxin at the lowest possible get, and he can, if he will, see that rate. It is spending about $10,000 a the county physician arranges for the year to produce antitoxin in order that people of the county to have State they may have it within easy financial antitoxin at convenient depositories. reach. The State antitoxin costs 25 We have nothing against the chair- cents a package regardless of the size man of your board of county commis- of the package, whether it contains sioners. If he suits you, he suits us, 1,000 units, 5,000 units, or 10,000 units. but his negligence in this matter is The charge is made for the syringe, causing some of the citizens of the the wrapper, the postage and express. county to pay a great deal more than The antitoxin itself is free. they should have to pay for diphtheria Now, my reader, if somebody who in antitoxin. We think you ought to some way is interested in commercial know this. W. S. R. antitoxin should tell you that any com- State mercial brand is better than the TTPHOID FEVER CAN BE antitoxin, ask him to please put that PREVENTED In writing and let us have it. It will make excellent material for a subse- Militarists tell us that the first line quent Bulletin. W. S. R. of defense of our nation is in the navy and that the second line is in the coast LAGGING COUNTIES fortifications and that the third line of defense is in the army. This is only counties The following twenty-one partially true since all three of these have made at this writing, March 10, lines of defense depend upon the wel- their people to no arrangements for fare of the people in their homes. The diphtheria: receive State antitoxin for main defense of this or any other coun- * Alleghany Greene try depends upon the health of the Anson Halifax people—the health of all the people, Avery Pender not of any class or division—and any Bladen Rutherford amount of money that can be expended Burke Scotland to create and improve health condi- Cabarrus Swain tions in the homes and thereby build Camden Transylvania up a strong and active race of men Columbus Tyrrell and women who are able to take care Cumberland "Vance of themselves will, from the standpoint Dare Warren of the State or the Nation, be wisely Graham and economically expended. People living in these counties have Typhoid fever is an example of a to pay from eight or ten to twenty disease that can be, and is being, pre- times the price of antitoxin that peo- vented in North Carolina through an ple living in the other seventy-nine application of the rules of sanitation counties have to pay for it. Who is and personal hygiene by our citizens. to blame? The chairman of your board Typhoid is a dangerous disease, in its of county commissioners. He is the beginning being rather insidious; and man. He is the chairman of your it extends over weeks and perhaps county board of health. He is the months when it runs its usual course. dominant influence on both the board The patient is left very weak and is of county commissioners and county often handicapped for life with the board of health. He is the man more after-effects of the disease. And, worst than any other responsible for the of all, the disease is very infectious kind of county physician that you and easily spread and kills about one The Health Bulletin 5 out of every ten who contract it. For diseases are all caused by germs which these reasons typhoid is a costly dis- pass from the body with the bowel ma- ease and causes great economic loss to terial, and if all the bowel material is the unfortunate family or community prevented from getting into the drink- in which it appears. ing water and flies cannot have access On the other hand, typhoid fever is to it and carry it to the food, these easy to prevent and there is no reason, diseases cannot occur. This protection except ignorance, why an individual, a can be secured by building and using family, or a community should con- sanitary (fly-proof) privies—and such tract the disease. An indivichial can privies are no more expensive than the protect himself by being vaccinated. ordinary open-back privy, or the open-

DEATHS FROM TYPHOID FEVER During the Years 1914, 1915, 1916, and 1917 (Death Rates per 100,000 Shown by Counties)

Total Deaths for Yearly Average Death Rate for County 4-year Period of Deaths Average Year Davidson 44 11 33.7 Forsyth 82 20^^ 37.7 Lenoir 53 13^4 52.9 Nash 42 10y2 27. Northampton 14 ZVo 15.2 Pitt 63 15% 40.1 Robeson 66 161/2 30.2 Rowan 57 14% 34.7 Wilson 57 I414 46.1

Total 478 1191/2 35.3

DEATHS PROM TYPHOID DURING 1918 County Population No. Deaths D Davidson 33,171 Forsyth 23,732 4 Lenoir 25,365 2 Nash 32.913 1 Northampton 23.061 Pitt 39,769 2 Robeson 54.223 5 Rowan 41,575 4 Wilson 31.207 6

Total 305,016 24 6 The Health Bulletix from typhoid fever being an indication each), we can estimate the great finan- of a reduction in the number of cases cial saving that has been brought and deaths of all diseases which are about in North Carolina through sani- spread through pollution of the soil. tation and vaccination. In North Carolina we have statistics The reduction in typhoid fever dur- of typhoid fever since 1914. There has ing 1918 in the nine counties cooperat- been a steady reduction in the number ing with the State Board of Health is of deaths, and hence in the number of shown in the accompanying table which cases, each year; as follows: also gives the typhoid statistics for 1914—839 deaths these counties for the years 1914 to 1915—744 deaths 1917. It will be seen that nearly 1916—700 deaths ninety-six (76%) of the total State 1917—628 deaths reduction of 126 deaths from typhoid 1918—502 deaths was in these nine counties. When we consider that there are at In view of these important results least ten cases of typhoid fever to the action of the General Assembly of every death we can determine the de- 1919 in requiring the building and creased amount of sickness, and if we maintenance of sanitary privies and place a monetary cost on each case and in providing for an extension of co- each death (Rosenau, an authority on operative county health work is seen public health matters, places the aver- to be wise and economical. age cost of all cases of typhoid at $400 B. E. W.

WHO AM I?

I am as old as the first man and as Where ignorance, poverty, dissipa- young as the last born babe—ever tion or physical stress prevail I take changing and unchanged. Where hu- my greatest toll. I am insidious, in- man intercourse is possible there may satiable, malignant—the unceasing I be found. enemy of all mankind. I devastate cities and countries and To the superstitious and the unin- continents. Athens I robbed of her formed I am inscrutable, but my clan- glory and Rome of her strength. I destine methods of travel and approach conquer the armies of conquerors. cannot withstand the enlightenment of I laugh at barriers and bars and men. Where publicity and education bolts. I penetrate both hovel and exist, there I do not prosper. palace and ravage the frames of the I avoid those with clean lives and young, the old, the weak, and the careful habits. I languish before the robust with equal delight. I feel no investigation of science, which steals pity for age, nor sex, nor beauty, nor away my virulence. rank. I can be banished by organized com- I assume many forms, and those munity effort, and when this shall be whom my first malevolent touch has accomplished my name will lose its left weak and defenseless, I seek, potency of mystery and fear, and my ghoul-like, in other guise, again and ravages cease—for I am again to destroy. Cooing infancy, laughing childhood, ambitious youth, CONTAGION happy motherhood, protecting father- ! hood and contented age—all these I —Kansas State Board of Health Bui- * garner in my remorseless harvest. letin. The Health Bulletin

THE SWORD OF DAMOCLES

By William Colby Ruckek, M.D.

T was hot and sultry in the rooms of the County Medical Society and the general sleepiness of the atmosphere was not in any way relieved by the droning voice of Dr. Erasmus P. Hicks dilating on the superiority of goat's milk for artificial feeding. A few of the older men who felt themselves above criticism boldly stalked out to the cool of the antechamber and one by one the youngsters trickled through the door, leaving behind only the occupants of the first three rows and those who had fallen asleep in their chairs. In the outer room Marcus was holding forth, an alienist of international reputation, noted for a taci- turnity which sometimes broke its bonds with the rush of a spring freshet. "I tell you it gets 'em every time—sooner or later a man has to pay. You fellows see the beginning of things—the finding of the indictment, as it were; I see the endings—the execution of the sentence. And. God, what punishments! Not only does the man who breaks the law of nature suffer—if that were all it wouldn't be so bad—but the mental and physical agony of the family, yes, and of the generations yet unborn, is something unbelievable. The cruelty of it all! You know how it is; sometimes after a short bodily inconvenience, often

not enough to be called an illness, they go on for years in fancied security, even forget- ting, perhaps, the sin of long ago. And then the concrete pavement begins to feel like a plush carpet beneath the foot, the gait becomes uncertain in the dark, the lightning pains begin to rend the victim—you know the symptoms. Maybe it's a constant headache; and a round of oculists and internists and sanitariums begins. Then one day something breaks the fine fiber of self-restraint and 'Change wonders at Ms absence until the court appoints a conservator and the name of the asylum comes out. "Let me illustrate. I can tell it now because he's long since dead and the family all live in Europe on his money. About two years before the fire, I was called into the case as a consultant. Clear case of paresis; in my own mind

I didn't give him a year. Asked usual questions about previous history; patient claimed good record—denied any wrongdoing and was upheld in this by the family physician who said they had been intimate for twenty years. Still, it didn't look right to me. I knew the doctor wouldn't lie about it and the patient acted like he was telling the truth. But it piqued my — —

8 The Health Bulletin

curiosity and afterwards I used to catch answer to the question which had per- myself wondering about it and debat- plexed me so long. ing whether I was unjust to the man. "The beginning was about like that "Well, he got so it wasn't safe to of any diary. Resolves to make jour- keep him at home so we sent him to ney before finally settling down lion Boardman's. One day his wife came voyage dinners — into the office to talk about the case journey to New you know how they do—and in some York — sailing o f way it came out that the patient had ship — waving toured Europe about a friends on pier—all year before his mar- that sort of thing. riage. This was a new Makes an acquaintance on board, young aspect of the case to me man about his own age; decide they

so I let her gabble on. will make the tour together. Cherbourg She told me what an extensive trip —Paris—rather a gay time—a Mile. it had been and that he had kept Louise Louis joins party and the three a most minute diary during the en- travel through Norway, Sweden, and tire time, but that she had never been Denmark together, finally winding up a.llowed to read it. I felt at once that in Berlin about two months after the I must have that book. At my request, diary begins. Here the first rift in she searched the house for it—couldn't the lute. The apple has turned to find the thing anywhere; had his pri- ashes. He feels sick; consults a doc- vate papers at his office gone over tor—is sent to Fournier in Paris. You

not a single trace of it. I was con- know what that means. The diary siderably put out—made me sore to reads, 'Saw Dr. Fournier today. I am lose such a chance of proving up and to return in ten days for my sentence." •settling the worth of a deduction I Poor ignorant boy, little did he realize believed correct. the meaning of that sentence even "Just as I had about given up and after it had been delivered. From that told my curiosity it was an old med- time on the course of the dler to start me on such a fool's errand, disease was that of a typi- Etoardman writes me that he found a cal light form, apparently greasy old notebook on yielding perfectly to treat- the patient when he was ,^t^^^^ ment—a treacherous viper admitted and that any waiting until it can strike attempt to take it away the most telling blow, bid- from him always made ing its time until success has crowned him violent. It was the years of labor and brought the pleas- diary; I knew it in- ant anticipation of retirement from stinctively and I didn't active life into the calm and peace of lose any time in getting the family home. out to the asylum. Well, after a lot of "In three or four months the young wheedling I got the book, a little, dog- man thinks he is cured, leaves Paris, eared, dirty volume written full of completes his tour, and, after a year's the account of that journey. It wasn't absence, returns to New York. That an easy job to read it though. The day he made this entry (how it sticks grease had soaked through and the in my mind!) 'And thus today ends faded letters in that methodical busi- my wanderjahr—a period of great ness hand didn't stand out very plain profit, much pleasure, and nothing to on the yellow paper. But I knew I look back to with regret.' How little had a human document containing the inipression this awful thing had made —

The Health Bulletin 9

on his ignorant young mind! He had Influenza which has just swept the already forgotten the worst thing country afforded an opportunity for a which was to happen to him in all his further imposition on the credulity of life. And in the after years nothing a suffering public which was not over- •occurred to recall it, but always the looked by the "get-rich-quick Walling- sword hung above his head. Only one fords" of the patent medicine trade. of his sons reached manhood, his only Some enterprising druggist started daughter was a chronic invalid, and the rumor that a bag containing cam- he sometimes wondered at the puni- phor worn around the neck would pre- ness of his grandchildren. But he did vent influenza. In a short time signs, not see in this the punishment for the "Camphor, one cake only to a custo- sin of his youth nor did he realize the mer," were displayed in many drug price he was to pay for this season of store windows. For a few days the apparent immunity. All the time he street cars smelled as though every- remained well, pushing his way up the body had got out his winter flannels narrow ladder of success, accumulating at once. wealth, gaining civic honors, respected, Three papers circulated looked in Provi- up to, no one apparently so dence carried advertisements of much to thirty- be envied. And the blow fell; two different preparations which, but God was kind—he scarcely lived according to the manufacturers, out the twelvemonth." would prevent or cure influenza, some of There was silence for a moment and these being changed frequently. then one of the Two youngsters blurted advertisers quoted from out: "Wonder reports of the what happened to the Surgeon-General chum?" of the Public Health Service in such a way as to "Well, lead the I did, too. So I went innocent care- reader to assume that their fully through the book particular patent was recommended by again and found his full that authority. Another used extracts name and address. I from a bulletin of a State Health De- know him well. He's partment as an implied testimonial. been in a roll- Overnight compounds previously ad- ing chair with vertised as remedies for indigestion, loco m otor rheumatism, constipation, headaches, ataxia for the as general tonics, etc., suddenly be- past fifteen came specifics for infiuenza. Two well years, suffering the pains of hell." known dental preparations became Copyright 1917, Amer. Social Hxjgiene grip preventives. For some mysterious Asso'n. Reprinted by permission of reason the manufacturers of corn cures The American Social Hygiene Associa- and hair restorers appear to have over- tion, Neio York. looked this golden opportunity. One astute manufacturer did, however, call attention THE EPIDEMIC AND THE to the possibility that cock- PROFITEER roaches might spread the disease and advised free treatment of his insect Attention has been called more than powders. once to the practice of patent medi- The extent of this raid on the public cine firms of turning the great Ameri- pocketbook is indicated by can the adver- failing for self dosage to their own tisement of one manufacturer that in financial advantage through the ex- 19 days he had sold more than two ploitation of worthless or exorbitantly million jars of his preparation priced valued "remedies" for all sorts of hu- at over ^400,000.—Bulletin of the State man ills. The epidemic of Spanish Board of Health of Rhode Island. Bulletin 10 The Health

HFliDHilAHB C0Cr.80ACBES .. WflUENZA LEAVES ^ P^^'^bo<*«r," r^H^se^ THE BLOOD THIN AND' THE NERVES WEAK

Dan^rer from the DiccMe Is

GRiP V'CriMS Soanlth iDfloesza 're people who I 9e( Epidemic weak and .] runilown.Yoj «^ can -jajn Uqht \ Me inq BEST sJrenq.n. B' THE ' from m ifm. (3 Antiseptic JOHNS MEDICINE "^^ SPANISH iSfSenxa m8 Spanish Influenza %^«^A^y4

d*>"^ fwcribed for orttaary ^-»»2^-Ue ^-^ Crip. A good plan Is oot t« £?^ 5*5* * ."^ ,^ tn-"^** ~ ^ Q wr. until Tou an »ick_ hut 7^^kh^«b *

your blood iSmok^* fo«i/y^;^f"P and^ Out For '/—-oyyour body a.,.~!: ; r^-irtkl Took against ,^.^rT:r:^w:i sjS^^^^^ ^P^n^^ influenza

Precautions Against r^HS^^—^ «J^-/lAl\daK ^i'fes^^V: .^^^*--^'»-f -^ '^^*^*' Colds and Grippe -I^S^— -

Preventative S^l^.^,

About :><^=^^i^-^—— ad TWs f \ r-y^? INaUENZA SpanfliMnza RAGES IN U.S. A. gU«M ObMt Oold Ottm^

Remember "The Three Civj»_ v,fui ^l^"^"=:f?|; ^r-<:^ 2^?ySCEPTlBl£ TO IT To Avoid Infhieoza jCripPaHeabNecda ^UvvHiNt h Dcclrle leH Pil

SIGNS OF THE. TIMES Infant Hygiene

Edited by Mrs. Katk Brew Vaughn.

