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Thirty- Fourth Biennial Report

OF THE

NORTH CAROLINA
STATE BOARD OF HEALTH

JULY 1, 1950— JUNE 30, 1952

PRINTED BY

OWEN G. DUNN CO.
NEW BERN. N. C.

MEMBERS OF THE STATE BOARD OF HEALTH

Elected by the North Carolina Medical Society

G. Grady Dixon, M.D.
Term expires 1955

John R. Bender, M.C.
Term expires 1953

Ben J. Lawrence, M.D.
Term expires 1953

G. Curtis Crump, M.D.
Term expires 1955

Appointed by the Governor

H. Lee Large, M.D.
Term expires 1955

Hubert B. Haywood, M.D.
Term expires 1953

A. C. Current, D.D.S.
Term expires 1953

Mrs. James B. Hunt
Term expires 1953

H. C. Lutz, Ph.G.
Term expires 1955

EXECUTIVE STAFF AS OF JUNE 30, 1952

J. W. R. Norton, M.D., M.P.H., Secretary and State Health Officer

John H. Hamilton, M.D., Assistant State Health Officer and Director State

Laboratory of Hygiene
Ernest A. Branch, D.D.S., Director Oral Hygiene Division
J. M. Jarrett, B.S., Director Sanitary Engineering Division
C. C. Applewhite, M.D., Director Local, Health Division
A. H. Elliott, M.D., Director Personal Health Division
♦Charles P. Stevick, M.D., Director Epidemiology Division

•Dr. Stevick resigned in May, 1952, and Dr. John H. Hamilton was designated to serve until a
successor was named.

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LOCAL HEALTH OFFICERS IN NORTH CAROLINA

N. C. State Board of Health, Local Health Division
Raleigh, N. C.

SEPTEMBER 25, 1952

Department

Health Officer

Address

Alamance

Dr. W. L. Norville

Graham

Alleghany- Ashe-Watauga

Dr. M. B. H. Michal

Boone

Anson

Dr. Warren D. Carter,

Wadesboro

Act. P.T.

Burnsville

Avery- Yancey-Mitchell

Dr. Cameron F. McRae

Washington

Beaufort

Dr. L. E. Kling

Bayboro

Pamlico

" " " "

Hyde

" " " " (Dr.W.S. Cans
P.T., in charge)

, Swan Quarter

Bertie

Dr. Cola Castelloe, Act. P.T.

Windsor

Bladen

Dr. R. S. Cromartie

Elizabethtown

Buncombe

Dr. H. C. Whims

Asheville

Madison

" " " "

Marshall

Burke

Dr. Carl C. Janowsky

Morganton

Cabarrus

Dr. J. Roy Hege

Concord

Caldwell

Dr. William Happer

Lenoir

Carteret

Dr. N. Thomas Ennett

Beaufort

Catawba-Lincoln- Alexander

Dr. Benton V. D. Scott

Newton

Cherokee-Clay-Graham

Murphy

Cleveland

Dr. Z. P. Mitchell

Shelby

Columbus

Dr. Floyd Johxsox

Whiteville

Brunswick

" " "

Southport

Craven

Dr. E. D. Hardix

New Bern

Cumberland

Dr. M. T. Foster

Fayetteville

Currituck-Dare

Dr. W. W. Johxstox

Currituck

Davidson

Dr. J. W. Varxer

Lexington

Duplin

Dr. Johx F. Powers

Kenansville

Durham

Dr. J. H. Eppersox

Durham

Edgecombe

Dr. W. A. Browne

Tarboro

Forsyth

Dr. Fred G. Pegg

Winston-Salem

Stokes

" " " "

Danbury

Davie-Yadkin

" " " "

Mocksville

Franklin

Dr. S. D. Stallixgs, Jr.

Louisburg

Gaston

Dr. J. T. Ramsaur

Gastonia

Granville

Dr. Donald R. Chadwick

Oxford

Guilford

Dr. E. H. Ellixwood

Greensboro

Halifax

Dr. Robert F. Young

Halifax

Harnett

Dr. W. B. Hunter

Lillington

Haywood

Dr. N. F. Lancaster, Act. P.T. Waynesville

Henderson-Transylvania

Dr. J. D. Lutz. Act. P.T.

Hendersonville

Dr. Charles L. Newland,

Brevard

Act. P.T.

Hertford-Gates

Dr. James A. Fields

Winton

Iredell

Dr. Ernest Ward

Statesville

Jackson-Macon-Swain

Sylva

Johnston

Dr. E. S. Grady

Smithfield

Lenoir

Dr. R. J. Jones

Kinston

Jones

" " " "

Trenton

McDowell

Dr. Virginia C. Row e.
Act. P.T.

Marion

Martin

Dr. J. W. Williams

Williamston

LOCAL HEALTH OFFICERS IN NORTH CAROLINA

(Continued)

Department

Health Officer

Address

Mecklenburg

Dr.

E. H. Hand

Charlotte

Moore-Hoke

Dr.

J. W. WlLLCOX

Carthage

Nash

Dr.

J. S. Chamblee

Nashville

New Hanover

Dr.

C. B. Davis

Wilmington

Northampton

Dr.

W. R. Parker

Jackson

Onslow-Pender

Dr.

Eleanor H. Williams

Jacksonville

Orange-Person-Chatham-Lee Dr.

0. David Garvin

Chapel Hill

Pasquotank-Perquimans-

Dr.

B. B. McGuire

Elizabeth City

Camden-Chowan

Pitt

Dr.

Walter C. Humbert

Greenville

Randolph

Dr.

G. H. Sumner

Asheboro

Richmond

Dr.

G. Fletcher Reeves

Rockingham

Robeson

Dr.

E. R. Hardin

Lumberton

Rockingham-Caswell

Dr.

George E. Waters

Spray

Rowan

Dr.

C. W. Armstrong

Salisbury

Rutherford-Polk

Dr.

G. 0. Moss

Rutherfordton

Sampson

Dr.

Donald Evans

Clinton

Scotland

Dr.

K. C. Moore

Laurinburg

Stanly

Dr.

R. E. Fox

Albemarle

Montgomery

" " "

Troy

Surry

Dr.

R. B. C. Franklin

Mount Airy

Tyrrell-Washington

Dr.

Claudius McGowan,
Act. P.T.

Plymouth

Union

Dr.

Clem Ham

Monroe

Vance

Dr.

A. D. Gregg

Henderson

Warren

" " "

Warrenton

Wake

Dr.

A. C. Bulla

Raleigh

Wayne

Dr.

S. B. McPheeters

Goldsboro

Greene

" " "

Snow Hill

Wilkes

Wilkesboro

Wilson

Dr.

H. W. Stevens

Wilson

Asheville

Dr.

Margery J. Lord

Asheville, Box 7148

Charlotte

Dr.

M. B. Bethel

Charlotte

Rocky Mount

Dr.

Robert J. Walker

Rocky Mount

Note:

Indented counties are not a part of the health department immediately
preceding them, but are merely served by the same Health Officer.

LETTER OF TRANSMITTAL

Raleigh, N. C, September 25, 1952

The Honorable W. Kerr Scott
Governor of North Carolina
The State Capitol
Raleigh, N. C.

Dear Governor Scott:

Pursuant to the provisions of Section 130-3, General Statutes of North
Carolina, I herewith submit to you, and through you, to the General Assembly
of North Carolina, the Biennial Report of the North Carolina State Board of
Health for the fiscal years of July 1, 1950— June 30, 1952.