CARE OF THE BABY REALLY PAYS to do all this, as I must do my work, but I have found that it is much better A letter fi'om a mother of an 100 to take care of a well baby at regular per cent baby, who learned that it was hours than it is to care for a sick baby better to care for a well baby by a all the time, so Richard, Jr.. has had schedule and according to rule rather regular hours for feeding, sleeping, than take care of an ailing baby all of bathing, and waking from the very the time: first day. He has never had a mouth- ful of solid food from the table. He R. F. D. No. 6, Raleigh, N. C, has had his milk and orange juice, and February 6. 1919. since he was two months old it has not Bureau of Infant Hygiene, been necessary to feed him at night, State Board of Health, from 9 p. m. to 6 a. m. Raleigh, N. C. My baby has always slept by himself, My dear Mrs. Vaughn: day and night, in a bed—not a cradle, I am sending you herewith a picture with the windows down from the top. of my baby, Richard, Jr. He was born He has never had a taste of soothing April 23, 1918, weight seven and one- syrup or baby medicine and he has half pounds. I nursed him for six never been sick. When he is consti- weeks and he gained one-half pound in pated I use a soap stick and I have had that time. Owing to my own health I to do that only three times in his life. could not nurse him and my doctor At the age of nine months, he weighs advised me to put him on the bottle. nineteen and three-quarter pounds, and Realizing that I knew nothing what- as my cow was about to go dry I felt ever about babies, I got all the advice he needed more food and applied to from the State Board of Health for you to help me supply him with the myself and baby. Two little books. right kind. You will be glad, I am Prenatal Care and Infant Care, were sure, to know that he likes his egg and sent me and these I studied very care- toast and oatmeal jelly and that he fully and was greatly benefited by do- continues to gain weight. ing so. I learned from these books I am glad you think my baby is that it was best to have regular hours attractive, for no mother was ever to feed baby and to give him the same prouder of her baby than I am of mine. quantity at each feeding, to take very I think the "regular" program has a great care in preparing the milk and great deal to do with keeping him well the bottles and to keep same chilled and happy. after the bottles had been prepared for Yours truly, the day. It was a good deal of trouble (Signed) Mrs. Richard H. Tyson. 12 The Health Bulletin

THE CORNERSTONE OF A CHILD'S FUTURE

By De. Aldeet Smedes Root, Consulting Specialist Children's Diseases, North Carolina State Board of Health

The cornerstone of a child's con- the food next best to mother's milk. stitution and future health is laid We will speak of these dilutions or during the first two years of its life. modifications, as they are called, later It is in this period that 2,626 babies on. die from intestinal and diarrheal dis- How shall we know whether baby is eases in North Carolina every year. thriving? The best and surest indica- The reason for this is (1) the intes- tion of this is the child's weight, for tinal tract of an infant is very delicate if there is not at least a weekly gain and susceptible to attacks by germs, of four ounces, or, roughly speaking, and (2) a majority of these deaths a pound a month during the first year, occur in babies fed on cows' milk in the baby is not doing as well as should which the disease-producing germs are be expected. The best investment a nearly always present UNLESS the mother can make is scales which will milk is carefully cared for. weigh in ounces, and if this is not Every mother should strive to nurse possible, the baby should be taken to her baby for twelve months, other a nearby grocery store and weighed. things being added to the diet when The baby should be weighed once the baby fails to gain in weight, be- weekly—at the same time of day and cause breast milk is the ideal food for the same interval after nursing. this age. It is an ideal food because Suppose the nursing baby fails to (1) it is sterile—that is, contains none gain for three weeks or a month, and of the germs which cause diarrheal suppose it has been nursed at regular diseases; (2) it contains the proper intervals of three hours during the day ingredients of food for the baby's and twice during the night, up to six nourishment; (3) the ingredients are months of age, and then every four in the right proportion; (4) are in a hours during the day and once at more digestible form than in any other night, then the child should be given sort of food. additional food. It is a rare thing indeed that mother's How shall we know how to dilute milk disagrees with the baby, provided the milk and to prepare it to suit the the hours of nursing and the baby's child's age? Most infants will do well habits are regulated, and a great re- on the following milk mixtures: sponsibility is taken when a baby Baby Tico Months Old: under a year of age is denied its Whole cow's milk, 9 oz. natural food. (or 18 tablespoons) (Cow's milk from which Modified Cow's Milk cream is not removed) Water, 18 oz. (or 36 tablespoons) If the breast milk is insufficient in Milk sugar, 3i^ quantity, or poor in quality, and the level tablespoons baby does not thrive, then additional The infant should be fed 3 14 ounces feedings or some other food should be every three hours for seven feedings supplied. In such a case, cow's milk during the twenty-four hour interval, properly diluted with water and sugar and should be awakened for feedings added to suit the age of the child, is during the day. —

The Health Bulletin IS

Baby Three Months Old: boiled when first bought and after this kept in Whole milk, 17 oz. (34 tablespoons) a solution of boracic acid (one teaspoonful Water, 17 oz. (34 tablespoons) of boracic acid crystals to a glass Milk sugar, 4 level tablespoons of water). After each nursing they should be Give 41^ ounces every three hours for washed with soap and seven feedings. water and dropped into the boracic acid solution. Baby Six Months Old: Boiling the milk kills the germs, which, as mentioned before, will be Whole milk, 24 oz. (48 tablespoons) found in all cow's milk, but if the milk Water, 12 oz. (24 tablespoons) is not kept cold they will again make Milk sugar, 3i^ level tablespoons their appearance. These germs multi- Give 61^ ounces every four hours for ply by thousands in warm milk five feedings. within a short time and hence it is most im- Baby Nine Months Old: portant to cool the milk as quickly as possible after milking and to keep the Whole milk, 1 quart bottles containing the milk mixtures Water, 11 oz. (22 tablespoons) in a cold place, preferably on ice. Milk sugar, 3i^ level tablespoons If milk cannot be . kept cold, it la Give 8 ounces every four hours for five better to use dry milk—that is, milk feedings. which has been dried and made inta Method powder. Depending upon the child's, The milk, water and sugar should be weight, so many tablespoons of this boiled for three minutes from the time milk is used to sufficient number of the little bubbles begin to come through ounces of boiling water to nourish. The the milk. It is then cooled QUICKLY Bureau of Infant Hygiene will be glad by placing the vessel containing the to tell you more about this. No milk hot milk into a larger one of cold should be used which is over twenty- water; then into each of seven bottles, four hours old, even if it has been 31^ ounces of milk is placed. Bottles boiled and kept on ice. Milk which should have been thoroughly washed in has been taken from the ice and warm- warm water with soap by means of a ed for the baby should not be used bottle brush, and boiled for a few again. minutes. Filling is best done by pour- Additions ing the milk into the bottles through a small glass funnel into which is tucked At nine months of age, oatmeal gruel a piece of cheese cloth, which has been (oatmeal cooked four hours in a double boiled. In this way the milk is boiler and strained) should be added thoroughly strained. Bottles contain- one tablespoonful in the morning and ing the milk are then stopped with one in the late afternoon at the same sterile, absorbent cotton (which can be time milk is given, a pinch of salt bought at any drug store) and placed added, and some of the milk from the on ice in summer, if possible, or in a bottle poured over it. cool place in the winter. Just before At twelve months of age the baby giving to baby, the milk is warmed to should be entirely weaned from the about skin heat. Nipples should be bottle and this schedule followed: —

14 The Health Bulletin

6:00 to 7:00 a. m. Milk, % cup, diluted with 4 to 6 tablespoons of barley or oatmeal gruel (oatmeal cooked 4 hours and strained.) 9:00 A. M. Orange juice, pineapple or prune juice: 2 to 6 tablespoonsful 10:00 A. M. Cereal (thoroughly cooked and strained) 1 large tablespoonful. Milk—% cup—part of it on cereal; 1 piece crisp, dry toast. 2:00 P.M. Beef juice, 2 to 4 tablespoonsful, or mutton or chicken broth, Ya to V2 cup; or i/j — (later) 1 entire soft egg. 1 piece of crisp, dry toast. Milk 14 to % cup.

6 : 00 p. M. Same as at 10:00 A. M.

10 : 00 p. M. Same as at 6:00 A. M., but given from bottle.

Boil Milk Daring Summer Months of life. It is most important that children should be taught to take it. Cow's All babies whose diet consists en- milk has a tendency to constipate most tirely of cow's milk should have some babies, and in this case the addition vegetable juices, either orange juice, of one-half to two tablespoons of milk prune juice, evaporated peach juice or of magnesia in the night bottle will strained spinach. This prevents cer- usually correct it. tain diseases which sometimes occur Castor oil should not be given for when the baby is wholly on cow's milk. constipation, as it leaves the child more Orange juice should be strained and constipated afterwards. diluted with equal parts of water and Practically none of the baby foods, one-third of a teaspoon of sugar added. which are sold at all drug stores, con- Weaning tain the ingredients of food in proper proportions for the baby. If continued Weaning should be done gradually, for any length of time the baby will the breast milk being gradually re- gain, but its flesh is soft and not placed by cow's milk. When cow's healthy flesh, and if the baby becomes milk is first added to the diet it should ill, it is often unable to resist disease. be weaker than that which is required In addition, they frequently upset the by the baby of a certain age. For in- baby's bowels because they contain too stance, a baby six months old should large an amount of sugar. begin on the one month old diet, and during the next three weeks it is gradually increased to the strength the WOULD YOU SHARE TOUR CHILD'S FOOD WITH THE FLY? child should have according to its age. Weaning the baby, or the addition of Flies are the natural enemy of chil- cow's milk to the diet, is a trying time dren, usually very successful enemies, for the mother. Babies who have had because the younger the child the more breast milk at first refuse cow's milk, helpless the victim. but the mother must not become dis- Flies breed in filth couraged. It is a good plan to have Manure piles too near the house. her go out of the room at feeding time Open privies. and let someone else give the baby the Dead carcasses. bottle. Every other day she can starve Flies cause diarrheal diseases and the baby for six or eight hours, pro- typhoid fever. vided the child is well nourished. The housefly will breed in almost any Important Cow's Milk fermenting organic matter, but prefers No other food will take the place of horse manure and takes as second cow's milk during the first two years choice human excreta. The female fly The Health Bulletin 15

lays on an average 120 eggs at a time ing house, but the fact that a pigpen and may do this several times during close by, a livery stable, a hen house, her life time. During midsummer, and an open privy contributed their eggs of the fly hatch in eight hours, quota of flies, made eating a rather and in five days the egg has envolved dubious and hazardous affair. Aunt to an adult fly capable of infecting the Betsy helped to biscuits with one hand food for the entire family. The life and "breshed" the flies with a peach of an adult fly is about 21 days, during tree brush wielded in the other. When which time said fly may deal death to much occupied, often the bresh failed as many people, if they are available its mark and flies fresh from pigpen or and opportunity presents. Flies do not stable were bresh^'} in the coffee of the live on clean premises. guest. Aunt hietsy did not add to her In some places the fly is called ty- popularity by suggesting that they

out. phoid fly, and in others, the diarrheal throw the fly One guest, long a

fly, and this should be taught to sufferer, and bolder than the balance, school children to remind them of the suggested one day that screens would business of flies, that of causing ty- solve the problem and undertook to ex- phoid fever and diarrhea. plain how the house could be screened A story was told by a "drummer," as and her time and effort saved. After the traveling salesman used to be a lengthy and enthusiastic discussion, called, which shows the attitude of Aunt Betsy sighed and said "I 'low as mind of some people. Aunt Betsey how that would be mighty fine, but it Smith was the proprietor of an "eat- would be right lazy like." ing" house at a crossroads town which Only the shiftless parent will neg- was visited by most of the traveling lect the screening of the house. men in North Carolina. Aunt Betsey's Hot weather, filth, flies and diarrhea

food was not bad for that type of eat- all go together ^— why? Flies breed —

16 The Health Bulletin

should more rapidly in hot weather; they are child from the fly, but a parent child to be dependent upon filth for a breeding be ashavied to allow his the fllthiest place, and wherever there are flies exposed to the danger of and a baby in close proximity, there of all creatures—the Fly. also will be found diarrhea.

fly is bred in filth, hatched in . The INVITATION TO EXPECTANT fllth, lives in filth, and is the filthiest MOTHEES creature on earth. The fly has the Time was when women were wont to filthiest habits—one moment crawling withhold even from their most inti- over excrement and filth, the next mate friends the fact of their expec- flying in the window and alighting on tant condition. As the farmer has been the pie, or on fruit one is preparing to benefited by expert advice in the rais- lift to the mouth. ing of stock and the selection of the Flies are not necessary and their proper crops for his fields, so the presence in your home shows an in- woman of the State who is raising the difference on your part to the health most wonderful crop realizes that the of your family, and your baby par- advice of physicians and nurses is of ticularly. such vast importance that the false desire to rid yourself of flies, If you modesty of a few years ago has been it will be necessary first to protect all lost. their contamination. To do food from Ten years ago a body of women dis- the windows, and doors, so, screen cussed books, new patterns for knit- cover the garbage pail, clean the ting, embroidery, and crochet, but sanitary privies, con- stables, build maternity was too sacred or intimate struct fly trap and use a swatter. Sec- a thing to be spoken of in groups and ond, get your neighbors to do likewise. it was only when with "one of the Get your community interested in ex- neighbors" that the sacred function terminating flies, get the boys and was discussed, too often with harrow- fighting them, get girls interested in ing details, and the interviews were the boys to making fly traps, and teach anything but reassuring, and inter- the children to hate flies and to be spersed as they were with folklore and ashamed to have them about, swat- superstition, which would not be ting them whenever they make their countenanced by the farmer regarding appearance in the house. Start the his stock, left an unwholesome jumble campaign before the flies get a start of ideas in the mind of the expectant begin with the fight before the eggs mother, and at the very time when of are laid or hatched—and keep it up all others she should be reassured and without ceasing. comfortable. Babies are the prey to flies; if their Now because of the very sacredness bed is exposed to flies they crawl all and responsibility of maternity, as it over them during their daytime sleep, is realized, prenatal care is attracting speck their faces and lips. The food the attention of all women. Thought- and its containers are not forgotten by ful husbands are making every effort the fly, as they particularly like the to procure for their wives constructive articles of food usually given to the information from some recognized child. All babies have not the robust source. constitutions to throw off the germ The Bureau of Infant Hygiene, State deposited by flies, which get into their Board of Health, invites the expectant stomachs and intestines. As an act of mothers to write for the advisory let- humanity everyone should protect the ters. K. B. V. ?^ wsm

^^-^iTi\\s,l^xi[\ztx\\ri\['bQ. 5er\t free io cxv^ dfoen of the State -upoATCguestl

Vol. XXX W('3i) IVLIY, 1919 No.