Respectfully submitted,

J. W. R. Norton, M.D.,
Secretary and State Health Officer

TABLE OF CONTENTS

Page
Chronological History, North Carolina State Board of

Health 9

Report of Secretary and Treasurer and State Health

Officer 73

Annual Report of State Board of Health to Conjoint

Session of 1951 101

Conjoint Session of 1952 — Looking Ahead for Health in

North Carolina 106

Central Administration 112

State Laboratory of Hygiene 114

Division of Epidemiology 146

Sanitary Engineering Division 165

Oral Hygiene Division : 173

Personal Health Division 176

Health Publications Institute 189

THE CHRONOLOGICAL DEVELOPMENT OF
PUBLIC HEALTH WORK IN NORTH CAROLINA

In the seventies Dr. Thomas Fanning Wood, of Wilmington, caught the
vision of the possibilities of public health work to North Carolina. How
fully he grasped the far-reaching consequences of his idea, how clearly he
saw the ever-growing hosts of lives saved as a result of his vision and
inspiration, we shall never know. We do know that the vision never left
him, and that under its sway he worked, through the Medical Journal
which he edited and through the North Carolina State Medical Society
until his influence reached the people of the State in their General Assembly
of 1877, with the effect that on February 12, 1877, the North Carolina State
Board of Health was born. Ours was the twelfth state board of health to
be established.

Without treating the development of the newly-established board with
that thoroughness that could be termed history, we think it enough to set
down here in chronological order the principal events in the life and growth
of the North Carolina State Board of Health.

1877. Board created by the General Assembly. Consisted in the beginning

of entire State Medical Society. Society acted through a committee.
Annual appropriation, $100.

1878. First educational pamphlet issued. Subject, "Timely Aid for the

Drowned and Suffocated." Annual appropriation, $100.

1879. The General Assembly reconstituted the Board of Health. Made it to
l£>. consist of nine members: six appointed by the Governor, three

elected by the State Medical Society. Term of office, five years. Dr.
Thomas F. Wood elected first Secretary of the Board, May 21. Dr
S. S. Satchwell was first President of the Board. Other legislative
provisions: (1) Chemical examination of water, and (2f^organiza
tion of county boards of health, composed of all regular practicing
physicians and, in addition, the mayor of the county town, the cha:r-
man of the board of county commissioners, and the county surveyor.
Four educational pamphlets issued. Subjects: "Disinfection, Drain
age, Drinking Water, and Disinfectants"; "Sanitary Engineering":
"Methods of Performing Post-mortem Examinations"; "Limitation
and Prevention of Diphtheria." Annual appropriation, $200.

1880. Much of the activity this year was devoted to efforts to control diph-

theria. Prompt reporting of cases was urged. Water supplies and
sewage disposal provoked much discussion. A survey of schoolhouses
was carried out through the County Superintendents of Health. Most
of the public schoolhouses were of one-teacher size, of frame and log
construction, and none of them in rural districts had any type of privy

1881. General Assembly passed a law requiring regulation of vital statistic

at annual tax listing; law ineflective. Annual appropriation, $200.

10 Thirty-Fourth Biennial Report

1882. Dr. Thomas F. Wood, State Health Officer, was President of the North

Carolina Medical Society and the annual meeting was held in Con-
cord. At this meeting the State Board of Health appointed a com-
mittee for each county of one physician to "canvass (the people) in
the interest of prospective legislation" on public health matters. The
subject of the annual essay presented by Dr. W. P. Beall of Greens-
boro was "Preventive Medicine." The chief items of public health
interest this year were the emphasis placed on the effectiveness of
smallpox vaccination and the increasing realization of polluted water
as a source of typhoid fever.

1883. Dr. J. W. Jones of Wake Forest was elected to membership on the State

Board of Health by the State Medical Society at its annual meeting
at Tarboro. Dr. Jones became at once an active "friend and promoter
of sanitary work." Due to his efforts, a meeting of all county super-
intendents of health was called in Raleigh early in the next session
of the Legislature. One of the chief purposes of the proposed
meeting was to urge the enactment of vital statistics legislation,
and to procure a small appropriation for printing.

Several epidemics of smallpox with numerous deaths were reported
— one of the most severe was in Clay and Graham counties.

1884. Dr. Wood, Secretary and Treasurer of the State Board of Health, made

a pessimistic report this year. He said that "during the year little
more had been done than to issue pamphlets on the subject of city
sanitation." Dr. Wood pointed out that it was impossible to inau-
gurate public health work, to say nothing of carrying it on without
some money, at least.

The State Medical Society adopted a resolution at its conjoint ses-
sion held in Raleigh requiring the President of the Medical Society
to appoint a committee "to go before the Legislature and request an
adequate appropriation to be used by the Board in behalf of the
high and humane objects of the Board."

1885. General Assembly made county boards of health more efficient; allowed

printing privileges not to exceed $250 annually. Annual appropria-
tion, $2,000.

1886. The Health Bulletin made its appearance in April. Pamphlet on "Care

of Eyes and Ears" by Dr. Richard H. Lewis, printed and distributed.

1887. Fear of yellow fever which had made its appearance late in the year

through the port of Key West, Florida, where a patient with the
disease had been smuggled in, was one of chief concern to the Board.
Much interest and discussion in the Board membership throughout
the state this year centered about the necessity for providing some
safe method of drinking water and sewage disposal.

1888. Yellow fever epidemic in Florida and refugees to Western North Caro-

lina demonstrated value of a Board of Health to cope with situation.
Annual appropriation, $2,000.

1889. The chief item of interest and importance to the cause of public health

was a state-wide "sanitary convention" held in Raleigh February 6.

North Carolina Board of Health 11

It was largely attended by physicians and others from many cities
and towns who were much concerned about the problems of pure
water supply and sewage disposal. The Board published an exhaust-
ive paper by Dr. H. T. Bahnson of Salem, President of the Board,
entitled: "The Public Water Supply of Towns and Cities in North
Carolina."

Providing refuge for hundreds of people who had fled from their
homes farther south on account of yellow fever was a grave problem.

1890. A widespread epidemic of influenza or as it was commonly called at

the time "grip" or "La Grippe," spread over the state in January.
The epidemic appeared first in Russia about November 1, 1889. By
December 15, 1889, 200„000 cases were reported in New York alone.
It struck North Carolina during the first week in January and in two
weeks time it was reported to be raging in 68 counties.

1891. Influenza continued to be present in all sections of the state through-

out the year. The conjoint session met in Asheville on May 27. The
term of Dr. W. D. Hilliard of Asheville as a member of the Board
expired this year. Dr. S. Westray Battle also of Asheville was elected
to succeed Dr. Hilliard. Dr. Thomas F. Wood was re-elected Secre-
tary and Treasurer for a term of six years.

1892. Dr. Thomas F. Wood, the Secretary of the Board, died August 22. Dr.

Richard H. Lewis elected Secretary to succeed Dr. Thomas F. Wood,
September 7. Annual appropriation, $2,000.

1893. Legislative provisions, (1) Laws improving the reporting of contagious

diseases, (2) the protection of school children from epidemics, (3)
protecting the purity of public water supplies, and (4) regulation
of common carriers. Legislature provided that the Governor appoint
five of the nine members of the Board of Health, that the State Med-
ical Society elect four, and that the term of office of the members of
the State Board of Health be six years. The $250 printing limit was
removed. Pamphlet on quarantine and disinfection was prepared
and reprinted by many of the state papers. Annual appropriation,
$2,000.

1894. A number of public health conferences were arranged and held in

different towns of the state. Bulletin was increased from a mailing
list of 800 to 1,200. Annual appropriation, $2,000.