His Excellenry, Thomas Walter Bickett GOVERNOR OF NORTH CAR* A FREE PUBI.IG KEALTBI OTERATURE

The State Board of Health has a limited quantity of literature on health sub^ectB for free distribution. If you are interested in one or more of the following subjects, or wani same sent to a friend, write to the State Board of Health for free literature on that particular subject. WHOOPING-COrGH Saxitary Privies German Measles Hookworm Disease Residextiax, Sewagb Typhoid Feveb Public Health Laws Disposal Pi^nts Diphtheria tubekoulosis laws Eyes Pellagra Tuberculosis Flies Constipation Scarlet Pe\t2r Colds Indigestion Infantile Paralysis Teeth Infant Care Care of the Baby Cancer Child of Pre-School Ply Placards Malaria Age Typhoid Placards Smallpox Corner Stone op Tuberculosis Placaeds Adenoids Child's Future Clean-up Placards Measles Pke-Natal Letters Spittikg Placards SEX HYGIENE BULLETINS Set a—Fob Young Men Set D—Fob Parents Reasonable Sex Life for Men. A When and How to Tell tne Children. Sexual Hygiene for Young Men. Venereal Diseases Vigorous Manhood. —A Sociologic Study. The Need for Sex Education. Smash the Line. (The case against the restricted district.) List of Reliable Pamphlets. List of Reliable Pamphlets. Set E—Fob Girls and Young Women Set B—^FoR Public OVfioials and Business Men Your Country Needs You. (Especially for girls 11 years of age and over.) Public Health Measures in Relation to Ve- nereal Diseases. Note.—For girls under 11, see "\Vhen Venereal Diseases Sociologic Study. —A and How to Tell the Children" (Set D); Smash the Line. (The case against the re- portions of "Your Country Needs You" stricted District.) also may be read to younger girls. Girls The Need for Sex Education. 15 and over may be given "The Nation's A State-Wide Program for Sex Education. Call to Young Women" at the discretion List of Reliable Pamphlets. of the parent. Set C—For Boys The Nation's Call to Young Women. Vigorous Manhood. (Especially for boy a 12 List of Reliable Pamphlets. years of age and over.) Note.—For boys under 12, see "When Set F—Foe Teachers

and How to Tell the Children" (Set D) ; The School Teacher and Sex Education. portions oi "Vigorous Manhood" also may Sex be read to younger boys. Boys 15 years Education in the Home and High and over may be given Bulletin "A Rea- School. sonable Sex Life for Men" (see Set A), Venereal Diseases—A Sociologic Study. at the discretion of the parent. Smash the Lino. Sexual Hygiene for Young Men. The Need for Sex Education. List of Reliable Pamphlets. List of Reliable Pamphlets.

Any of the above will be sent without charge, Please send for only those bulletins for which you have definite use.

EDWARDS 4 BROUCHTON PRINTINS CO., RALIICH. N. C. JLrJji PUBLI5AE.D 5Y TMS:. npi^TA CAgOUMA STATE, pOAgD s^MEALTM

Vol. XXXIV MAY, ISIS No. 11

EDITO iviAL

TEE CHILD AS AX IXDSX TO tics law) has recognized the waste. OUR CIVILIZATION Recognizing it, there is but one course to pursue—stop it. Care for childhood someone has said, To stop this enormous waste of its is the best index to a state of civiliza- childhood, its future life, the first step tion. Care for childhood is perhaps was to get a plan. In formulating a the highest form or expression of fore- plan, naturally the first move was to sight. As to the place of foresight in ascertain the more important causes civilization, Prof. Irving Fisher has of death. . Vital statistics again. Here said: are the essential facts: "One of the first symptoms of In 1917, 11,749 children under five racial degeneracy is decay of fore- years of age died, which was more sight. Normal, healthy men care for than one-third of all the deaths occur- and provide for their descendants. ring in the State. Of these deaths, A normal, healthy race of men and 5,199 occurred in the last weeks of such alone, will enact the laws or pregnancy and in the first month of life, develop the public sentiment needed and a large per cent of these deaths to conserve natural resources for were chargeable to ignorance as to generations yet unborn. When in the proper conduct of pregnancy and foresight was lost, care for Rome the management of labor. Another future generations practically the 2,626 deaths of babies under two years ceased. Physical degeneracy brought of age were caused by diarrheal with it moral and intellectual de- diseases of infancy resulting largely generacy. Instead of conserving their from improper feeding. The remain- resources the spendthrift Romans, ing 3,924 deaths were attributable to from the emperor down, began to several causes. These figures teach two feed on their colonies and to eat up perfectly obvious lessons. iLeir capital. Instead of building (1) The State must get in touch new structures they used their old with its expectant mothers through the Coliseum as a quarry and a metal Bulletin, through the press, through mine." local organizations, local departments Eight million dollars ($8,000,000) of health, the medical profession, and annually appropriated by the State for public-spirited citizens especially the the education of its children one-fifth women, and furnish these mothers with of whom die before reaching the school the necessary and essential informa- room and one-third of whom are dead tion as to the safe conduct of preg- before their school days are over, nancy and management of labor. One Lospeaks a civilization right in prin- important agency in reaching these ciple but wasteful in practice. The mothers will be the employment of ijtate at last (through the vital statis- public health nurses by counties or by The Health Bulletin counties coopei'ating with the local kills the infectious germs that cause Red Cross Chapter, by women's clubs, diarrheal diseases of infancy. Pay no and various organizations. attention to the hair-splitting doctrin- (2) Our people must be impressed, aire who tells you that boiling the milk thoroughly informed as to what con- kills the vitamines of the milk and stitutes the proper feeding of infancy, predisposes the child to scurvy and and, lirst, they must understand that rickets. Tell him he is looking through

90 or 95 per cent of the mothers can a microscope; that he is seeing little if they only will, nurse their babies; things big and out of their right pro- that the incidence of disease among portions. Tell him that scurvy and bottle or artificially fed children is rickets are very rare diseases, compara- 27 times greater than among breast-fed tively speaking and that diarrheal babies; that the death rate of bottle- diseases of infancy are the most "fre- fed babies is 10 times greater than quent diseases to which a child is ex- among breast-fed babies. The breast posed, and the most deadly. Tell him, is the baby's first birthright, and the further, that you can restore the greatest assurance of healthy infancy. vitamines by giving the baby a couple Second, our people must understand tablespoonfuls of orange juice or other that v/^hen for some good reason breast- juices, or the liquor in which the feeding is impossible or when the child cabbage or potatoes are cooked. What is in its second summer and milk must we shall teach in North Carolina with be used, that any unboiled milk is of regard to the feeding of infants, then, doubtful purity. There is no certified is this: breast first, boiled milk next. milk in North Carolina, practically Much will be written and said in the speaking. Fresh cow's milk should be next few years in North Carolina ou used only when the mother knows and the subject of infant hygiene, but all controls the conditions under which that is written and said must supple- the milk is produced, that is, when the ment, expand and emphasize (1) the family owns the cow, and when the importance of intelligent maternity, milk is fresh, not over six or eight and (2) breast feeding and boiled milk. hours old, and has been kept in a cool Any thing written or said that con- place. The one safe thing to do with fuses or in any way obscures these milk that is sold in the towns and two primary essentials in the conser- cities of North Carolina is to boil it vation of infancy is, to say the least, before giving it to the baby. This of questionable value. W. S. R. WAYS AND MEANS OF REDUCING INFANT MORTALITY IN NORTH CAROLINA

THE CAEE OF THE KETVLY BOP.X harm is done through too much BABY bathing than not enough. The baby should have a bath every In liis "Light of Asia," one of the day. most beautiful poems in any language. 5. Dress the cord with a piece of clean sterile gauze, first cover- Sir Edwin Arnold has something like ing the stump with a bit of boric this: "The babe is wise that weepeth, acid powder. See that the bowel being born." Now, to unblushingly and urinary passages are open. misappropriate his meaning in toto, A band is not generally necessary, but if used, should not be applied, nothing is more im- literally pinned tight as much injury than to set portant to a new-born babe often results. If used at all up a great big cry the moment it is the band should be soft cloth and born. It expels the mucus from its should be wide enough to cover the whole abdomen. upper air passages, thoroughly aerates 6. Cleanse the eyes thoroughly with lungs and fills its system full of its a solution of boric acid, 10 oxygen, the elixir of life. grains to one ounce of clean So the first and most important boiled water, then, most important of all, drop into each things to do for a new-born baby may eye two drops of a solution of silver enumerated as follows: be nitrate. This is furnished free to all physicians and midwives 1. Get it to cry lustily, and see that by the North Carolina its throat is clean of mucus. State Board of Health. See that it is 2. Have the room warm and quiet. used without fail, it may prevent 3. See that the "cord" has been securely tied and cut and that blindness later on. there is no oozing of blood from 7. As soon as the baby is dressed and the cord, then wrap the baby in laid on its right side in a little warm flannel or woolen cloth and bed of its own, where it should place on its right side, leaving go to sleep without rocking, the plenty of breathing space. nurse should see that the doctor Leave it alone for something or midwife fills out properly a like a half hour, being careful birth certificate, which should be of course that it is in a warm, sent promptly to the Registrar comfortable place and breathing of Vital Statistics for the town- naturally. ship or city or town, so that there will be 4. The nurse should then have the no question of its bath ready, preferably before an birth being properly registered. open fire or in the warmest part 8. After mother and baby sleep of the room. The books say that quietly from four to six hours the water should be about 95° to the baby should be placed to the 100° F., but no doctor ever heard mother's breast, no matter if the of anyone being fool enough to milk is not flowing, practice will plunge a new-born baby in water do it good. A few drops of clean under about 105° F., which is boiled water given the baby about right, a few degrees over from a wisp of wet sterile cotton milk-warm. First thoroughly is good for it. This should be grease the baby all over with repeated every few hours for the sweet oil, then use a soft cloth flrst few days. The water should with a small amount of castile be warm and never sweetened. soap and bathe only part of the 9. Don't forget to weigh the baby and body at a time, keeping rest of remember to keep this up regu- body well covered. An "all-over" larly once a week for the first tub bath should not be given two years, weighing each time uuiil the baby is two weeks old, on the same scales and with as it is somewhat of a shock. about same quantity of clothing Don't 'vdo the bath, get it on. The baby at birth should over Wx^^ a hurry as more weigh from seven to eight The Health Bulletin

with pounds, 'j. he. gain in weiglit for neighbor woman a bottle the first several months should of "soothing syrup" or "worm average something like four to medicine" and the doctor who six ounces a week. insists on giving the baby castor oil. Don't let either get in at 10. The clothing should be loose and the door. Soothing syrup was comfortable. No tucks or devised to make millionaires and wrinkles should be in the cloth- castor oil to grease cart axles. ing. But in summer the clothing G. M. C. should be very light. 11. Unless the family physician positively advises against it, the MATERNAL NURSING mother should always nurse her babies are own baby. Breast-fed The Bureau of Infant Hygiene urges healthier and happier, and the i all mothers, if they can do so, to nurse mortality is much lower among them than artificially fed babies. or partially nurse their babies for the The mother's nipple should be first twelve months of life. There are carefully cleansed before and ; a few conditions where this should not after each nursing, this often where ' be done and these are (1) the prevents infection of the breast mother has tuberculosis in any form, and sore mouth for the baby. j unless the or (2) epilepsy or insanity, (3) where . Let wet nurses alone woman's blood is examined at a she is in very feeble health or has a good laboratory. serious chronic disease, (4) where she necessary to feed the baby If it is has had child-bed fever, severe hemor- on modified cow's milk, get the convulsions at the time her services of the very best phy- rhage or sician you can secure and follow baby was born, (5) where. she is again his directions to the letter. pregnant. study It requires a great deal more In case the mother has syphilis she for a doctor to learn how to pre- should nurse her own baby, but none pare proper food for a baby than latter. it does to learn how to perform other, as she would infect the an operation for appendicitis. In case of premature babies, too weak 12. A very young baby should sleep to nurse, or those few who are too about 21 hours of the 24. Never weak at birth to suckle, or in case of rouse it to show to friends; and defect, as hairlip or cleft palate, come what may, put it to bed at some a regular hour each evening, the the mother should use breast milk ob- earlier the better. Never rock it tained by means of a breast pump and sleep, but put in its own bed to this given with a medicine dropper or and leave alone. Begin right. spoon. If it is rocked to sleep one night it will never forget it. If it Where the nipples are inverted and cries one night after being put the baby unable to nurse, a breast taken up and to bed and is shield should be used and this steri- rocked, all is lost. lized before using. Those made of 13. Beginning at one month of age in summer and two in winter the glass with a rubber nipple are the best baby should be taken out in the kind. the open air every day. But Where the baby fails to gain properly eyes should be protected from upon the breast (4 ounces at least a light and it should be properly clothed. Cleanliness, sunshine, week) and is otherwise in good fresh air, simplicity, quiet, and health, the breast milk is either too cheerfulness should be the baby's poor in quality or too small in qantity; portion. in such a case the child should not be 14. Never allow a pacifier in a baby's but cow's milk, prepared to mouth. Never give it any pro- weaned, prietary medicine, cold drinks or suit the age of the child, added to the dope of any kind. maternal feeding. 15. Finally, the two people in all the No mother who has become pregnant world for the young mother to before her baby is a year old should fear most is the well meaning The Health Bulletin continue to nurse her infant. This symptom of which is swollen, painful, throws too much of a strain upon the and bleeding gums. mother, who then is nourishing three Proper Food lives. She should be absolutely certain for Two Years her ' ndition before weaning the ot Proper or improper feeding during b;iby, be. ng in mind that even during the first two years of life deter- the perio of nursing the menstrual mines more than any other factor periods do not return and when they whether the baby wiU develop into a they usually occur at irregular CO, strong, healthy, able-bodied adult. intervals. She should have her physi- Breast milk for the first 12 months cian's advice if she suspects that she gives the best start in life and, where -n-egnant. is this cannot be had, cow's milk properly modified to suit the age and weight of the infant is the next best choice. PSOPKIETARY FOODS This modified cow's milk will be more nearly like mother's (Prepared Baby Foods) milk than anything else which can be obtained. To the mother who is so unfortunate Why do most of these babies not thrive :;s not to be able to nurse her baby it is as they should on proprietary foods, or baby .. great temptation to use one of the foods, as they are called? ;;iany baby foods which are sold at the The reason is that they are not well drug stores or groceries as a substi- balanced foods. By that we mean they tute for breast milk. In spite of all contain too little fat (which furnishes line may say as to the value of clean, heat and energy), too little protein :resh cow's milk properly prepared, for (muscle-forming food), and they contain ;!ie baby, the mother's faith is often too little iron and mineral salts shaken by glowing advertisements of and have too much sugar (which ;!atent infant foods and she is tempted furnishes energy and forms body fat).

Liv their convenience to give credence One of the most common diseases of

\i) their flaunted virtues. She has reason infants is called fermental diarrhea

•.0 think these foods suitable and good and is caused by the fermentation :ur her baby, (1) because they are so chiefly of sugar in the intestines. It ..ttractively advertised by the manu- is the large amount of sugar contained in these : icturer, (2) because so many babies "baby foods" which causes 'io gain flesh rapidly where they are this diarrhea so often in children who used, and (3) they are easy to prepare, are fed upon them. ;:iuch more so than in the case of modi- 3Ia,ny Kinds of Baby ..od cow's milk; but they are not the Foods i'cst substitutes for breast milk and in Proprietary foods or baby foods :.iscs where the babies seem to be embrace a long list of condensed thriving and fattening it can be noticed milks, malted foods, farinaceous or .n the majority of cases, that the flesh starchy foods, dry milks, etc. The .s soft and flabby not — good, sound, latter can be used so that they will be ;.;ird flesh such as it should be. nearer cow's milk mixtures than the Children who are fed on proprietary others, as they contain more fat and ' 'oJs are apt to be pale, they are sub- protein and the sugar is not excessive. ct . to bowel upsets, and if the feeding Some of these baby foods advocate ~- prolonged they are apt to have cer- adding cow's milk and these are open •in diseases. In one of these diseases, to less objection than those to which :!led rickets, there are changes in the it is not added; but generally speak- •^'!ios with certain deformities; and ing the proprietary foods are neither •nother is scurvy, the most prominent necessary nor desirable. —

The Health Bulletin

DEVELOPMENT OF THE BABY when her baby should hold up its head, stand, walk, and talk, for if her baby Every motlier should know liow the average normal baby develops, in order is far behind the average, probably to compare with it the progress her there is either some physical or mental own child is making. She should know fault present.