1895. Dr. Albert Anderson and Dr. W. T. Pate were elected bacteriologists for

the Board. Annual appropriation, $2,000.

1896. Board passed a resolution requiring chemical and bacteriological exam-

inations of municipal water supplies. Dr. Venable, of Chapel Hill,
undertook the chemical examination, and Drs. Anderson and Pate
the bacteriological examination. Board also directed Mr. John C.
Chase, the engineer member, to inspect all municipal water plants
in the state. Annual appropriation, $2,000.

1897. General Assembly enacted law requiring county superintendents of

health to be elected by county commissioners and reduced term of
office to one year. Annual appropriation, $2,000.

12 Thirty-Fourth Biennial Report

1898. The address of the President of the North Carolina Medical Society

this year by Dr. Francis Duffy of New Bern was devoted almost
exclusively to the promotion of public health. It really marked an
epoch as sounding an advanced note in the advancement of human
progress.

The State Health Officer, Dr. R. H. Lewis, devoted a great deal
of time and energy to try to arouse the people of the state to the
necessity for vaccination against smallpox.

1899. General Assembly improved the laws protecting public water supplies.

Smallpox prevailed extensively in the state. Dr. Henry F. Long, and
later, on Dr. Long's resignation, Dr. Joshua Tayloe, were employed
to travel over the state, consulting with and advising the local sani-
tary authorities as to proper means for protecting the public. Annual
appropriation, $2,000.

1900. State Board of Agriculture, on request of State Board of Health, agreed

to examine samples of water from public water supplies until Board
of Health could provide its own examiner. Annual appropriation,

$2,000.

1901. State Board of Embalmers, with representatives of State Board of

Health, established. County health work placed in the hands of
county sanitary committees composed of county commissioners and
two physicians which commissioners elected to serve with them.
Term of office of county superintendent of health made two years.
Annual appropriation, $2,000.

1902. This year will be long remembered for the widespread prevalence of

smallpox in virulent form. It caused many deaths in different sec-
tions in the early months of the year. In one county at least fifty
people died, including many well-to-do persons. Not having any
system of vital statistics reports, it is impossible to even estimate
the number of cases, except from physicians' voluntary reports and
death notices in the newspapers.

1903. General Assembly enacted law permitting Board of Health to charge

$5 for each analysis of a public water supply, this fee to be used in
paying Department of Agriculture for services of examiner. Dr. C.
W. Stiles, U.S. P.H.S., before the State Medical Society at Hot Springs,
called attention to prevalence of hookworm disease in the South.
Dr. J. L. Nicholson and Dr. W. S. Rankin, working under State Board
of Health during fall of 1903 and spring of 1904, showed prevalence
of this disease in North Carolina. Annual appropriation, $2,000.

1904. A stenographer was employed. One hundred and twenty thousand

pamphlets on tuberculosis were printed and distributed. There was
a renewal and an extension of cooperative work between the Board
of Health and the state press, a number of articles dealing with
hygienic and sanitary subjects being furnished the papers and pub-
lished in them. Annual apppropriaton, $2,000.

1905. General Assembly established State Laboratory of Hygiene; imposed

water tax of $64 on al lpublic water companies; voted $600 annually

North Carolina Board of Health 13

for the support of laboratory. Small appropriation made it necessary
for the Department of Agriculture to continue to assist State Board
of Health. Annual appropriation, $2,000.

1906. The North Carolina Association for the Study and Prevention of Tuber-

culosis was organized. Annual appropriation, $2,000.

1907. Two thousand dollars appropriated for the State Laboratory of Hygiene.

Pasteur treatment provided. State Sanatorium for the treatment of
tuberculosis founded; $15,000 appropriated for permanent improve-
ments and $5,000 for maintenance. A law requiring the separation
of tuberculosis prisoners from other prisoners was enacted. Annual
appropriation, $4,000.

" 1909. General Assembly provided for (1) whole-time State Health Officer;
(2) collection of vital statistics of towns having a population of 1,000
or over; (3) that all public water companies file plans and specifica-
tions of their plants with the State Board of Health, and that the
State Board of Health pass necessary rules and regulations for the
care of public watersheds and plants and furnish such rules and
regulations and other advice to those having charge of public water
supplies; (4) that counties provide free diphtheria antitoxin for
county indigents, and (5) that the maintenance appropriation for
the Sanatorium be increased from $5,000 to $7,500, and an additional
$30,000 be granted for permanent improvements. Dr. Richard H.
Lewis resigned as Secretary of the Board, and Dr. W. S. Rankin was
elected as his successor, beginning his official work July 1. Annual
appropriation, $10,500.

1910. General effort to interest the people and state organizations in public

health work. Bulletin increased from 3,500 edition to 10,500 edition.
Addresses on public health work delivered to Conference of County
Superintendents of Schools, State Federation of Women's Clubs, State
Press Association, and Sanitary Sunday observed in April. Dr. John
A. Ferrell elected, February, Assistant Secretary for Hookworm
Eradication; began work under State Board of Health and Rockefeller
Sanitary Commission.

1911. Legislature established county boards of health to take the place of

the county sanitary committees; county board of health composed
of chairman board of county commissioners; county superintendent
of schools, mayor of county town, and two physicians, selected by
the three county officials to serve with them. Legislature also abol-
ished quarantine for smallpox and improved the quarantine laws.
One thousand dollars annually appropriated to contract with antitoxin
manufacturers for state supply of high-grade diphtheria antitoxin,
with result that price of antitoxin was cut to one-fourth former price,
saving the citizens of the state over $30,000 annually. Bulletin in-
creased from 11,500 copies to 20.000 copies each edition; closer coop-
■ eration with press of state developed; regular weekly press articles
prepared and sent to papers; increase in numbers of popular pam-
phlets for distribution. Hookworm this year largely educational
through the school forces and investigated through county dispen-

14 Thirty-Fourth Biennial Report

saries; thousands of children found infected and treated. Strong
sentiment began to make itself felt for better health work by counties,
four counties employing whole-time county health officers. Guilford
County — one of the four — began its work June 1 and was the first
county in the United States to inaugurate full-time county health
work. Maintenance appropriation for State Sanatorium increased
to $12,500, with $20,000 voted for permanent improvements. Annual
appropriation, $22,500.

1912. Bulletin increased to 40,000 edition; number of popular pamphlets

dealing with different diseases increased; press work improved;
educational work of Board along all lines amplified. Secretary of
Board of Health called attention of conjoint meeting of State Medical
Society and State Board of Health to the relative importance of
health problems and the bearing of this subject upon the proper
apportionment of health funds; instrumental in passing a resolution
to the effect that pellagra was an interstate problem, not a state
problem, and requesting the Federal Government to deal with pel-
lagra as a Federal problem; resolution responsible, to a considerable
extent, for successful effort on part of Hon. John M. Faison's secur-
ing Congressional appropriation of $45,000 for the study of pellagra
by the Federal Government. Hookworm work extended and county
funds appropriated to supplement state and Rockefeller Foundation
for this work. Annual appropriation, $22,500.

1913. General Assembly passed Model Vital Statistics Law with $10,000 ap-

propriation for its enforcement. County superintendent of health
changed to either county physician or county health officer, depend-
ing on whether part-time or full-time service. Educational efforts of
Board continued and enlarged. Hookworm work along same line as
year before increased in amount. Dr. John A. Ferrell resigned as
Assistant Secretary to accept position with the central office of the
Rockefeller Sanitary Commission in Washington, D. C. Dr. C. L.
Pridgen succeeded Dr. Ferrell. The movement for improved county
health work had by this time resulted in ten counties electing whole-
time county health officers. The State Sanatorium for Treatment
of Tuberculosis turned over by Extra Session of 1913 to Management
of State Board of Health. Annual appropriation, $40,500.