The average baby should be able to accomplish these things:

being supported. At S to Jf raontlis: Hold its head erect, the body 4 months: Attempt to reach for objects. 6 to 8 months: Sit alone for a short while without support. 9 to 10 months: Stand on feet, holding to an object—as a chair. 12 months: Stand alone. Walk with aid of mother's hand. Say a few words as "mama," "papa," "bye-bye." 15 months: "Walk alone. 2 years: Connect words into a few short sentences.

There is a great difference in the ones in front, at 6 to 7 months of age. have: time of walking of normal infants The baby should some being able to do so at 10 months At 1 year: 6 teeth. and others not until 18 months. 1^2. years: 12 teeth. 21/2 years: 20 teeth. If the baby is several months back- children do not cut ward in performing these acts, a phy- Often healthy their first teeth before 10 months of age, sician should be consulted, for unless but delayed teething is very often due there has been a prolonged sickness or to rickets and it also occurs in babies the baby is very poorly nourished, and who are poorly nourished from birth. cannot do these things at the required Teething often lowers a child's resist- disease age, he probably has a ance so that he catches cold easily affecting the bony tissues, called or becomes susceptible to intestinal "rickets," or is mentally backward. diseases. Therefore during the very In connection with the development warm days of summer the milk mix-

of the baby it is well to know when tures of bottle fed babies should be the teeth should come. The ilrst teeth made about one-third weaker than to appear are usually the two lower ordinarily.

Or APPEARAMCE TiAM£0? TOOTH UPPER JAW LOWER JAW Cenl-ral Incisor 7 to 9 4 to 7

La'feral Ir.cisor a to 10

Cuspid

Fir5l: Molar

Second Molan The Health Bulletin- 9

3IB. IIIGGOS DECLAUES her AGAINST tonsils took out as they was the THE PACIFIER cause of her rheumatis' an' heart spells. An' you remember "I see by The Bulletin," remarked how Marthy, when she was a little kid, would Mr. Higgins to his wife, "where the yell night an' day if she didn't have a State Board of Health is warnin' ag'in' pacifier in 'er mouth. the use of pacifiers." Doc says this made 'er mouth crooked—kept the "Do tell!" commented Mrs. Higgins. arches from developin', he says—an' crowded "What will that Board be next doin' to 'er teeth an' caused 'em to decay. ones chillun? First, it's registerin' the This with the tonsils an' adenoids, babies same as if they was thorough- he claims, makes 'er have earache and bred cattle; then it's a buildin' a new rheumatis'. It may be this that is kind of closet to keep off summer keepin' young John an' Sally from complaint an' the like; then vaccinatin' makin' their grades at school. I been an' keeping 'em home when they has blamin' the teacher but Doc, he says, measles an' chickenpox; an' boilin' it's mouth trouble an' that unless milk for the little uns an' not givin' its fixed right away they'll alius be dul- of soothin' syrup an' catnip tea; an' lards an' are likely to have tubercu- the brushin' of their milk teeth an' losis later on. What do you think of keepin' 'em fixed just the same as if that?" they was their second set. An' now "Men are all they're incriminatin' the pacifier! alike," said Mrs. H., "they'll What will come next? I don't place believe anything they read before much stock on such unpractical idears. they'll take the word of women what I bet if the truth were tol' that have had real experience in such I have ' things. raised more young uns than that Doc's been readin' medical papers Board. Five out of my eight are or that Bulletin an' he's fol- lowin' liviu' an' doin' well, exceptin, for what a set of hospital doctors coughs an' colds, earache and tooth- say." ache, an' such natchel ailments like "Well, I am goin' to say one thing, that, an' ever' single one of 'em was an' this is that!" emphasized Mr. H. raised with pacifiers to keep 'em quiet. "I don't want to see Baby Woodrow Next I looks for 'em to pass a law with a pacifier ag'in, an' you mus'n't iiulictin' honest folk for havin' typhoid give it to iiim. He dropped it on the au' such diseases. That Board ought hearth while you was cookin' supper to be doin' somethin' practical to bene- an' the cat was lickin' it when I saw lit folks it; an' leave off advocatin' of so an' the baby grabbed it an' put it many highfalutin' idears that it ain't back in his mouth before I could even had no experience with. That's my wipe it off with my pocket han'kerch'ef. say!" Such things can't be sanitary! "This artickle," resumed Mr. Hig- "Now, Doc Hines tells me it will sins, "says that pacifiers cause ade- cost nigh on to two hundred dollars noids an' ear diseases an' deformed to have Marthy an' John's adenoids mouths an' bad teeth an' keep chillun took an' Sally and Buddy's teeth in poor health an' not able to learn at worked over. Pacifiers are too expen- school an' I sorter believe there's sive for me an' aint to be used in this >omethin' in it. Doc Hines tol' me fambly ag'in while I heads the house." today that our Marthy ought to have B. E. W. 10 The Health Bulletin

NEGATOR INFATSTIUJI—THE remain there. Flies—hundreds and mURDEIlER OF INFANTS thousands of them—visit the privy every day during the warm season and The open-back, insanitary privy is feast on the filth found there. From one of tlie chief murderers of infants the privy they go into the house and in North Carolina. The death-rate in carry this germ-laden filth to the food children under two years of age from in the kitchen and dining room and the diarrheas, or summer bowel com- even into the baby's milk, often alight- plaints, is appalling and is one of the ing on the milk bottle or the baby's chief causes of death during this face. The baby, as well as other period of life. And the fact that, here members of the family, eats the bowel in North Carolina, a large percentage material and the germs it contains. of these deaths and the many more The baby, being the weakest member cases of illness and suffering can be of the family may be the only one prevented, makes it all the more made sick. And everybody knows the serious. The outlay of a few dollars suffering and anxiety caused by sum- sanitary privy by the owner mer bowel complaint, and many of us to build a _ of each home in the State would save have had to experience a death in the hundreds of babies from death and family from the disease. thousands from having to suffer and If a family doesn't want to run the be crippled each year. risk of sacrificing a child or infant to Many forms of bowel complaints the fly and summer bowel complaint, with which young children suffer are the family can be insured against very contagious and easily spread these. The policy is not expensive. maintenance of from one child to another if proper The construction and precautions are not taken. ..Iso, and a sanitary fly-proof privy is all that it this insurance should be this is very important, an adult may costs. And before the coming of be infected with the germs of dysentery taken out early and the deadly fly. without becoming seriously ill—or ill summer B. E. W. at all, for that matter—and^ still spread his disease to a child or to other adults. The child to whom the disease SLIRRHEAL DISEASES OF grown- is given is not as strong as the INFANCY naturally, does not . up person and, have as much resistance against dis- Two thousand six hundred and ease germs. And so, it often happens twenty-six babies under two years of that the child may become very ill and age died in North Carolina last year bowel even die from an infectious of diarrheal diseases. Think of this adult who may trouble caught from an waste of human life, of the actual that he is spreading such not know economic loss, of the intense suffering germs. To be specific, a parent may of these little ones and the sorrow give the baby a type of diarrhea that brought to the grief-stricken parents! will prove fatal to the infant without Can we not, by understanding more ever realizing what has been done. about the causes of these diseases, by It is here that the privy plays the feeding of our infants and chief part. The par.;nt or adult with the proper the proper treatment the infectious bowel complaint uses by instituting this frightful mortality? the open-back surface privy found at early, reduce necessary, first, to have a clear so very many of our North Carolina It is causes and so prevent homes and the disease germs are left knowledge of the if such be possible. under the privy. But they do not their occurrence ; .

The Health Eulletin 11

First of all, an infant's intestinal (1) Boil the baby's milk mixtures, except in cold weather, for tract is most sensitive to three or four minutes. Cool (1) Improper food it quickly by placing the vessel of hot milk into a (2) Infection by germs larger one of cold water. Bear in mind that breast milk is the Pour into the nursing bottles, stop with sterile cotton most easily digested food and is free and keep cold. from the germs which cause these (2) Boil the nursing bottles just diseases and hence every baby should, before making up the milk mixtures. if possible, be nursed or partially (3) "Wash the nipples after each first year of life. nursed for the feeding with soap and water Mother's milk then, is the first great and keep in boric acid solu- preventive. tion (1 teaspoonfui of boric acid crystals to a glass of Proper bottle-feeding of well babies water ) first year, when necessary, during the (4) Never use milk for the baby and proper feedi;.,^ during the second which is over 24 hours old. year is the next important considera- (5) Always wash the bottles immediately after the baby has tion and preventive. Schedules of feed- finished its feeding. infants at various ages and the ing of (6) Never warm a bottle over method of preparing the food will be again which has been re- furnished by request to any one in the fused at a previous feeding. State by the Bureau of Infant Hygiene, Tiiree Kinds of Diarrheal Diseases State Board of Health Raleigh, N. C.

It is important to know that the Without going into details, let's most serious of all the diarrheal understand a little more about the diseases is caused by germs which are different kinds of diarrheal diseases.- .swallowed by the baby. These more They occur much more frequently in often come from impure milk than summer for several reasons: (a) be- from any other source, and also from cause it is harder for an infant to impure drinking water, and sometimes digest food in hot weather; (b) be- from food contaminated by flies. cause germs multiply in the milk so Milk is easily made unfit for infant much more rapidly and (c) because feeding. There are certain things you of the presence of flies. do to keep milk pure during the must There are three kinds of diarrheal milking. These are process of diseases:

the stable clean; (1) Keep (I) Simple indigestion (2) Keep the cow clean; (II) Indigestion with fermentation (3) Wasn the cow's udders with soap and water; (III) Infectious diarrhea, often (4) Scrub your hands with soap called colitis. and water; (5) Milk into a vessel which has Simjile Indigestion is caused by been washed and scalded, and scald all other vessels either too much food, or a milk mixture into which the milk is which does not suit the baby. poured Symptoms: Loose stools, usually (6) Cool the milk immediately three or four daily, containing mucus after milking and keep it cool. and undigested food. There may or may not be slight fever. After protecting the milk so far, you Indigestion with Fermentation is must further care for it according to caused by the action of germs in the these directions: intestines chiefly upon the sugar—also —

Bulletin 12 The Health

If castor oil is vomited, give broken upon the fat in the milk. This is the babies doses of calomel-1-6 of a grain every type which is so often seen when foods," hour for six doses for a child 1 are fed upon prepared "baby half hours after which contain a large amount of sugar. year old and followed 2 the last powder with 2 teaspoonfuls of Syini)toms: Loose, green, mucus magnesia. stools—three to six daily—which are milk of baby's the purgative. Much acid as a result of which the Do not repeat buttocks are "scalded." They are harm is done by giving castor oil day sometimes frothy in character. There after day, as is so frequently done in often it is is always some fever and these cases. Give, therefore, a suffi- distinctly very high. The baby is ciently large dose of purgative to simple indiges- sicker than in case of empty the intestines thoroughly and tion. then stop. (Colitis) is Infectious Diarrhea Intestinal Rest: Give nothing but germs introduced from out- caused by barley water or plain boiled water for side the body, having been swallowed 12 to 24 hours. (The mother who is by the child. These attack the lower nursing her baby can use a breast part of the bowels, causing ulcei's. pump during this time.) At the end Symptoms: It may begin suddenly of 12 to 24 hours, a baby who is or follow indigestion with fermenta- nursing its mother should be put to .tion. The stools are frequent—the the breast every four hours and nursed bowels moving as often as every half for five minutes only. Boiled water hour or hour. At first the stools con- be given between nursings. tain mucus and undigested food, but must be gradually increased later consist of mucus and blood. They Nursing may have an odor resembling wet hay. so that in three or four days the baby ' of food. Straining accompanies each stool will have its usual amount abdominal often very intense. There is In bottle-fed babies : after the starva- pain and great prostration. The child tion period, buttermilk freshly made is has fever, heavily coated tongue and the best food. The buttermilk should loses its appetite. In the case of those be kept cold and the amount given babies who survive, the symptoms the baby boiled and cooled just before gradually subside, but it is always a feeding. No sugar should be added to matter of weeks, and more often the buttermilk, as sugar and cream are months, before they entirely recover. harmful in these cases. For an infant Treatment: At the beginning of any under 6 months of age, 1 to 2 ounces of diarrhea, the buttermilk with an equal part of water, of these three types of four hours and boiled treatment is the same: given every tract; waler between feedings. For a baby (1) Cleanse the intestinal rest by 6 months, three to four ounces (2) Give the intestines a over stopping all food. each of buttermilk and water (boiled) used at each feeding at first, and Cleansing the Intestinal Tract: This after a few days two parts of butter- should be done at once, preferably by milk, one part of water. When the castor oil stools become solid, boiled skimmed teaspoonful under 6 months of 1 milk and water mixtures, to suit the age; age of the child, may be given. The 2 teaspoonfuls for a child 1 year cream is allowed to rise on the milk old; and all of it removed, for the first teaspoonfuls for a child between 3 few days—then gradually left on the 1 and 2 years of age. The Health Bulletin" 13 milk—at first one-third, a few days is always great danger of further up- later one-half, then two-thirds, etc. setting the stomach and intestines ^oy Sugar is added last to the milk mix- their use. As a matter of fact, most of ture, but not until the bowel move- these cases, unless they are infectious menis have decreased to two daily. At diarrhea, require no drugs whatever, first one-third the usual quantity is except the initial purgative but the added, then one-half, later the total greatest care in the kind of food and quantity. its preparation. Those cases which Where buttermilk cannot be had, have indigestion with fermentation— dry milk can be used to advantage.' where the stools are acid and turn the Dry milk may be ordered skin from any of the buttocks red, etc.,—are retail druggist in Raleigh, Charlotte, often benefited by giving bulgarian Greensboro, Asheville, and Wilmington! bacilli, either in tablet or liquid form. They can secure it through the whole- These should be given as often as every sale druggists in these cities, if they two or three hours. do not carry it in their stock. Dry Aldeut SiiEDEs Root, M.D. milk is cow's milk which has been dried and powdered and to which nothing has been added. When mixed with the A VACCINE THAT PUEVENT proper amount of water, it makes a well-balanced food, thereby DiriiTi.^::Li differing fz'om most of the prepared Among the recent important dis- "baby foods." In case of a well baby, coveries of preventive medicine are iy-2. level tablespoonfuls are required in methods for diagnosing and for im- 24 hours for each pound the baby munizing (vaccinating) against diph- weighs. It is prepared as follows: theria. An application The of the new proper amount of water at a method of finding out who is and who feeding is brought up to boiling. is not susceptible to diphtheria This (the removed from the stove and the Schick test), and of giving the newly- dry milk stirred in and then cooled discovered vaccine for the disease to about body heat and given. Each (toxin-antitoxin) should prevent at feeding must be made at the time least three-fourths of the four hundred it is given the baby. The quantity deaths which occur annually in of water North used for different ages is Carolina from this cause. Of the four 1 month-. .2^/4 ounces hundred deaths from diphtheria each year, 2 months. .Zy-2 ounces 75 per cent of them occur in infants 3 months. .4 ounces and children under five years 4 months. ounces of age, 20 per cent between the ages 5 months. ounces of five and ten, and only 5 per cent 6 months. ounces after ten years of age. By far the greatest S, 9 months. ounces mortality is in the first five years of life, and by vaccinating in- In case of diarrheal diseases after the fants and children under ten years of starvation period, only one-fourth of age, diphtheria can almost be wiped the required amount should be given out of the State. at first. The medical treatment of The 'vaccine (toxin-antitoxin) for these cases must be under the care of diphtheria is prepared by mixing - physician. Feeding these children diphtheria antitoxin and diphtheria is by far the most important part of toxin. This is injected under the skin liie treatment and the fewer drugs of the arm in the same used manner in the better for the child. There which typhoid vaccine is given. Three 14 The Health Bulletin doses given at intervals of a week are APPEAL TO MOTHERS BY necessary to produce immunization. MOTHEHS or THE STATE The immunity, nowever, develops EXECUTIVE MAXSIOX, rather slowly and, for this reason, is Raleigh, N. C. not suitable for use during a sudden May 1, 1919. and acute outbreak of diphtheria when "A child more than all other things a considerable number of children have brings forward-looking thoughts." been exposed to the infection and have "We who today are planning and become carriers of virulent diphtheria building for the future, find in our germs. In such cases prevention is children the greatest asset of the more quickly established by prophylac- state and nation. We can give them the tic doses of antitoxin, thougn the pre- chance we never had; we can make of vention is of very short duration. them what we yearned to be; we can It has not been definitely learned realize through them the dreams we how long the new diphtheria vaccine could not, or would not make come true. will keep off the disease but the period Let us then each one, mothers and is longer than four years as a number fathers, and you whose dream-children of cases have been under observation call with outstretched hands, give of for this long a time; therefore infants our very best to the babies of our who are given immunity against diph- State. theria with toxin-antitoxin will be pro- Let us see to it that they enter the tected through the most dangerous race with no handicap that they go period of life. As has been stated, the forward with sound minds in sound immunity following the vaccine is slow bodies, that they are trained in and to develop, four to ten weeks after the inspired by high ideals and noble first dose of the vaccine being required thoughts so that like Sir Galahad of to prevent the disease. Since a ma- old they may say, jority of the cases of diphtheria occur "I\Iy strength is as the strength of ten during the first five years of life it is Because my heart is pure." recommended that infants and small Better mothers and fathers make children be given the vaccine as a better babies and better children; bet- precautionary measure. ter babies and better children make Toxin-antitoxin is being used by a better men and women; better men number of health officers and pediatri- and better women make a better state, cians both in the United States and a better nation. Let us make ours the of some the European countries with very best. wonderful success. Children and Faxxy Yarborough Bickett. babies who have had toxin-antitoxin given them have been exposed to To 'North Carolina Club Wo/nen: diphtheria, infected with the diphtheria All over the State this spring there