1914. Preceding work of the Board continued. Board of Health took over

management of Sanatorium; started out under many difficulties on
account of the institution owing many debts and the appropriation
being limited. Hookworm work changed to community work directed
to the installation of sanitary privies in all homes. Laboratory be-
gan to produce and distribute free anti-typhoid vaccine. Dr. C. L.
Pridgen resigned as Director Hookworm Eradication, and Dr. W. P.
Jacocks succeeded him. Annual appropriation, $40,500.

1915. General Assembly makes state vital statistics law conform to national

model by requiring burial permits in rural communities; enacts
legislation permitting county commissioners and towns and cities
to appropriate money for support of tuberculosis citizens in State
Sanatorium; provides $15,000 for purchase and building of anti-

North Carolina Board of Health 15

toxin plant; appropriates $60,000 for payment of Sanatorium debts
and new buildings and other improvements, and $25,000 annually
for maintenance and $10,000 for extension anti-tuberculosis work.
Educational work greatly extended: Bulletin now 47,000; traveling
public health exhibit shown at fairs and other assemblages; press
work greatly developed through employment of Miss Kate Herring,
a journalist, for her whole time; stock lectures with lantern slides
supplied public speakers in different parts of the state; community
soil pollution work under Dr. W. P. Jacocks stops in April, and
Bureau of Rural Sanitation, with Dr. G. M. Cooper at its head, suc-
ceeds, beginning work May 1. Considerable amount of work done
for improvement of prison conditions. The unit system of county
health work gets a good start; over 52,000 people given three com-
plete vaccinations against typhoid fever, and medical inspection of
schools put on in six counties. Annual appropriation, $50,500.

1916. North Carolina was admitted to the Registration Area for deaths. To

the educational agencies of the Board was added a self-supporting
moving picture health show. Many saw this show during the year
and, seeing, believed in health work as never before. Bulletin reached
51,000 edition. Cooperation with University in developing a plant
and putting on a home post-graduate course in medicine, giving
first course to 169 doctors. Put into operation an optional system of
hotel inspection, with grading and publishing scores. Continued
Bureau of Rural Sanitation, giving three anti-typhoid injections to
48,000, making 100,000 immunized in summers of 1915 and 1916. Did
complete medical inspection of six counties and with inspection a
large amount of educational work as to sanitary and hygienic living.
Secured effort by Federal Children's Bureau to develop unit of child
hygiene work, the Bureau using two employees to work in Cumber-
land and Swain counties for about eight months. Laboratory of
Hygiene buys land and erects its own building. Annual appropria-
tion, $55,500.

1917. The General Assembly rassed the following important health legisla-

tion: Chapter 263, entitled "An act to prevent and control the occur-
rence of certain infectious diseases in North Carolina"; Chapter 244,
entitled "An act to provide for the physical examination of the school
children of the state at regular intervals"; Chapter 276, entitled "An
act for the cooperative and effective development of rural sanita-
tion"; Chapter 257, entitled "An act to prevent blindness in infancy,
designating certain powers and duties and otherwise providing for
the enforcement of this act"; Chapter 66, entitled "An act to pro-
vide for the sanitary inspection and conduct of hotels and restau-
rants"; Chapter 286, entitled "An act to regulate the treatment,
handling and work of prisoners." Following the enactment of this
legislation, administrative machinery, consisting of a Bureau of
Epidemiology under the direction of Dr. A. McR. Crouch, a Bureau for
the Medical Inspection of Schools under the direction of Dr. Geo.
M. Cooper, and a Bureau for County Health work, under the direction
of Dr. B. E. Washburn was established. Dr. Washburn, an officer of
the International Health Board, was loaned to the state without

16 Thirty-Fourth Biexmal Report

cost, and the International Health Board, in addition to furnishing
Dr. Washburn, appropriated $15,000 annually for County Health
Work in accordance with the provisions of Chapter 276.

The United States Public Health Service in February, 1917, de
tailed Dr. K. E. Miller to study county health work in different
sections of the country and to establish for demonstration purposes,
in Edgecombe County, a department of health on an economic basis
easily within the financial reach of the average county.

The State Laboratory of Hygiene moved into its own building
January 15, 1917.

The state was admitted to the registration area of Union for births
in January, 1917, the Bureau of the Census having found after in-
vestigation that our birth registration was 96 per cent complete.

The special campaign against typhoid fever began so satisfac-
torily in 1915 was continued. Free vaccination of the people, how-
ever was interfered with by the difficulty in securing medical
officers to do the work, the preparedness program of the Govern-
ment having caused many physicians and nurses to enter the army
and navy; nevertheless, a total of 30,000 citizens of the state were
vaccinated as a direct result of the Board's activities, and many
thousands of others were vaccinated by the physicians of the state
as a result of the educational work of the Board directed to im-
pressing the people with the value of vaccination as a means of
prevention for typhoid fever.

In December, 1917, life extension work, which consisted briefly
of the free physical examination of interested citizens for the pur-
pose of advising them as to their physical condition and needed
hygiene reform and medical treatment, was begun on a county
basis. The funds necessary for this work were appropriated partly
by the state and partly by the counties in which the life extension
work was carried out. Dr. Amzi J. Ellington, of Raleigh, who at
the time was a resident physician in the New York City Hospital,
was employed and placed in charge of the work. Life extension
work was carried out in Vance, Alamance, Lenoir, and Robeson
counties, and resulted in the full physical examination of 4,000 citi-
zens. This work was very favorably received, and the outlook for
its continued development seemed excellent when, with the declara-
tion of war and the call for physicians to enter the military service
of the country, Dr. Ellington enlisted in the Medical Corps of the
Army. For this reason, and for the further reason that it has been
almost impossible to secure health officers during the past two years,
the work was not resumed.

The educational work of the State Board of Health consisted in
the issuance of eight issues of the Monthly Health Bulletin, each
monthly edition amounting to 45,000, and a daily newspaper health
article. The Bureau continued its moving picture show exhibit.
Arrangements were made for the preparation of newspaper plate,
which was sent to and extensively used by 202 papers having a total
circulation of 303,000.

North Carolina Board of Health 17

The annual appropriation for the State Board of Health was $60,-
772.16. The annual appropriation for the State Laborary of Hygiene
was $12,500, and this, in addition to $9,087.22 in fees permitted under
the laws of the state to be paid to the Laboratory for special work,
provided the Laboratory with a total annual budget of $21,587.22.

1918. Much of the work this year was influenced by the war and has to do
with preparedness. The State Health Officer visited Washington, at
the request of the Council of National Defense and as chairman of
a committee of State Health Officers, on a number of occasions for
conferences with respect to preparedness measures, provisions for
the control of venereal diseases, arrangements for coordinating the
control of infectious diseases in the civilian population with their
control in cantonments, and to arrange, if possible, with the Public
Health Service and the Surgeon-General of the Army for preserving
the personnel of state health departments during the war.

Considerable time was given to assisting Major John W. Long,
Medical aide to the Governor, in the work of organizing the
Medical Advisory Boards and in interesting physicians in enter-
ing the medical service of the Army and Navy, and later in the year,
in inducing the physicians of the state to become members of the
Volunteer Medical Service Corps.