germs but never developed the disease. is a most encouraging awakening of In order to protect children and in- club interest and a sincere desire fants against diphtheria mothers are among club women to make our organi- advised to have their children given zations of more definite and lasting toxin-antitoxin. service to our State than ever before.

The State Laboratory of Hygiene, The work that is behind us, with all Raleigh, N. C, supplies diphtheria its progress, is but a promise of what vaccine (toxin-antitoxin) upon request the future may be if we choose to make to physicians and health officers of the it so by careful divising of ways and State. A. McR. C. means, coordination of effort and a willingness to give unselfish service. "As the earth, wealth, art, property, all must in a few years be given over to these httle ones, may we not wkely use a large proportion of its income to make them worthier to possess it." —Robert Hunter By courtesy of Department of Health, City of Newark, X. J. 16 The Health Bulletin

that of the Bureau of Infant Hygiene As to the future club activities I of the State Board of Health. It is wish to suggest that they are planned eugenics reaching right down with a view of cooperation with the practical to the spot where it is most needed. different Departments of State, as far It has long been the whimsical ex- as possible, in order that our energies of some one that the education and influence may be rightly directed pression should begin a hundred and our work carried on along definite of a child birth. For the present and well-thought-out lines. years before its this chance appears to have In health work especially do we need generation been missed. But the Bureau of in- to be directed by the State Department fant Hygiene proposes to do the next for in no other regard are we so apt best thing, and that is wholly a to be unconsciously influenced by fads, practical thing—to begin with the unofScial information, new and attract- nascent child and teach the expectant ive but unwise ideas. Our State Board mother how to care for herself during of Health through its various depart- the prenatal period and for the child ments is the interpreter of scientific period of infancy and early knowledge, health laws and regula- during its childhood. And the excellent thing tions, and should be the source of our plan is its extreme practi- information along these lines. In about this simple machinery for whatever campaign the State Board cability and the carrying the help intelligently and wishes to launch at any time, I ask to so many mothers. the loyal support and influence of the effectively health, and hygiene prob- Club Women and also that the various All social, closely inter-related that women's clubs which have health de- lems are so corrective effort in one direction partments, do child welfare work or every others. We do not know conduct a "Baby Week" campaign, seek must help all where to place the greatest stress, the directions and help to be had from yet certain that personal health the State Board of Health, In this but it is close at the bottom of can we standardize our work and hygiene lie way only work all. One of the beauties of this to some extent and all the Clubs prog- it air. It that it is not a shot in the ress along the same line. is the spot where we know Cordially yours, goes right to needed both from a humane Mrs. Clarence a. JoIINSO^^ it is sorely an economic standpoint. President N. C. Federation Women's and we shall have a construc- Clubs. By and by which tive program for child welfare and will embrace every need for health education for every child from its breast to adolescence. Infant A FUNDAMENTAL WORK IN CHILD mother's is a fundamental problem. SAVING mortality Save the child in its right to health have By R. F. Beasley, and life and growth and you Public Welfare. State Commissioner of begun at the bottom of all problems. the basis range The intelligent mother js know of no work in all the I Mrs. Vaughn's great that is of civilization. of child welfare propositions work should have the practical co- more fundamental and has promise of operation of every welfare worker. more widely beneficial results than rEOGSA^ir FOil GEADED SCHOOLS

EA3Y WELFARE WEEK, iv^AY 11th Babies' lives, to say nothing of their growth and development, depend upon being well_^ born and healthy at birth, and upon being given the following

First, Proper Food: (a) Mother's milk best; Cows' milk (&) boiled and cooled and kept cold until needed, then heated. Boilmg IS done to kill germs. Germs often grow in milk boiled in the morning and allowed to become heated during day—hence the necessity to keep cold. (c) Dried milk—with boiled water and sugar added—when ice is not procurable and cows' milk cannot be kept cold. (d) Orange juice or some other fruit juice. (e) Regularity in feedings: three hours until G months of age- four hours after 6 months. Cleanliness— (/) being sure everything has been scalded or boiled before using, and kept carefully covered from flies. At nine (g) months in winter and twelve months in summer, baby should ^sef „, ^J^^ S^^'®^ juice, broths, toast, coddled egg in addition to milk (7i) Water boiled and cooled should be given baby frequently during the day. When baby cries it is often from thirst. (i) Baby is too weak and undeveloped to walk and in like manner baoy's aigestive organs are too undeveloped to digest the food of an adult, or resist the attack of germs.

Second, Sanitary Conditio7is:

(a) Plies are the cause of most of the diarrheal diseases. If diarrhea does not kill the child, it leaves him weak and susceptible to other diseases. 1. Fly-proof privies insure against flies. 2. Covered garbage pails and clean premises; 3. Screened houses and mosquito netting covering baby's bed while sleeping. (&) Thoroughly wash everything which comes in contact with the babv— wash mouth of milk bottle before pouring out milk, cup before"ciuie measuring, etc. ^ (c) Allow no one to kiss the baby. id) wash his hands before eating or handling food for ^^^^y'^^^^f^^'^^^

Third, Clothing: (a) Dress the baby for comfort: warm and lightweight clothes for winter ana coolest possible in summer. Many people dress children too much m hot weather. (&) Babies suffer from colds in winter because they are kept in close poorly ventilated rooms and then subjected to draft, or because they are taken out in a high wind (c) Babies too often suu'er from heavy clothing in summer time. Woolen band around the stomach of baby in summer is totally unneces^uuneoes . sary and sometimes dangerous. (d) Cover the babies to suit the weather during their sleep. Fourth, Rest: Babies should be encouraged to sleep all possible Never awaken a baby for anything but to feed it. This IS done for a few times to establish a habit of punctuality IS The Health Bulletin

Fifth, Every boy and girl in North Carolina can help to save the babies at home and in their community by killing the flies and cleaning up the premises. Insist that your father procure for his family a sanitary privy. Also by boiling and cooling the water the baby at home is to drink, and telling others that you know it is a necessary thing to do. By being sure that hands are clean before you touch anything which baby is to eat or drink, and to consult your mother before giving the baby ANYTHING to eat. A good plan is not to eat before the baby, as it will then not be tempted. Do not kiss the baby—you may have a cold, a sore throat, or some disease which you would surely not want to pass on to the baby.

INFANT MORTALITY UNDER ONE YEAR OF AGE AND UNDER FIVE YEARS OF AGE, OF SPECIAL DISEASES, 1917

Table I Table II

Causes of Infant Mortality Deaths under Mortality by age, stillbirths excluded. Sta- "'le year, by spec. soases, tor 19x7. tistics for 1917.

Table I

MORTALITY BY AGE. 1917

Number of Per Cent Age Groups Deaths of Total

100.0 All Ages 33.989 Under One Year 7,596 22.3 12.7 One to Five Years 4.330 35.0 Total Under Five Years 11,926

557 deaths from accidents of pregnancy. 3.153 etillbirths not included in table. The Health Bulletin 19

T.UJLE II CAUSES OF INFANT MORTALITY

{Deaths Under One Year)

Numbers International Per Cent of Causes and Number of Deaths Classifica- AH Caused tion

All Causes 7,596 100.0 104 Diarrhea and Enteritis 1,218 ICO (S9) Bronchitis, Acute 66 (91) Broncho-Pneumonia 369 (92) Lobar Pneumonia 257 Other Diseases of Respiratory System... 41

(Total) 733 fi.7

6-10 Chief Communicable Diseases:

28-33 (6) Measles 213 ; (7) Scarlet Fever 3

37 (8) Whooping-Cough 313 i (9) Diphtheria and Croup 75 (10) Influenza 51 (2S) Tuberculosis 30 Other Forma IS

' (37) Syphilis - 51

(Total) 7S7 10.4

Congenital JIalformation and Debility: (150) Congenital Jlalformation 181 (151) Congenital Debility, Icterus, and Sclerema. 1,6SS

(Total) 1,869 > 24.6

All Other Causes 2,989 39.3

Furnished by the Bureau of Vital Statistics.

The Bureau of Infant Hygiene was diagram furnished by the Bureau of created September 1, 1918. The first Vital Statistics of the State Board of two months were spent by the Director Health. It was decided that instead in looking over the field of Infant of trying to cover the whole field of Hygiene as operated in other states. infant mortality, to concentrate on the On account of the influenza epidemic it causes which may be looked upon as was found that much of the work had largely preventable. Diseases due to been interfered with and, returning to pregnancy, stillbirths, and deaths due North Carolina, it was found that no to congenital diseases are the founda-

• Sanization would look upon the work tion on which prenatal work is built.

1 everyone was deep in the relief Deaths from diarrheal diseases is a ork thrust upon them by the epi- subject on which our best efforts are -jiaic in our own State. being expended in the infant hygiene The need of the work in North Caro- work. .ca was pointed out by statistics Dr. Aldert Smedes Root was engaged graphically shown in the. foregoing as consulting pediatrician, and after —

20 The Health Eulletust

with the State determining of what sort of instruction officer in cooperation the women of North Carolina stood in Board of Health, and many of these need, we began to seek for those whom counties being in their third year, we might help. according to agreement, are entitled to First in the order of care to be a nurse for infant hygiene. At the given, and therefore the first in order present writing two of these counties, of prevention, comes the beginning of namely Wilson and Northampton, have the prenatal period. During this time just started this phase of the work the child is either well formed or with a nurse especially trained and malformed, and if the latter, the de- ^supervised by the county health offi- fects are likely to be irremedial, hence cer. A number of counties will have this is the most important period of this as part of the county work before life. What can be done, how can we the year ends. prevent things from going wrong? Realizing that this is but part of the Only by making it easier for them to program, the Bureau of Infant Hygiene go right than to go wrong. Prenatal has become active in creating an care must first then be educational interest in the work as a State agent the expectant mother must be taught and has sought to enlist the aid of all how to care for herself so that her organized bodies in disseminating in- baby may be properly developed and formation regarding the bureau, pro- to so take care of herself that maternal curing the names and addresses of ex- nursing after the delivery, will be pos- pectant mothers and the names of sible. bottle-fed babies, or those maternally Next in importance in the prenatal nursed and given supplementary feed- from the state is supervision, watching for the ings of cow's milk or food signs of possible evil and, at the table, or babies who for any reason appearance of trouble, to consult a phy- are not progressing as they should. sician as many a serious condition may Letters explaining our work were di- be prevented thereby. rected to the woman's clubs of the asked in The third point in importance is the State and their cooperation for instructing care of the mother at confinement organizing clubs community whose edu- and, as about sixty per cent of the mothers of the has lines of ' health births in North Carolina are attended cation along the the clubs by midwives, the supervision and in- been defective. Many of interest in the matter, struction of these seem a necessary professed an time they were in no part of our work. but at the position to do constructive work of Finally the care of the newborn and type, as their forces were dissi- general health condition of the home, this pated in doing war and relief work. and food of the baby. These clubs are beginning to take cog- The Bureau of Infant Hygiene is nizance of the bureau and adding their taking up diarrheal diseases, from the efforts to our own, receiving instruc- standpoint of bottle feeding and, what from Carolina, tion of a standardized character is more prevalent in North the State Board of Health which may breast feeding at irregular intervals to their club health depart- with supplementary feeding from the be applied Feder- feed- ments. In all of the District table. The instruction, then, in ation meetings held during the spring, ing and care as it applies to clothing, health, and especially the health of the bathing, and ventilation the first two infant, has been emphasized. Three years of the baby's life is important. clubs—Greensboro Woman's Club, Wil- Ten counties in North Carolina son Woman's Club, and the Rich Square ampioy a whole-time county health The Health Bulletin 21

Betterment Association—are doing con- mothers of pupils under their super- structive work in cooperation with tlie vision. State Board of Health. One of the most definite helps has Home demonstration agents under come from the mission nurses in the their community plan are of the mountains. Public health nurses greatest aid in securing the names and attached to the U. S. Public Health addresses of ailing babies, expectant Ser- vice, workers in the W. C. T. U., mothers and the mothers of bottle-fed ministers, cradle-roll superintendents, babies, and they are even instructing officers and welfare workers the mothers in their own communities of industrial corporations have al.l contributed in the care of mother and baby. to put us in touch with those These demonstration agents have from women requiring the advice which ten to fifteen well organized community we have to give. Manufacturers have taken a clubs in their counties and these offer keen interest in the development an excellent vehicle through which the of the work and as many as Bureau of Infant Hygiene may work. thirty have instructed their welfare workers Twenty-one demonstration agents have to cooperate with us. A few ministers given us personal cooperation in as have asked cradle-roll superintendents many counties. The work has been of to cooperate with the bureau tlie highest type and they have render- and several have furnished us with ed the greatest assistance yet received information regarding conditions by the Bureau of Infant Hygiene from in their communities. an outside agency. Three home demon- Physicians generally have stration agents have devoted a week not been asked to cooperate, as to the baby, in which weighing and we have been waiting until we had something measuring was done, and cooperation definite to use as an illustration before of community nurse attached to a we offered them this service but mill or factory, was secured, and there are seven who send the names of many defects have been brought to patients to this bureau lisht and are under advisement. for this information and we frequently get requests from Townships have conducted clean-up women for the prenatal letters, sent at week in the interest of the Safety the suggestion of their physicians. League and the Bureau of Infant Hy- In the January Health Bulletin giene, citizens cleaning up individually this bureau issued an article addressed their own premises and collectively to the general public which brought giving attention to churches and a large number of requests for in- sciiools. One town. Rich Square, in formation relative to mothers Northampton County, and voted a sum of babies. money sufficient to clean up streets, We have since January 1st sent out etc., outside of the work contributed by prenatal instruction individuals. in the form of nine letters, one for each month of the Registrars were appealed to and have pregnancy, to 579 expectant mothers, responded very generously. These whose names and addresses have been i.avo given the names and addresses furnished us from the before of expectant mentioned mothers and bottle-fed sources. To all of these have also '"abies, and this in itself has been of heen sent the Children's Bureau publi- ;i:estimatable value in aiding us to cation "Infant Care," and advise women. aside from the regular information, special infor- County supervisors of rural schools mation to suit unusual conditions. i-ive supplied information regarding Since January 1st we have sent infor- 22 The Health Bulletix

mation regarding diet of bottle-fed 20 or 25 years of age is due to an iu- babies, and maternally nursed babies fection received from a mother or who are receiving supplementary feed- grandparent or father or brother or ings to 375 mothers. The pamphlet, someone in the family when the child "Infant Care," has been sent to 1,861 was a few months to a few years old, mothers of newborn babies who were but such is a proven fact. not registei-ed with us but who:;e With this evidence before us we are names were taken from birth certifi- led to the conclusion that the preven- cates received at the Bureau of Vital tion of infection of children with Statistics. tuberculosis is second only in impor- With the intensive work of the week tance to the prevention of the diarrheal of May 11th, we hope to see a big step diseases that kill so many babies, for forward in the work of conservation tuberculosis pushes the diarrheal dis- of life of mother and child. K. B. V. eases of children a close second in toll of death.

illllc Infection

TUBERCULOSIS A>.^D TliS S.iBY Children can be and are infected through the milk of a mother who has Contributed by Dr. L. B. MoBeayee tuberculosis and through the milk

It is claimed by some that all tuber- from a cow that has tuberculosis, culous infection takes place in child- hence it follows that if a baby's mother hood; this has not been proven. How- has tuberculosis it should never be put ever, it is agreed by all that children to the breast. This seems to protect are less resistant to infection with the the baby from becoming infected germ of tuberculosis than adults. In through its mother's milk and also the fact it has been proven by the Bureau prevents the drain of nursing of of Tuberculosis of the North Carolina the infant on the tuberculous mother. State Board of Health, right here in Of course it goes without saying that North Carolina, that where a case of we wouldn't want to infect an infant tuberculosis occurs in a family and no with tuberculosis through cow's milk. precautions are taken to prevent the in- The State Dairy Department and the fection of other members of the family, United States Dairy Department of by shielding the mouth with a piece of the departments of Agriculture are co- gauze or cloth or paper napkin when operating in examining cows and ad- coughing and expectorating into proper vising us whether or not they have containers (sputum cups) —the gauze tuberculosis, in which case we would or cloth or paper napkin and the not use the cow and would kill her to sputum and cup being destroyed by keep her from infecting other cows, burning—that 90 per cent, that is nine hogs, and even children. out of ten of the members of that It may be that it is not convenient family will contract tuberculosis. This to get your cow examined for tuber- has been corroborated by the United culosis promptly, in which case there States Public Health Service by some is another procedure that is perfectly surveys made in Wisconsin. safe, to wit: 'pasteurization of the germs It has also been proven that the milk. This not only destroys the younger the child the more violent the of tuberculosis but destroys the germs infection and the earlier the death. of all other diseases, such as the germs Tuberculosis is not so rapidly fatal as of typhoid, dysentery, and diarrheal dis- diarrheal diseases of infancy and it is eases. The proper method of pasteur- fully set forth on another difficult for us to visualize on the fact izing milk is that a death from tuberculosis at 14 to page of this Bulletin. M ^ yf^ (^ ^

SlOO.OOlz

To School Children and Residents of New Hanover County.

A good opportunity to earn money and at the same time help us get rid of the

r-\ ' H 1'Jfh .n jL. i' i/ i^tny, uisease-Larrying Flies

Secure a trap before April 20th. Use fresh bait every week. Bring your traps to Department of Health for weighing the fly contents. Take your trao home empty and rebai . To those having the most fues in 90 days ciiumoending Syjuiy 19, prizes will be awarded.

To Employees of Hotels, Restaurants, Bakeries, Stalles and other rnercantile establishments, ONE PEIZE - - $25.00 To White School Children To Colored School Children

First Prize $10.00 First Prize $10.00 Second Prize 7.00 Second Prize 7.00 Third Prize 5.00 Third Prize 5.00 Fourth Prize 3.00 Fourth Prize 3.00 Fifth Prize 2.50 Fifth Prize 2.50 Ten Prizes of $1.00 each Ten Prizes of $1.00 each

Ask for a trap at once. Apply at OFFICE OF BOARD OF HEALTH

Vrilmington, N. C.

ôoi :::er\^.7h\ countf^vuTt'tiu'beX îL'^""? " r<>'^^'^î^^^y effect in the reduction of

..st.hB, ^' ^'^ "^'^ '^^ ^^'^'^^ °^ rational ideas of cleanliness into the schoorchUdi^n ^' PROCLAMATION

"^ little child shall lead them/' In this celestial saying of the Great Teacher there is a profound biological as well as spiritual truth. In the climb of the race to higher levels Better babies lead the ivay. The cru- sade for better babies insures a double bless- ing. It will bring a hardier race, and then the finest traits in men and luomen come to floiver when they are taking thought of these little ones.

Therefore, I, Thomas Walter Bickett,

Governor of North Carolina, do set apart the week beginning May 11, 1919, as Better Babies Week, and.during this week urge our people to study and put into execution all the plans devised by the State Department of Health for preserving the lives and promoting the health of babies in North Carolina.

Governor. WASHINGTON, D . C . M®M PU6LI5AE.D BY TME. 5TATL BQMgp s^^MLALTM I nPRJA CAROUhA

Vol. x*3ffv"33 JUNE, 1919 N»Hry^

EDITORIAL

COMMERCIAL INTERESTS VER- Health of making misrepresentations SUS PUBLIC RIGHTS* as to the prices charged for antitoxin by certain retail druggists, and you As Illustrated by the Greensboro mention especially our reference to the Drug Company Against Citizen charges for antitoxin by the Greens- S. B. Gann boro Drug Company against certain citizens of your own county. You do Editor of the Daily News: not dare say that our statement that One of your readers wagers a three- the Greensboro Drug Company charged cent stamp and the trouble of sending Mr. S. B. Gann $46.55 for antitoxin us a clipping from your issue of May that the purchaser could have secured 13 entitled, "Charge for Antitoxin Not from his State and county for $1.75, So High After All," on the probability and charged Mr. A. S. Campbell $18 of our having some words with you for antitoxin that he could have se- over your attempt to exonerate the cured from his State and county for Greensboro Drug Company from hav- 50c, is a misrepresentation. That is ing charged Mr. S. B. Gann of Stokes- the basic fact contained in the article dale, $46.55 for $1.75 worth of anti- that rubs your advertiser and his toxin. The reader wins the wager. friends the wrong way. If that fact We had not intended giving the bad been left out of the article, your Greensboro Drug Company further ad- advertiser would have had no com- vertisement in this matter, and if the [>laint to make about your news item, fol- said company does not like what and you know it and your readers lows, it may hold your article responsi- know it ; furthermore, your weak, eva- ble, or itself responsible for influencing sive charge that we "make it appear" the Daily News to write the article. that retail druggists buy antitoxin at The case of the Greensboro Drug Com- low prices and sell it at high prices is pany against Mr. S. B. Gann would be an admission on its face that you can- of no importance if it concerned only not be specific in your charges of mis- a drug store and an individual, but representation. You come into court the case has considerable importance without a bill of particulars. You attached to it because the parties are cannot put your finger upon a single representative—the Greensboro Drug sentence in the article of the April Company, of certain commercial in- Bulletin that is a misrepresentation. terests, and Mr. S. B. Gann. of the On the other hand, we dp particular- public. ize ; we give details, call names, and You accuse the State Board of furnish addresses. That is our of- fense, making responsibility personal. Greensboro Reply to article appearing In There is not a single reference in Daily News, May 13, 1919. ;;; : — : :

The Health Bulletix the Bulletin article to what druggists So much as to what the manufac- pay for the antitoxin that they sell. turer can produce and distribute for. That is none of our business, and it is Now a few words as to the profit to your way of introducing irrelevant ma- the retailer for selling. The manu- terial into the controversy to befog facturer allows the retailer an ascend- your readers ; however, since you have ing percentage of profit, depending raised the question of cost and profit upon the size of the package that he in the production and sale of antitoxin induces his customer to buy. The (and this was an awkward move on larger the package sold, the larger the your part in defending your adver- percentage of profit. For example, for tiser), we shall attempt to qualify as selling a package of 1,000 units for $2, something of an expert on what it the retailer gets 10 per cent, or 20c costs to make antitoxin and what H. K. for selling a package of 7,500 units for Mulford & Company and the Greens- $10, the retailer get's 30 per cent profit, boro Drug Company make in the way or $3, and between these two extremes of profits. It was antitoxin made by there is a gradation in the percentage H. K. Mulford & Company that was of profit. put over on ]VI,es.srs. Gann & Campbell. The following table shows in the Getting unplea.santly personal again, first two columns the size of the pack- you note. ages and the retail price of H. K. Until recently the State Board of Mulford & Company's antitoxin; the Health had a contract with one of the third column shows, approximately, leading antitoxin manufacturers of the total profit per package, and the fourth United States to supply antitoxin, and fifth columns show approximately through the State Boai'd of Health, to the division of the total profit between the people of North Carolina at the the manufacturer and the retailer following rates Units in Packages of 1.000 units, 50c per 1.000 units. Packages of 3.000 units, 45c per 1,000 units. Packages of 5.000 units, .39c per 1,000 units. Observe that the charge for 1,000 units of antitoxin was from 39c to 50c. This charge covered, of course

(a) Cost of production; (b) Cost of syringe, package. and wrapper (c) Cost of lost antitoxin through over age (d) Cost of advertising and sales- manship :

The Health Bulletin item; then, the telephone, your of- affair.' The tuberculosis method and fended advertiser, and over you went the alcohol-syphilis method are exam- with the following conclusion : "In- ples of well known means of self- vestigations made, however, show that destruction of life and efliciency. There the retail druggist, on the basis that is no more logic in preventing a man he must handle it, makes only a fair from filling his heart with lead than in rate of profit." The spirit was willing, preventing his filling his lungs with but the flesh took the count. tubercles. Bullets and consumption are about equal in their effectiveness, but it takes the latter six months or SUICIDE BY TYPHOID ROUTE a year longer to do its work. Syphilis is no less deadly, but it may require The question of moral responsibility, years of insidious progress before it which always arises in the minds of kills its victim. intelligent people in connection with "Why should causes of sudden death be rigidly guarded against, while the cases or deaths from typhoid fever, is public passively permits men and wo- well developed in an editoi'ial which men, often against their will or appeared In the Monthly Bulletin of through ignorance, to destroy them- the California State Board of Health, selves by means equally certain, but and which is as follows less swift? It is universally conceded to be the duty of government to pre- "Approved(?) Methods of Suicide vent murder in all its forms. Cali- "If the old saying that 'Silence gives fornia's 'poison law' is a wise meas- consent' is sound, one may say truth- ure, and its vigorous enforcement has fully, if cynically, that there are ways saved many persons from suicide or in which a man may accomplish his from habits leading to things far worse own destruction, not only with the than death, but it is relatively of far tacit approval of the American public, greater importance to society that the but with some assurance of sympathy. tenement-house law should be enforced He may not shoot himself or attempt to with equal energy. The enforcement take poison without incvirring public cen- of our public health laws generally sure and the restraint of law. If he would greatly reduce the needless loss jumps off a ferryboat, traffic is sus- of life and health which is now going pended until he is rescued and turned on all about us. Doubtless the time over to the police and the newspapers will come when society's distinction for investigation. He may not turn on between law and license will be based the gas, even in his own house, and upon the prevention of those things quietly snuff out the lives of his family which are fatal to good health as well and himself without encountering seri- as to life itself. ous penalties under the law if he fails "Legislation toward this end should in his purpose. But apparently these not be erratic nor extreme. There methods are condemned because they should be no undue interference with are spectacular and mess things up, personal liberty, and each advance not because society cares very much should be safeguarded by the adoption about the individual or his family. of adequate administrative measures.

"If he will go about it deliberately On the other hand, there should l)e no and with patience, he may destroy him- shirking of responsibility for steady self and his children and even their progress. We must make an end of descendants, while society looks on approved methods of suicide and mur- with the single comment, 'It's his own der." :;

The PTealth Bulletin

"THOU SHALT NOT KILL" should be lost as the result thereof, I ask you who will be responsible? This meaus that if you take the life Who will be guilty of murder or man- of a fellow-man, you will not only in- slaughter? And, remember, the day voke the wrath and indignation of God, of your judgment is coming. but of man as well. "A life for a life" A. J. W. is the penalty exacted by the civil laws of civilization. If you take the life of IGNORANCE OR CARELESSNESS a brother-man, you expect the judg- —WHICH? ment and punishment of the court of man. If you destroy your own life, Smallpox Very Prevalent in Certain while you are then beyond the punish- Sections ment of man, you cannot escape the judgment of that great Judge and It would be interesting to know Ruler of the Universe—God, because how much of unnecessary disease and "The Lord giveth and the Lord taketh death is due to ignorance, and how away. Blessed be the name of the much to carelessness. These two fac- Lord." tors are in such close partnership in You can refrain from taking your the business of disease production that own life ; it belongs not to you. but to it is difficult to know which is the God. You can refrain from murder- senior member of the firm, but in the ing your brother-man, your neighbor, case of smallpox, it would appear that your wife and your child, and to do so carelessness, not ignorance, plays the would be to commit a sin the stain leading role. We have known how to and stigma of which, even though you prevent smallpox for one hundred and escape the judgment of man, would twenty-five years. AVe have had an forever hover over you like unto a absolutely sure prevention, and yet black cloud casting its shadow upon people neglect to use it. the sun.shine of life. At present, the disease is entirely There are numerous ways of de- too prevalent in many sections of this stroying life, both active and passive, State. In January, there were 132 i'ou can either blow your head off with cases reported ; in February, 165 cases a large calibre pistol, or you can peace- and in March, 352 cases. Indications fully slumber upon the railroad track are that a still larger number of cases and wait for the flying express to do occurred in April. Forsyth, Guilford the deadly work. You may ingest a and Cabarrus counties had the largest few grains of the deadly potassium cy- number of cases, and practically all anide and die a hurried death, or you of the cases were in and around the may partake of your brother's excre- county towns of those counties, that is, ment laden with Bacillus Typhosus in Winston-Salem, Greensboro, and and die a lingering death of six to Concord. Winston-Salem has not been eight weeks duration. The end results free from smallpox for seven months are the same. And I ask you, is it any and there have been only three months the less a sin to die of poisoning from during the last sixteen months in typhoid than from potassium cyanide? which cases of smallpox did not occur Both can he prevented. If you do not in Winston-Salem. Moreover, it ap- exercise every precaution to protect pears that Winston-Salem has proba- yourself and family against typhoid bly been the distributing focus of in- fever and dysentery by means of vac- fection for neighboring towns. Of 1,688 cination and sanitation, and a life cases reported from the entire State — :