Partly as a result of these activities, the Surgeon-General of the
Army assigned Major Joseph J. Kinyoun to assist the State Board
of Health in the control of communicable diseases, the Board being
under no financial obligation for Major Kinyoun's assistance; and
as a result of the successful termination of the activities of various
interests looking to more effective control of venereal diseases, the
Kahn-Chamberlain bill passed Congress, and made available to the
State of North Carolina, and without condition. $23,988.61 for vene-
real disease work.

The Laboratory during this year began the distribution of a high
grade of diphtheria antitoxin.

The Bureau of Medical Inspection of Schools, under the direction
of Dr. G. M. Cooper, developed, and with a degree of success that we
may say established, free dental clinics for the public schools of the
state. The Bureau also developed to a successful extent an arrange-
ment in the form of adenoid and tonsil clubs for the practical and
economic treatment of public school children suffering from these
defects.

The Bureau of Epidemiology employed two third-year medical
students, equipped them with motorcycles, and put them into the
field to investigate infringements of the quarantine law. Sufficient
convictions were obtained to impress the people with the determi-
nation of the state to enforce its health laws, and a fairly satisfactory
compliance with the laws regarding the reporting of communiicable
diseases was brought about.

The Bureau of Venereal Diseases, paid for by the Federal ap-
propriation, was established in September under the directorship
of Dr. James A. Keiger.

18 Thirty-Fourth Biennial Report

Mr. Warren H. Booker, for the last seven years the efficient director
of the Bureau of Engineering and Education, left in September for
Red Cross work in France, the work of his bureau being continued,
with the exception of the engineering work, by Mr. Ronald B. Wil-
son, who had been employed earlier in the year to succeed Miss
Herring in assisting Mr. Booker with the journalistic work, Miss
Herring having been engaged by the War Department for educational
work.

Perhaps the most outstanding feature of the health work during
the year 1918 was the epidemic of influenza. The epidemic began
early in October and caused in October alone 6,056 deaths; in No-
vember 2,133 deaths, and in December 1,497 deaths, a total during the
last three months of 9,G86 deaths.

The annual appropriation for the State Board of Health for 1918
was $73,210.38.

The annual appropriation for the State Laboratory of Hygiene was
$12,500. The Laboratory, during this year, collected $8,532.48 in fees
for special work, so that the total income of the Laboratory for this
year was $21,032.48.

1919. The General Assembly passed the following important health legisla-
tion: Chapter 71, entitled "An act to prevent the spread of disease
from insanitary privies"; Chapter 192 entitled "An act to provide for
the physical examination and treatment of the school children of the
state at regular intervals"; Chapter 206 entitled "An act for the pre-
vention of venereal diseases"; Chapter 213, entitled "An act to require
the provision of adequate sanitary equipment for public schools";
Chapter 214, entitled "An act to obtain reports of persons infected
with venereal diseases"; Chapter 215, entitled "An act to amend
Chapter 671, Public-Local Laws of 1913, relating to the injunction
and abatement of certain nuisances."

The Bureau of Engineering and Inspection was organized in April.
The engineering work of the Board had been suspended with the
resignation of Mr. Warren H. Booker in September, 1918, Mr. Booker
having gone to France to engage in tuberculosis work under the
direction of the Red Cross. Between September, 1918, and April,
1919, the engineering problems coming before the Board had been
referred and very kindly and effectively taken care of by Col. J. L.
Ludlow of Winston-Salem, the engineer member of the Board. Mr.
H. E. Miller, an engineer and a graduate of the University of Michi-
gan, was placed in charge of the new bureau, and his brother, Dr.
K. E. Miller, of the United States Public Health Service, was detailed
by the Service to assist him in the organization of his work. Mr.
H. E. Miller and Dr. K. E. Miller spent the spring and summer and
a part of the fall in studying various types of privies, in preparing
plans for the construction and maintenance of privies, and in pre-
paring the necessary notices and literature to inform the people of
the objects and requirements of the new privy law.

On May 1 Dr. J. A. Warren, health officer of Rowan County, was
appointed to and accepted the position of Assistant Secretary of the
Board.

North Carolina Board of Health 19

About the first of the year, Miss Herring returned to the educa-
tional work of the Board. After a few months she returned to the
Federal Service, and Mr. R .B. Wilson, who had left the Board work
upon Miss Herring's return, was again offered a place with the Board.
Mr. Wilson accepted and assumed his duties on July 1.

On August 1 Dr. A. McR. Crouch, Director of the Bureau of Epi-
demiology, resigned to accept a position with the city of Wilmington.
Dr. F. M. Register, whole-time health officer of Northampton County,
succeeded Dr. Crouch as director of the bureau.

Dr. E. J. Wood resigned this year, effective at the end of his term,
and Governor Bickett appointed Dr. E. J. Tucker of Roxboro for a
six years term — first dentist to serve on the Board.

In September Dr. J. R. Gordon, Director of the Bureau of Vital
Statistics since 1914, resigned on account of impaired health, and
on October 1 the Bureau of Epidemiology and the Bureau of Vital
Statistics were combined and placed under the direction of Dr.
Register.

In September Mrs. Kate Brew Vaughn, Director of the Bureau
of Infant Hygiene, resigned. The bureau was reorganized under
an understanding with the American Red Cross and was enlarged
to include, in addition to infant hygiene, the problem of public health
nursing, the name of the bureau being changed to that of "Bureau
of Public Health Nursing and Infant Hygiene." Under the agree-
ment with the Red Cross, this bureau was to have an available ap-
propriation of $12,000 a year, half of which was to be furnished by
the American Red Cross and half by the State Board of Health. The
personnel of the bureau and its plan of work, under the agreement,
was made contingent upon the approval of both participating agencies,
the American Red Cross and the State Board of Health. In December
Miss Rose M. Ehrenfeld took charge of the new bureau and began its
organization and work.

On October 1 Dr. Jas. A. Keiger. Director of the Bureau of Venereal
Diseases, resigned and Dr. Millard Knowlton was appointed to suc-
ceed him.

The typhoid campaign carried on during the summer through pre-
vious years was continued in the summer of 1919, using third-year
medical students, furnished either with automobiles or motorcycles
for getting about. Campaigns were carried out in the following
counties: Bertie, Carbarrus, Chatham, Chowan, Columbus, Craven,
Hertford, Iredell, Johnston, Lincoln, Onslow, Pasquotank, Perquimans,
Randolph, Richmond, Rockingham, Stanly, Union, Warren, Wayne.
A total of 49,076 were given complete vaccination.

The educational work of the Board consisted of the publication
of a 48,000 monthly edition of the Bulletin, and the distribution of
about 350,000 pieces of public health literature.

The funds available during this fiscal year amounted to $198,549.14.
of which $102,301.98 was from state appropriations and the remainder
from outside sources.

20 Thirty-Fourth Biennial Report

The appropriation for the State laboratory of Hygiene for this
year was $28,500; in addition to this, the Laboratory collected in fees
for special work, for antitoxin, and in water taxes a total of $14,344.02,
making a total of $42,S44.02 available for work of the Laboratory.

1920. During this year there was a Special Session of the General Assembly,
lasting twenty days and held in the latter part of August. This
Special Session passed an act amending the vital statistics law,
making the fees for local registrars 50 cents instead of 25 cents for
each certificate properly filed with the State Board of Health.