The Health Bulletin recently, 265 oi* more than 15 per cent a committee appointed by a lodge for were in Winston-Salem. such duty may cut loose from pre- The practical conclusion for the in- cedent and the stereotyped form of telligent person to draw from these vvords, and startle the brethren with facts are: tirst, that smallpox is preva- a pronouncement in this fashion lent in North Carolina to the extent "Whereas, the Mayor, the City Coun- that one is likely at any time to come cil and the health authorities of this in contact with a case of the disease town have criminally failed in their on the train, in the street-car, in the duty of safe-guarding the lives and store, or elsewhere; second, if that he health of citizens ; and, whereas, this gets vaccinated, it does not make any lodge has, by reason of such criminal difference how prevalent the disease and inexcusable neglect, been called is or how prevalent it may become, or upon to mourn the loss of our dear when or where or how intimately he Brother Blank ; therefore, be it Re- comes in contact with a case of small- solved, that this lodge does hereby pox, he is absolutely safe. Get vac- condemn such delinquent authorities, cinated ! Do not take a chance. None holding them up to the reprobation of of the 1,688 cases recently reported all good citizens; and be it further were vaccinated, because they believed Resolved, that we call upon the au- that the probabilities of smallpox were thorities of the State, and the courts something that concerned the other to take official cognizance of such will- fellow and not themselves. It is the ful neglect and misconduct." It is unvaccinated person that has the dis- altogether likely that such treatment ease; that brings trouble to himself, to would have beneficial results. The his family, and to his community, and course now adopted is not fair to God, gives a black eye to sanitary condi- and suffers offending men to continue tions in North Carolina. in wrong-doing, while still retaining respectability and the regard of their WHO IS TO BLAME, GOD OR IN- fellows. As for Brother Blank's trans- DIFFERENT OFFICIALS? lation to "the Grand Lodge above," such happy consummation would be in A lot of Masonic "resolutions of con- no way interfered with by the unusual dolence and respect" begin with a truth-telling on part of his surviving bald-faced lie. The "Whereas, it has and sorrowing brethren. It might pleased Almighty God to call our dear even help him through the pearly gates Brother Blank from labor to reward," as proving the good quality of his late is a clear case of "passing the buck." associates, and presumably his own ex- It attempts to shift blame for an un- cellent character. Anierwan Freema- timely death from the shoulders of son. very culpable mortals. When citizens permit unsanitary conditions to pre- SMALLPOX VACCINATION vail and x?ontinue ; when they allow Smallpox is probably the oldest of the authorities to become lax and in- all the historic epidemic diseases. Out- different in matters that concern the breaks of smallpox still occur in the health of the community, the regret- United States. Smallpox can he absolutely prevented by vaccination. Every table death of an honored resident child should be vaccinated by the time should not be attributed to the will it reaches the age of one year. Physi- and pleasure of the Almighty. Such cians and nurses have no other means resolutions should properly begin with of protecting themselves against this disea.se, yet they seldom contract it. a "mca culpa," for every citizen must Universal vaccination will banish small- share in the responsibility. Some time pox permanently. : :

PUBLIC HEALTH RND SANITATION

DURHAM COUNTY LEADS THE responsible for an epidemic of typhoid STATE fever. The responsibility for individual cases is going to be fixed also courts of the states, as is clear- Martin County is a Close Competitor by the handed For First Honors ly indicated from a decision down by the Supreme Court of Wis- distinguished it- Durham County has consin in the case of Vennen v. Dells self by leading the State with the Lumber Company. 154 N. W. Rep. 640 from typhoid fever. highest death rate (October 26, 1915). The Supreme rate for 1918 Durham County's death Court of Wisconsin decided that the death rate for the was 75.6, while the death of an employee caused by ty- 1018 was only State at large during phoid fever, which was contracted by 23.6. drinking impure water furnished by were reducing While other counties the employer, was the result of an per cent the typhoid death rate by 50 "accident" under the terms of the Durham was trying to make up for the Workmen's Compensation Law. and deficit. the person responsible for the impure takes the second Martin County water was liable for damages result-

) with a typhoid death rate honor ( ? ing therefrom. A. J. W. of 72.4. Martin County should not and cannot be excused for the neglect of her citizens' health and the high ty- REDUCTION IN TYPHOID DEATH phoid death rate, but if leniency were RATE to be shown, then Martin is less culpable than a county having a whole- Typhoid fever is gradually on the time health department like Durham decline in North Carolina. This fact or Wilson counties. is clearly shown by the following The ten banner counties that are figures blighting the State with their typhoid In 1914, 839 deaths in State from records, are typhoid. Rate, 35.4. Typlioid Death In 1915, 744 deaths in State from County Rate typhoid. Rate, 31.3. 1. Durham 75.6 In 1916, 700 deaths in State from 2. Martin 72.4 typhoid. Rate, 29.1. 3. Richmond 54.3 In 1917, 626 deaths in Ji.tate from 4. McDowell 49.4 typhoid. Rate, 25.7. 5. Rockingham 46.7 In 1918, 514 deaths in State from 6. Wilson 44.8 typhoid. Rate, 23.6. 7. Wayne 44.2 This reduction is not the result of 8. Perquimans 42.8 providence alone, but is due to the spe- 9. Harnett 42.2 cific work that has been directed 10. Pender 41.7 against typhoid fever in North Caro- The time is not far distant when lina by the State Board of Health. local health authorities will be held There are just three things that have ;

The Health Bulletin 7

caused this reduction, namely, educa- were the most ordinary, then we tion of the people at large to the fact would expect to have typhoid dis- that typhoid can easily be prevented, tributed more or less evenly through- and second, the use of this knowl- out the year, probably reaching its edge in doing the third, which is get- maximum during the cold winter ting vaccinated and building sanitary months, because human contact is privies. A. J. W. about the same throughout the year, probably a little closer during the win- HOW TYPHOID IS CONTRACTED ter. If the third or the FLY route were the prevailing route of infection,, Typhoid fever is due to the Bacillus then we would expect to have typhoid Typhosus, a small germ that lives in most common during the FLY season, the bowels of human beings. from April to September. And that is These germs of typhoid are found in just what happens. During the win- all the discharges that come from peo- ter and spring we have little or no ple who have typhoid fever, the ones typhoid. But with the coming of hot actually sick, and in the discharges of weather and FLIES come typhoid and some who have had the disease but dysentery. have recovered. There is recorded a If the FLY is the chief factor in the case of a man who continued to dis- distribution and transmission of ty- charge the typhoid germ from his bow- phoid fever, how does he carry the els forty years after he had recovered germ and how do we get it from him? from the disease. A great many peo- The answer to this question goes di- ple have mild cases of typhoid fever rectly back to the problem that the and do not know it. They are not State is now dealing with, the open- sick enough to go to bed, and the doc- back, insanitary privy. Flies lay their tor is rarely called to see the case. eggs and live only in some form of This mild type is the most dangerous, filth. They prefer stable manure, and because they probably travel from next to that they would choose human place to place and do not take any pre- excrement. They not only live in hu- cautions to prevent the spread of the man excrement, but they feed on it. disease. The entire body surface, and espe- If the typhoid germ lives only in cially the legs of the fiy, is covered the bowel of human beings, then for with fine, stiff hairs so that when a you to have typhoid fever you must fly lights upon and crawls upon filth, partake of the bowel discharges of especially human excrement, his body some other person. How does this surface and legs accumulate quite a bit human filth containing typhoid germs of the excrement which he, of course, get into your mouth? There are just bring along with him when he comes I three principal ways : first, through in the dining-room at meal time. And water ; second, by personal contact as he walks proudly and gallantly and third, by FLIES. Of these three, about upon the butter, the biscuit, and which one is the usual or most common route of infection? Let's reason other food, he, of course, leaves in his a bit and see. If the first or the wake a small portion of the human water route wei*e the most common, we excrement he has so graciously brought would expect the disease to be most in. You remember the first thing the prevalent during the winter and fly did yesterday when he so gracefully spring, when the rainfall is heaviest perched himself upon the butter just and the earth is saturated with mois- as you were preparing to serve your-

ture. If the personal contact route self a portion? I did not .see him, but I !

8 The Health Bulletin

I know what he did. His first act was phoid germs through careless habits to vigorously rub his two front legs, and the indiscriminate disposition of one against the other. And did you human excrement in the vicinity of ever stop to think why he did it? He the source of water supply. This, did it for the same reason that you again, reverts back to the homes that use the door mat to cleanse your feet have open-back, insanitary surface before entering the house, to rid his closets, and to homes that have no toi- feet of accumulated filth so that he let whatsoever. Human excrement de- might walk with more comfort. So posited upon the surface of the ground if you allow Mr. Fly to use your food will be carried, during a rain, by the as a door mat to rid his body and feet surface water into the spring or well. of the filth, and especially human filth, Most people have the idea that wells then you can expect typhoid fever and are polluted by the excrement filtering dysentery and "summer complaint." If through the earth, and entering the you give him an inch, he will take a well several feet below the surface, yard. He will not only use your food but this is not the usual occurrence. It enters the well from the ground surface around the curb. It also gets into the well as a result of dogs and chickens with excrement on their feet, walking about upon the platform of the well, where some of the excrement

is deposited and later washed through the cracks between the planks, into

the well ; also by dirty hands handling the well bucket and rope, which go directly into the water. All open EVER wells are a constant menace to your health. Springs are particularly dangerous, because they are usually located in a low place and the surface UtS water from the bushes and surrounding territory sweeps over it. Now is the time to safeguard the and the baby's mouth and face for a health of your family by making safe door mat, but as a cuspidor as well. your water supply. If you don't know Ajfter banqueting upon human excre- how, write the State Board of Health, ment containing the germs of typhoid Raleigh, for information, which will and dysentery, he repairs to the din- be gladly furnished. A. J., W. ing-room or to the baby's crib, and after cleansing his feet, his next act PLAN FOR DEALING WITH Is to relieve his stomach of a portion TYPHOID of its crowded contents. The result is "FLY SPECKS." A tiny, black "FLY During the summer months the SPECK" might, in a few weeks time, State Board of Health is going to con- grow into the black veil of death. So duct a typhoid vaccination campaign beware in thirty counties of the State. The Are you still a friend and advocate first thirty counties applying will be of the fly, your most deadly enemy? the thirty that will be selected. The Water contamination: I'our drink- State Board of Health will conduct ing-water gets contaminated with ty- and assume the entire responsibility The Health Bulletin 9 of the campaigns in these thirty coun- enough for grandfather and so on. So ties. The only requirements necessary they substituted unboiled water for the for your county to be one of the thirty sterilized stuff when nurse was not is for your county commissioners to looking, and so had the laugh on that agree to pay to the State Board of scientific smarty. It was a joke on

Health the sum of 12 1/^ cents for each her all right; for later she died of complete vaccination done in your typhoid fever as did also her patient county. So if your county is not and three other members of the funny among the list of those who applied, family. and you have a case of typhoid in your home or an epidemic in your county, TWO TOWNS you may linow that your county com- Mr. Billy Jolly of Bumtown, dropped missioners failed in their public re- an orange peel on the sidewalk. His sponsibilities. If your county commis- eellow-citizen, Mr. Bob Ernest, stepped sioners should fail to give you this pro- on it, broke his leg, and was laid up tection for 12% cents, then do not for three months with no accident yourself fail in your own moral re- insurance policy to help out. Neither sponsibility by neglecting to be vacci- Billy nor Bob knew that it was Billy's nated. Go at once to your family phy- fault- in fact, Billy did not remember sician and have him vaccinate you he had dropped an orange peel. He against typhoid. never thought about such things. He In addition to the vaccination cam- was a good-hearted fellow at bottom, paign, the State is going to attaclc fond of Bob, and both put the whole typhoid fever from another angle. The blame on the orange peel. If Billy State Board of Health is going to had known the truth, it would have strike a blow that will fall at the been a terrible lesson for him. and Bob most strategic and vital point of the would have been obliged in his heart typhoid fever problem. A victory for of hearts to blame Billy for doing such the State Board of Health and a a fool trick. Of course, no one blames crushing defeat for typhoid fever is those who did not kick the orange certain to be the result. No armistice peel ofE the sidewalk before it got in will be granted. Nothing short of its work. complete annihilation of typhoid fever Mrs. Ownway, also of Bumtown, let will satisfy the State in this "Battle little Jack play on the sidewalk when to a finish." This great annihilating his sister, Ethel, had the diphtheria; wave against typhoid fever is going little Jenny Lovejoy, from the other to be the enforcement of the state- side of town, stopped to speak to Jack, wide sanitary privy ordinance. and now little Jenny is dead. Mrs. A. J. W. Ownway had said she really hadn't the heart to keep Jack so closely con- A TYPHOID TRAGEDY fined when he was perfectly well, and Up in the country a professional that this foolish quarantine was so nurse, sent to take care of a bad ty- perfectly unnecessary. Of course, Mrs. phoid case, suspected the dear old Ownway really killed little Jenny; but family well. she didn't know it, and Mrs. Lovejoy Pending an analysis, she ordered all didn't know it. Mrs. Ownway was the drinking-water boiled. The intelli- terribly distressed, wrote Mrs. Love- gent family thought this was all non- joy a sweet letter of condolence, and sense. Besides, they resented any as- sent a bunch of lilies of the valley persions on the well. It had been good for the little coffin. The two mothers 10 The Health Bulletin agreed that these germ diseases were them preferred death and an early one. awful and that the blame was on the Still, if one looked carefully, he would germ. Mrs. Lovejoy did not blame have observed that the very best citi- anybody and Mrs. Ownway felt no per- zens spit on the sidewalks, that food sonal responsibility. was sold under most unsanitary condi-

That was the way in Bumtowii, tions (even candy was handled with which, by the way. had a very high dirty hands and soda fountains were death rate, especially among children, vile), that the sections in which the and for communicable and intestinal servants lived who served the food diseases. were refused proper water and sewerage facilities, that flies were bred in Bumtown was inhabited by some of stables permitted to be run under con- the best people in the State, kindly, ditions contrary to law, that for the accommodating and easy-going. They servants a vile surface privy on the had excellent sanitary regulations all lot was considered good enough, and printed out in plain English on paper, above and beyond all, that press and and most of them could read. They pulpit were silent on the moral re- would not have hurt a fly, and, in sponsibility of each man for the health fact, they seldom did. It was the of his neighbor. business of the town government and the health officers, armed with these The story of Goodtown is less event- nice laws, to bring health to Bumtown. ful, because nothing happenwl. Mr. The citizens felt no responsibility indi- Bob Jolly went there on a visit, to be peel vidually or collectively. But the city sure, and dropped an orange on government was composed of good, the sidewalk, but Mr. Aristides Faith- it off. No- kindly, fairly intelligent, average citi- ful came along and kicked zens, who were elected to give a nice, body was hurt. Nobody felt grateful quiet, neighborly government to Bum- for not being hurt. Mr. Faithful did town, and who honestly tried to do so. not know whether he had saved any "Laws were not to be taken too seri- one or not, and. if he thought he had, there was the whole town to choose ously ; to enforce these sanitary laws strictly might offend some of our best from. citizens. We are getting on very well."' Mrs. Ownway, who had not devel- So said they all. oped diphtheria but who proved to be visited as No citizen, meanwhile, complained of ii carrier, also Goodtown discharged. the lack of law enforcement, or saw in soon as little Ethel was Strange to say, a child in the house it a cause of the high death rate. If diphtheria. But any one was shot, the shooter was she visited soon had promptly punished. The shootee knew they at once administered the proper he was hurt and who hurt him. and treatment, gave every one in the house the strict- immediately got busy. The govern- the antitoxin, and observed in spite of the incon- ment and the citizens were opposed to est quarantine else got open crimes of violence that endanger venience. Therefore, no one invalid soon well. the lives of innocent people. But, it and the was

when it came to sanitary matters, no- So it was with sporadic cases of sev- body made any fuss. It would not be eral other communicable diseases. nice or popular. As to the death rate, They seldom got beyond the first case. they were sure there was some mis- Everybody cheerfully obeyed the laws