On January 1 Dr. B. E. Washburn, who had had general direction
of the cooperative county health work and who had rendered most
acceptable service, was recalled by the International Health Board
and detailed to take charge of their interests in Jamaica. Dr. K. E.
Miller, of the United States Public Health Service, who had been
detailed in January, 1917, to organize a model county health de-
partment in Edgecombe County and then, in 1919, to assist his
brother, Mr. H. E. Miller, in organizing the work of the new Bureau
of Engineering and Inspection, to which was assigned the duty of
enforcing the state-wide privy act, succeeded Dr. Washburn as director
of the Bureau of County Health Work.

In January a cooperative effort with the United States Public
Health Service and the International Health Board to demonstrate
the possibilities and advantages of the eradication of malaria from
certain towns and cities in the eastern part of the state was begun.
The terms of cooperation were that the International Health Board
and the State Board of Health were to pay one-half of the expenses
of the local work and the town or city in which the work was done
the other half, the Public Health Service furnishing as its part, expert
supervising personnel. The towns and cities chosen for this work
were Goldsobro, Farmville, and Greenville, the budget for each muni-
cipality being respectively: Goldsboro, $13,670.98; Farmville, $5,000,
and Greenville, $9,000, a total investment in this work of $27,670.98.
Mr. W. A. Fuchs, Associate Sanitary Engineer, was detailed by the
Service to have supervision of the work.

In February Dr. A. J. Warren, Assistant Secretary of the State
Board of Health, resigned his position in order to accept the ap-
pointment of city health officer of Charlotte, N. C.

In the winter and spring of 1920 the North Carolina Landowners
Association, under the progressive leadership of Mr. W. A. McGirt,
of Wilmington, undertook a very extensive educational campaign
against malaria, which was carried on through the public schools
of thirty-eight counties in eastern North Carolina. A series of county
and state prizes for the best essay on malaria by public school
children were offered as an inducement to the school children to
interest and inform themselves and, indirectly, their parents with
regard to the importance of this disease. To make possible this work
by the school children, 75,000 malaria catechisms, prepared by Dr.
H. R. Carter, of the United States Public Health Service, were dis-
tributed through the public schools of the eastern part of the state
to the school children. Thousands of essays were written, and it is

North Carolina Board of Health 21

reasonable to believe that the campaign was one of the most suc-
cessful public health educational attempts yet undertaken.

In June it was found advisable to separate the Bureau of Epidemi-
ology and the Bureau of Vital Statistics which had, on account of the
scarcity of health officers, been placed under the directorship of a
single bureau chief, Dr. F. M. Register. Dr. Register was appointed
Director of the Bureau of Vital Statistics and Dr. J. S. Mitchener was
appointed Director of the Bureau of Epidemiology.

In April the Interdepartmental Social Hygiene Board assigned to
the State Board of Health several workers for making a study of vice
conditions in North Carolina towns and cities and for taking such
steps as were found expedient for decreasing prostitution. This
group of workers was withdrawn in September on account of differ-
ences developing between them and Dr. Knowlton, chief of the Bureau
of Venereal Diseases, with the understanding that another group of
workers would be assigned to this work at a later date.

In June arrangements were made with the United States Public
Health Service and the American Social Hygiene Association for the
development of an elaborate educational unit on sex hygiene and
venereal diseases designed to reach rural meetings through the use
of picture films and a portable truck. An outfit consisting of several
lecturers and a moving picture truck began work in Cumberland
County in August, and from its very beginning met a most cordial
reception and gave every promise of developing into one of the most
useful agencies for dealing with the venereal disease problem.

During the year anti-typhoid vaccination campaign was continued
in Alamance, Bladen, Columbus, Duplin, Franklin, Gaston, Harnett,
and Mecklenburg counties. Cooperative campaigns, in which the
counties furnished the working personnel, were also carried on in
Anson, Johnston and Rutherford counties. A total of 29,435 citizens
have been vaccinated against the disease, and this does not include
Columbus County, in which the work was just beginning when this
report was completed.

The educational work of the State Board of Health during this
year consisted of a 48,000 monthly edition of the State Board of
Health Bulletin and the distribution of approximately 350,000 pieces
of public health literature.

The funds available during this fiscal year amounted to $342,284.33,
of which $176,152.61 was state appropriation and the remainder from
outside sources.

The appropriation tor the State Laboratory of Hygiene for this
year was $25,000; in addition to this, the Laboratory collected in fees
for special work, for antitoxin and in water taxes, a total of $13,-
698.89, making a total of $38,698.89 available for the work of the
Laboratory. The above amount being insufficient, the Special Ses-
sion of the Legislature authorized a loan of $15,000 to enable the work
of the Laboratory to be carried on, making a total of $53,698.89 avail-
able for the work of the Laboratory during this year.

22 Thirty-Fourth Biennial Report

1921. The Legislature meeting early in January of this year was asked by

the Board to amend the state law restricting the salary of the execu-
tive officer of the Board to $3,000 annually, so as to make the salary
$5,000. Such an amendment was passed. A further request from the
Board was that legislation be enacted removing the inspection tax
of forty cents from privies coming under the supervision of the Board
of Health. Such an amendment to the State-wide Privy Law was also
enacted. A bill was introduced in this session of the General As-
sembly under the initiative of Hon. Emmet H. Bellamy requiring a
physical examination of all applicants for marriage and making
issuance of license contingent upon the physical qualifications of the
applicant. The State Board of Health approved and supported Mr.
Bellamy's bill, realizing, as did the author of the bill, that the pro-
posed legislation was but a step in the right direction and was,
therefore, rather loosely drawn and left many things to be desired.
The bill finally passed in amended form as Chapter 129, Public Laws
of 1921.

The Governor appointed Mr. Charles E. Waddell, an engineer of
Asheville, to succeed Col. J. L. Ludlow as the engineer member of the
Board.

Perhaps the most important change inaugurated in state health
administration during this year was the adoption of a cost basis for
standardizing and measuring the efficiency of public health work in
those counties in which the state participated financially. This new
principle is fully described in the State Board of Health Bulletin for
January, 1922, and a further discussion of cost basis for public health
work is unnecessary here except, perhaps, to say that it is appar-
ently at least one of the first attempts to introduce the cost system
of industry into government.

The Bureau of Venereal Disease, in charge of Dr. Millard Knowlton,
established as a part of the war-time activities of the Board in co-
operation with the Bureau of Venereal Diseases of the Federal Gov-
ernment, was combined with and made a part of the work of the
Bureau of Epidemiology, under the general direction of Dr. J. S.
Mitchener.

Funds available for the year included state appropriations, $275,000;
miscellaneous receipts, $164,184.42; total, $439,184.42.

1922. In order to bring the records of this department into harmony with

those of other state departments, in accordance with the Act of the
General Assembly of 1921, changing the fiscal year of the state so as
to begin on July 1 of each year, this report ends with June 30, 1922.
It, therefore, covers a period of nineteen months, one full fiscal year
from December 1, 1920, to November 30, 1921; seven months from De-
cember 1, 1921, to June 30, 1922. Effective February 1, the American
Red Cross Society abrogated the agreement existing since 1919 by
which it jointly financed, with the Board of Health, the Bureau of
Public Health Nursing and Infant Hygiene. This bureau was reor-
ganized April 1 as the Bureau of Maternity and Infancy, for its
maintenance the state receiving $27,259.66 annually from the United
States Government in accordance with the Sheppard-Towner Act for

North Carolina Board of Health 23

the promotion of the welfare of mothers and infants, Dr. K. P. B.
Bonner of Morehead City, was secured as the director of the reorgan-
ized bureau, with Miss Rose M. Ehrenfeld as supervisor of nursing
and Mrs. T. W. Bickett in charge of educational work.

The funds available during this period, and their distribution were
seven-twelfths of the amounts set out under the tabulation for 1921.

The appropriation for the State Laboratory of Hygiene for the
nineteen months between December 1. 1920, and June 30, 1922, was
$87,083.33; in addition to this, the Laboratory collected in fees for
special work, for antitoxin and in water taxes, a total of $30,872.51,
making a total of $117,955.84 available for the work of the Labora-
tory.

1923. The General Assembly of 1923 enacted some important and far-reaching
legislation affecting public health work in North Carolina. The most
important legislation enacted this year was the act providing for an
independent board of directors for the State Sanatorium for Tuber-
culosis, removing the direction of that institution from the authority
of the State Board of Health. Facilities were also provided at the
State Sanatorium for the confinement, care, and treatment of tuber-
culosis convicts. Other legislation included the act to provide for
the sanitary manufacture of bedding, the latter act to be enforced by
the State Board of Health. The Bureau of Epidemiology was again
combined with the Bureau of Vital Statistics.

On March 1 Dr. G. M. Cooper was made Assistant Secretary of the
State Board of Health, and Dr. J. S. Mitchener was assigned to the
Bureau of Medical Inspection of Schools, after the consolidation of
the Epidemiology work, which he had directed with the Bureau of
Vital Statistics. Dr. K. E. Miller, of the United States Public Health
Service, was recalled for duty elsewhere.

In order to experiment with the plan of District Health Work,
an effort was made to place responsibility for all State Board of
Health activities under the direction of district directors attached to
the staff of the State Board of Health. This effort was continued
throughout the year, but proved to be ineffective and unsatisfactory.

During the year Dr. F. R. Harris resigned from membership on
the State Board of Health to become health officer of Vance County.
The Board elected Dr. D. A. Stanton, of High Point, to fill the un-
expired term of Dr. Harris.

In order to further carry on the important work of malaria con-
trol in a number of the counties of the coastal plain area of the
state, which was work so effectively commenced in an educational
capacity in 1920, the International Health Board was requested to
participate in this work and to provide a director for that service.
The International Health Board agreed, accepted the invitation and
assigned Dr. H. A. Taylor, of Alabama, to head this division. Pamlico
County was selected as headquarters for Dr. Taylor. The cost of
this work was borne by the State Board of Health and Pamlico
County contributing 40 per cent each and the International Board
the remaining 20 per cent. The International Health Board, of
course, paid the salary of Dr. Taylor.

24 Thirty-Fourth Biennial Report

In June Dr. J. S. Mitchener resigned as director of the Bureau of
Medical Inspection of Schools and Dr. Roy C. Mitchell, who had been
doing some special educational field work for the Board, temporarily
succeeded Dr. Mitchener.

Early in 1923 Dr. W. S. Rankin, the State Health Officer, was
invited by the Committee of Municipal Health Department Practice
of the American Public Health Association to become field director
for the committee in making a study of municipal health practices
in the United States. This was for the purpose of working out a
basis or set of principles through which city health departments
could be given classification or grading, and also for the purpose of
assisting such departments in their organization work. The request
was brought before a special meeting of the executive committee of
the Board, and it directed the Secretary to take advantage of the
opportunity offered. The Board granted to the Secretary one year's
leave of absenee, but requested him at the same time to continue in
touch as executive officer of the Board with the work of the Board.

On November 1 Dr. Rankin assumed his duties and established
official headquarters in New York City for the work of the com-
mittee.

The general organization of the executive staff of the Board was
continued with the Assistant Secretary, Dr. G. M. Cooper, as official
head of the staff. Local health work in the eastern half of the state
was directed by Dr. H. A. Taylor, and that in the western part of
the state by Dr. E. F. Long, who had been assistant to Dr. K. E.
Miller as director of county health work. To assist Dr. Taylor in
the east, Dr. George Collins, formerly health officer of Mecklenburg
County, was employed, and to assist Dr. Long in the western half of
the state Dr. C. N. Sisk, formerly health officer of Forsyth County,
was employed.

During the year a plant for the more adequate sanitary control of
public milk supplies in the state was formulated. This work was
undertaken under the direction of the Bureau of Engineering and
Inspection, and Mr. Malcolm Lewis was employed to organize this
work. Several changes in personnel took place this year. Dr. M. L.
Isley, who had been employed in county health department work,
and Dr. Roy C. Mitchell resigned. Miss Rose Ehrenfeld also resigned.

1924. During this year Dr. Rankin continued his work with the American
Public Health Association until November 1. During this period the
work of the Board was directed by Dr. G. M. Cooper, serving as Act-
ing Secretary. On November 1 Dr. Rankin returned, and during
that month, under the direction of Dr. Maxey of the United States
Public Health Service, a school for health officers was conducted
under the auspices of the State Board of Health for one week in
Raleigh. This meeting was well attended, and every modern method
which might be utilized in the work of a modern public health de-
partment was discussed throughout the week.

Dr. M. L. Townsend was placed in charge of the Division of Health
Education. Dr. K. P .B. Bonner resigned as director of the Bureau
of Maternity and Infancy.

North Carolina Board of Health 25

1925. Dr. Rankin resigned, effective June 1, to accept the position of director

of the Hospital and Orphan Division of the Duke Foundation. At a
meeting of the Board of Health on May 30 Dr. G. M. Cooper was
unanimously made Acting Secretary for an indefinite period of time
to succeed Dr. Rankin. During the year Dr. E. F. Long resigned as
director of county health work and Dr. C. N. Sisk, who had been
assistant to Dr. Long, was placed in charge of county work, without
an assistant.

1926. One June 21 rD. Charles O'H. Laughinghouse, a member of the Board,

was elected permanent Secretary and State Health Officers to fill
the unexpired term of Dr. Rankin. Dr. Laughinghouse accepted and
took office October 1. Dr. G. M. Cooper, who had for sixteen months
administered the work of the Board as Acting State Health Officer,
continued with the service and was assigned to the Bureau of Health
Education succeeding Dr. M. L. Townsend, who resigned. On August
6 Dr. Richard H. Lewis died. Dr. Lewis had served as a member of
the Board singe 1885, and from 1892 to 1909 he served as Secretary
of the Board. Since 1909 he had been a member of the executive
committee. Dr. Lewis held his membership on the Board by ap-
pointment from the Governor. To fill the term of Dr. Lewis, expiring
in 1931, Governor McLean appointed Dr. John B. Wright, of Raleigh.
Among other reasons ior this appointment, the Governor stated that
it had been the rule since the Board of Health was established to
have at least one of the members of the Board a resident of Raleigh.

When Dr. Laughinghouse resigned, in order to accept the election
to the position of State Health Officer by his fellow members on the
Board, the remaining members of the Board elected Dr. W. S. Rankin,
of Charlotte, former Secretary of the Board to succeed Dr. Laughing-
house.

1927. There were no changes in personnel or in staff organizations during the

year 1927. The most important event occurring this year was the
death of Dr. J. Howell Way on September 22. Dr. Way had been a
member of the Board ior many years and had been President of the
Board for a long time. Governor McLean appointed Dr. C. C. Orr,
of Asheville, to succeed Dr. Way. At the first meeting of the State
Board of Health following the death of Dr. Way, Dr. A. J. Crowell,
of Charlotte, was inatie President of the Board. In April of this
year Dr. W. S. Rankin resigned as a member of the Board, and Dr.
L. E. McDaniel, of Jackson, was elected by the other members of the
Board to succeed Dr. Rankin.

1928. Dr. J. C. Johnson, who had been director of the Oral Hygiene Division.

resigned as director of the oral hygiene work of the Board, effective
December 31.