take about it. They said they liked a and backed up the doctors and health quiet life. But, as they continued to oflScers. Goodtown people did not have die, it rather looked as though many of typhoid. They knew that, in plain The Health Bulletin 11

language, it came from swallowing the RECIPES FOR KILLING FLIES other people, and they excrement of The United States Government think it was nice. Besides, it did not makes the following suggestion for the was so unnecessary. They actually in- destruction of house flies : Formalde- sisted on the strictest enforcement of hyde and sodium salicylate ai-e the the sanitary regulations (which Bum- two best fly poisons. Both are supe- town had adopted word for word) rior to arsenic. They have their ad- besides, they all took the anti- and, vantages for household use. They are typhoid vaccination every few years. not a poison to children, they are con- insisted on this for all who han- They venient to handle, their dilutions are dled food, raw or cooked food, in pub- simple and they attract the flies. lic or in private houses. Any one who of Solutions had typhoid in Goodtown brought it Preparation is worried with him ; in fact, this what A formaldehyde solution of approxi- Goodtown. Being a delightful, healthy mately the correct strength may be town, it attracted many visitors from made by adding three teaspoonfuls of the best people in many of the finest the concentrated formaldehyde solu- after ar- cities of the State, and soon tion, commercially known as formalin, typhoid. riving, some of them had to a pint of water. Similarly, the They blamed Goodtown. Goodtown proper concentration of sodium salicyl- loathed them and doubted their intelli- ate may be obtained by dissolving gence, their Christianity, and their pa- three teaspoonfuls of the pure chemi- carefully triotism. They nursed them cal (a powder) to a pint of water. and pulled most of them through. Some of them died, and for these they wrote nice obituaries and tried to respect their memories. The city government of Goodtown had no easy time. They had to fight some of the oldest citizens, but they well knew that that was what they were elected for, and that failure to enforce the law strictly on every one would surely prevent their reelection. The press fearlessly told the whole truth about health conditions and violations of law. The pulpit joined with A container such as shown above the press in preaching that any one has been found convenient for auto- was a fool who did not look out for the matically keeping the solution always health of others for his own sake, and available for flies to drink. An ordi- no Christian if he did not do so for nary, thin-walled drinking glass is the sake of others. Hence, every one filled or partially filled with the solu- felt a conscientious responsibility for tion. A saucer, or small plate, in which the life and health of every one else, is placed a piece of WHITE blotting everybody, and the everybody loved paper cut the size of the dish, is put life insurance companies just loved the bottom up over the glass. The whole town. is then quickly inverted, a match Which town would you prefer to placed under the edge of the glass, and live in? Like which town are you try- the container is ready for use. As ing to make your town? the solution dries out of the saucer the 12 The Health Bulletin liquid seal at the edge of the glass is Now, however, light has been turned broken and more liquid flows into the on the problem, and we find the pro- lower receptacle. Thus the paper is gressive men and women of the day always kept moist. eager for knowledge of the cause and cure of this malady. Other Simple Preventives Another cause of delay in securing Any odor pleasing to man is offen- proper treatment has been the common sive to the fly, and vice versa, and will dread of operation. This dread of an drive them away. operation will unquestionably be over- Take five cents worth of oil of lav- come when the public can be made to ender, mix it with the same quantity appreciate the fact that the disease is of water, put in a common glass atom- of local origin and that in its early izer and spray it around the rooms stages prospects of complete cure are where flies are. In the dining-room excellent. spray it lavishly, even on the table The statements in this article are linen. The odor is very disagreeable based on the publications of the Can- to flies but refreshing to most people. cer Society as authorized by its Na- Geranium, mignonette, heliotrope and tional Council, which includes many white clover are offensive to flies. of the foremost American physicians, They especially dislike the odor of surgeons and pathologists. honeysuckle and hop blossoms. What Cancer Is According to a French scientist, flies have intense hatred for the color blue. Cancer is a lawless growth of body Rooms decorated in blue will help to cells which destroys life if allowed to keep out the flies. run its course. In the beginning the Mix together one tablespoon of cancer is limited to one spot, and, cream, one of ground black pepper and while so localized, can easily be cured. one of brown sugar. This mixture is Unless controlled it next invades the poisonous to flies. Put in a saucer, surrounding tissues and, if allowed to darken the room, except one window, run its course, some of the cells of and in that set the saucer. which the cancer is composed are

To clear the house of flies, burn thrown off and carried by the blood or pyrethrum powder. This stupefies the lymph vessels to other parts of the flies, but they must be SWEPT UP body, where they start secondary and BURNED. growths. When this stage is reached, the can-

cer is beyond control and there is less CANCER—A CURABLE DISEASE hope of cure. Theoretically every case of cancer What knowledge has done for tuber- can be cured by removing the growth culosis, knowledge will do for cancer. from the body while it is confined to The greatest difficulty encountered in the single cell or microscopic group of the past has been the hesitancy of cells in which it begins. There are, of those aflJicted with beginning cancer course, cases in which no symptoms at- to seek medical advice because of their tract the attention of the patient until dread of having their fears confirmed. the tumor has developed beyond the They have believed that cancer was a operable stage, or in which the loca- loathsome disease, something to be tion of the cancer is inaccessible to ashamed of, and therefore kept secret present surgical skill, as, for example, until it had progressed too far for in the middle of the liver. Such cases cure. are, however, comparatively rare, and The Health Bulletin 13

fortunately warning signs are almost tious. Among the thousands of opera- always given when the disease attacks tions for cancer on record there is no the common sites, as the breast, uterus, report of a case acquired from the pa- stomach, intestines or rectum, and tient by any surgeon or nurse. Ordi- growths in these organs can be suc- nary care and cleanliness should be cessfully remoA^ed in the early stages. observed in attending cancer patients, Cause of Cancer but isolation and fumigation, as in Nothing definite with regard to the the case of contagious diseases, is unnecessary. ultimate cause of cancer is at present known in the way that the specific Investigation of "cancer houses," causes of tuberculosis and other dis- "villages," or "streets," wherein an un-

eases are known ; nor is it to be as- usual number of cancer cases have been sumed that there is a single specific said to occur, has invariably shown causative agent of cancer. We have, that the apparently high mortality has however, knowledge of certain agents been due to special conditions, such as and conditions which exert a direct an unusual proportion of old people, influence in the formation of a cancer. among whom the cancer death-rate When, for example, a part of the would naturally be high. body is subjected to repeated irritation Cancer of the Breast until a sore or ulceration is produced The most significant warning of can- and that sore or ulceration is allowed cer of the breast is a lump. If a no- to remain unhealed and the irritation dule, lump or hard area is found in continued, a cancer frequently results. the breast, it may not be cancer, but Nearly all moles and warts are harm- it should be brought at once to the less and remain so, but occasionally attention of a physician. Such lumps one may take on an increased activity should not be rubbed or manipulated as a result of irritation or of some because of the danger, if unknown cause and become malignant. the lump proves to be cancer, of scattering the The essential points to be remem- cancer cells throughout the system. bered are, tlierefore, the avoidance of Cancer of the breast is one of the all chronic irritation such as may oc- most hopeful and- curable forms of the cur from eyeglasses, a badly fitting disease because of the ease of early dental plate, broken or jagged teeth, diagnosis and of its removal. Any etc., and if a sore or ulceration does lump in the breast is vitally important, form as a result of such irritation to whether painful or not, and demands have it promptly cured. a medical examination. Retraction of Is Cancer Hereditary? the nipple and nodules under the arm The evidence of statistics is against are later symptoms. the popular idea that cancer is hereditary. Practical confirmation of this Cancer of the Uterus

evidence is furnished by the stand This is a frequent form of the dis- taken by life insurance companies. ease, but fortunately one in which These companies ignore a family his- early diagnosis is easy and removal is »tory of cancer in issuing policies be- usually possible. The two danger signs cause their statistics show that the to be remembered in regard to cancer chance of an individual's developing of the uterus are (1) any change in cancer is not increased by there being the vaginal discharge and (2) any cancer cases in the family. change in the menstruation. These Is Cancer Contagious? "^ should not be considered as positive Cancer is not contagious or infec- symptoms of cancer, but only as warn- —

14 The Health Bulletin ing signs that should send the patient means a minor operation or the use to a surgeon for an examination. of X-Rays or radium. Excessive flowing at any period of Radium and X-Rays is abnormal and should be imme- life These methods of treatment are of investigated. Treatment with- diately definite usefulness, especially in cer- examination is wrong and, by out an tain types of superficial cancer, such as delay, may forfeit the patient's causing those which appear on the skin. In cure should cancer exist. chance for some cases they are of use following Cancer of the Digestive Organs an operation. They are also a recognized treatment for cancer which has About thirty per cent of all deaths gone so far that it cannot be operated from cancer are caused by cancers of upon. In an increasing groui) of cases the stomach, intestines and liver. in which the cancer is comparatively These are formidable types of the dis- inaccessible, or in which there is some ease, but can, in many cases, be suc- contraindication to operation, radium cessfully treated if the diatjnosis is is being used with success. made early enough. The earliest pos- Only a few doctors have enough ra- sible attention to the danger signals is dium for proper treatment and only of the greatest importance and, since a few know how to administer it cancer of these organs cannot be seen, safely. a very thorough examination should Fake Cures and Quacks be made by the use of the latest and advertisement most approved diagnosis methods. The Every '•cancer cure" use of valueless danger signals of these cancers are is "a swindle, and the preparations means persistent indigestion, vomiting and medicines and of and time. Testimo- pain at the pit of the stomach. waste money and The danger signal of cancer of the nials of advertising "specialists'" "institutes" are either fabrications or rectum is the passage of blood. There probability, on the re- may be either constipation of diarrhea. are based, in all which were not These symptoms are frequently caused moval of conditions all. Woman's Magazine. by hemorrhoids, but on the appearance cancer at of such symptoms an examination should in every case be made. Periodical Physical Examinations

External Cancer Among the many valuable things emphasized by public-health workers Cancer of the skin frequently origi- within the past few years is the neces- nates in old warts, pigmented moles sity for periodical physical examina- and unhealed wounds, scars and sores. tions for all persons. There are many Most warts and moles are unimportant, serious diseases whose beginnings are but those which change in size, shape insidious and not noticeable to the or appearance or are subject to irri- average person. If such diseases are tation should be regarded with sus- recognized in time, many such condi- picion. tions can be arrested or improved by In the beginning, cancer of the lip proper treatment. often resembles the common cold sore. The practice of having periodical Any ulceration of the lip or tongue physical examinations at intervals of that does not quickly heal should be six months or one year is to be seen by a surgeon. Competent treat- strongly recommended to every person of the conditions which are lia- ment interested in the preservation of the actual ble to become cancer and of health. Consult your family physi- generally disease in its early stage cian about it. CARRY ON! and 12 per cent more occur next door, leaving only 8 per cent to occur from other than close contact. If You Are Not Fit to Fight, Fight Your own body is a to Get Fit! very important sector of the battle front, where to you L. B. McBrayer the most important battle must be All men disqualiiied for military fought, which compared with Verdun, service on account of tuberculosis and Kemmel Hill, Chateau Thierry and the Hinderburg all men, women and children that have Line, makes them look insignificant, at least to been or may be attacked by this dis- you. Trained soldiers needed! When our ease are hereby called upon to enlist government went to war with Ger- in the fight against this insidious foe. many she went through the following // you don't enlist, you icill he steps: (1) decided to make the fight; drafted BY DEATH. (2) mobilized our forces: (3) trained Offer your services again, disabled them; (4) proceeded to licK Germany. or man woman. Not to our army or The fight against tuberculosis in your our navy, for our medical corps—all own body must be carried out in the praise to them for their gallant and same way if you desire to win. effective work—have already decided You too must decide to nuike the that you are disqualified for such serv- fight, for without this decision you ice; and such decision, with have lost the condi- already : and for you to lose tions found, is of record in the War in this fight means death for you. The Department. decision once made must become the Yet you have an opportunity to do ruling passion of your life; nothing your bit in making the world "safe for must be allowed to turn you away for democTacy," which means, among a moment from the purpose in hand. other things, "equality of opportunity You too must moMlize your forces. for health." You can still be a hero The forces that are to win the battle and a patriot, you can still fight the are your white cells, and in this in- fight of a true soldier, and the next stance they are already on the job and "greatest" war since we have con- so well trained that you would think (luered the Germans, is the war they acted automatically when a tu- against tuberculosis. I^erele bacillus gained entrance into Your country needs you. your your body. Pages could be written de- friends need you, and most of all your scribing how these soldiers (white loved ones need you, for it is for the cells) whose duty it is to protect you protection of your own home, your from tubercidosis and other diseases own family, that you are called upon act, but in this instance, (piite difl:"er- to enlist. It is an ascertained clinical ent from our condition when we went fact that 80 per cent of all the cases to war with Germany, it is the cap- of tuberculosis occur in the family tain, yourself, that needs to become where there has been a previous case, the trained soldier. 16 The Health Bulletin

When our nation decided to make the orders from the general command- the figbt against Germany it sent its ing—your doctor. soldiers to training camps and its offi- If it be impossible for you to go to cers to training camps, and gave them a sanatorium, then you can do the next intensive training over a period of best thing—you can enlist under a gen- months. If you expect to win the fight eral (a good doctor), stay with him against tuberculosis you must go to an through life, and get such additional In- officers' training camp, where you can structions from the Bureau of Tuber- learn the "rules of the game" by culosis of the State Board of Health, doing it. Sanatorium, X. C, as are to be had on The training camp in the fight the subject. against tuberculosis is the SANATO- If you are uninformed as to whether teaching you is invading your RIUM ; and in addition to or not the enemy the rules of the game, the medical body, secure an examination by a com- staff and the nurses will for the time petent physician, and when informed being act as generals for you and see —CARRY ON! to it that you have whatever help may needed in getting your soldiers be DIARRHEAL DISEASES OF CHIL- (white cells) into fighting order. If WIDESPREAD IN STATE. hole (a cavity DREN the doctor finds a shell NOT CAUSED BY INFLUENZA. in your lung) he will help your soldiers to surround it and wall it off. The diarrheal diseases of children, He will help your soldiers to capture commonly known as summer bowel the germs and destroy tbem. In order complaints, are being reported from to make your soldiers "fit to fight" many sections of North Carolina. The the doctor will have you husband your State Board of Health states that this resources just as Hoover did. stop class of diseases is not caused by in- wasting your vitality. As a means fluenza, as is being commonly reported, to this end he will have you spend all and that there is no direct connection your time in the open air, rest system- between the two infections. Infant atically all the time if needed, and take diarrhea is an infectious disease and such food as may be best suited to is caused this year, as it has always bring about the desired end. been caused, by improper feeding and The first thing we did when we went lack of sanitation about the home. into the fight with Germany was to Errors of diet are mainly responsible see to it that General Foch was put in for starting the condition which is a command of the allied armies. We serious one and kills more than 2,600 will all agree that had the allied armies babies each year ; a diet containing too instead been placed in France and much sugar (proprietary foods, as a Belgium and the captain of every com- rule, come under this class) being the pany told, "now go to it," there would most usual cause. Too much sugar not one of our soldiers have been left upsets the baby's digestive tract and to tell the tale. But with every com- predisposes to the infectious forms of pany of every army acting under Gen- diarrhea which are transmitted by eral Foch the rout came to the Ger- flies from open privies and soiled nap- mans. And so it is in the fight against kins or spread by strawberries and tuberculosis : you are the captain, you other vegetables. must command your company (com- The State Board of Health will be re- posed of white cells) , but you must glad to send literature regarding the ceive and obey, just as implicitly and disease and its prevention to any one faithfully as the captains in France, writing for it. B. E. N.