During this year a corps of nurses employed in the Maternity and
Infancy Division of the Board, one-half of whose expenses were paid
by the Federal Government from Sheppard-Towner funds, held mid-
wife classes in about thirty counties of the state. The nurses gave
special instruction to mid wives in groups, and the county authorities
enacted midwife rules and regulations for the control of their practice.

26 Thirty-Fourth Biexxial Report

The educational work of the Board was of a high order during this
year. A thirty-two page Bulletin was issued monthly, and a moving
picture machine with several films on modern health subjects was
exhibited in many sections of the state.

1929. With aid secured from the International Health Board, the Life Exten-

sion Division was added to the activities of the Board this year.
Dr. Frederick R. Taylor, of High Point, was made director of this
division. Dr. Taylor carried this work before the medical profession
in all sections of the state.

On January 1 Dr. Earnest A. Branch accepted the appointment as
director of the Division of Oral Hygiene to succeed Dr. J. C. Johnson,
resigned. Dr. Branch immediately set in motion reorganization
plans for the oral hygiene work to include more lectures and more
educational demonstration work. Dr. Branch made contacts with
several of the colleges of the state and training schools for teachers.

Expenditures for the Board work this year reached the highest
peak in the history of the Board, totaling about $486,000. There
were no significant changes, other than those mentioned above, in
personnel during the year.

1930. This year marked many significant changes in the affairs of the State

Board of Health. Early in the year Dr. C. N. Sisk, director of county
health work, resigned. Dr. D. A. Dees succeeded Dr. Sisk as director
of county health work. Soon after the resignation of Dr. Sisk, Dr.
F. M. Register, director of the Bureau of Vital Statistics, resigned,
and the work of that bureau was assigned to Dr. G. M. Cooper, in
connection with his work as director of health education. On
August 26, Dr. Chas. O'H. Laughinghouse, State Health Officer, died.
Soon after his death, in a meeting of the Board, Dr. H. A. Taylor
was made Acting State Health Officer. On September 24, following
the death of Dr. Laughinghouse, the Board elected Dr. W. P. Jacocks
State Health Officer to succeed Dr. Laughinghouse. On November
20 Dr. Cyrus Thompson, for many years a member of the Board, died.
On December 16 the Board met and unanimously elected Dr. James
M. Parrott, of Kinston, as a member to succeed Dr. Thompson.

1931. At the beginning of this year, Doctor Jacocks having declined to accept

the position of State Health Officer, to which he had been elected
by the Board on September 24, 1930, a bill was introduced in the
Legislature abolishing the State Board of Health as then constituted.
This bill was passed and became law during the session of 1931.
With the enactment of the new law the terms of the members of the
old Board were automatically terminated. Under this new law
governing the state health work, legislative machinery providing for
the establishment of a new organization to carry on the public health
work of the state was enacted. The new law differs in many respects
from the old law under which the Board had operated for so long.
However, the most important provision of the old law was retained;
that is, the non-political character of the Board and the retention
of the permanency of the policies of the Board, although shortening
the terms of office and making it impossible for the Board to become
a self-perpetuating machine.

North Carolina Board of Health 27

The important provisions in the new law under which the Board
of Health work is now operating are as follows: The Governor
still retains the power to appoint five of the nine members of the
Board, the maximum term of office being four years instead of
six, as under the old law. The Medical Society of the State of
North Carolina still retains the power to elect four of the nine
members of the Board, the same conditions as to term of office to
obtain here as in those appointed by the Governor. It was recom-
mended to the Governor, although not written into the law, and
Governor Gardner accepted the suggestion, that he appoint one
member from the State Dental Society and that he appoint a man
recommended by that society. This is equivalent to allowing the
State Dental Society to name one of the members, but still leaves
the balance of power in the hands of the Governor. This seems to
be a very satisfactory arrangement.

Another important change is that the Board still elects the State
Health Officer, but it can only become effective upon the approval
of the Governor. The term of the State Health Officer, along with
members of the Board of Health, was restricted to four years.

Following the adjournment of the Legislature, the Governor ap-
pointed the following named members: Drs. J. T. Burrus, High
Point; H. Lee Large, Rocky Mount; J. N. Johnson, Goldsboro, the
dental member; Professor H. G. Baity, of the University of North
Carolina and Mr. J. A. Goode, a druggist in Asheville. The State
Medical Society at its first meeting after the adjournment of the
Legislature elected the following physicians to membership: Drs.
James M. Parrott, Kinston; Carl V. Reynolds, Asheville; S. D. Craig.
Winston-Salem; L. B. Evans, Windsor.

It will be noted that Dr. Parrott was the only member of the out-
going Board honored with election to membership on the new Board.

On May 28, the new Board met and organized. On that day it
unanimously elected Dr. James M. arroPtt State Health Officer. Dr.
Parrott took the offer under consideration for a period of two weeks.
On June 11 the Board met again. Dr. Parrott accepted the election
and agreed to assume office on July 1. Dr. Parrott resigned his
membership on the Board before being elected to the position of
State Health Officer, and under the provisions of the new law the
executive committee of the State Medical Society selected Dr. G. G.
Dixon, of Ayden, to serve in Dr. Parrott's place until the 1932 meet-
ing of the State Medical Society. It will be noted that this is an
important variation from the provisions of the old law. Under the
old law the other members of the Board held authority to name a
successor, whether a member resigned or died. Under the new law
the Governor names his vacancies in his list and the executive
committee of the State Medical Society is permitted to name a suc-
cessor to serve only until the first meeting of the State Medical
Society following.

In the meeting of June 11 the Board found it necessary to elimi-
nate some members of the staff to make some consolidations, on
account of reduced appropriations for the Board work. The services

28 Thirty-Fourth Biennial Report

of Dr. D. A. Dees and Mr. R. B. Wilson were dispensed with, effective
July 1. The Board reorganized the staff and made many consolida-
tions. The new reorganization follows:

The Board reorganized the work into divisions, making many
consolidations and increasing the duties of the directors of each
division. Following are the divisions organized: Administrative
Officer, Dr. James M. Parrott; Director Division of Laboratories,
Dr. C. A. Shore; Director Division of Preventive Medicine, Dr. G. M.
Cooper; Director Division of Oral Hygiene, Dr. Ernest A. Branch.
The Division of County Health Work and Epidemiology was tem-
porarily assigned to Dr. H. A. Taylor, but on August 3, Dr. Taylor
resigned and Dr. John H. Hamilton, health officer of New Hanover
County, was appointed director of this division. The position of
director of the Division of Sanitary Engineering was filled on July
14 by electing Mr. Warren H. Booker, who had formerly headed that
work, to succeed Mr. H. E. Miller.

The election of Dr. Parrott was received throughout medical and
public health circles of the entire state with enthusiasm. Under his
able direction the work of the Board during the last half of this
year moved with a precision which was gratifying to all the friends
of public health work in the state.

1932. The year 1932 was uneventful in public health work. The term of
none of the members of the Board expired this year, but all mem-
bers continued their service just as the Board was constituted at
the close of 1931.

The International Health Board awarded a scholarship to Dr. J. C.
Knox for a year's special Public Health Work at Harvard and to
R. T. Stimpson for a year's special work in the School of Hygiene
at Johns Hopkins.

Following the very favorable reception of Doctor Parrott's annual
report at the conjoint session of the State Board of Health and the
State Medical Society, which was presented at Winston-Salem in
April, the work of the Board was carried on on all fronts with sat-
isfactory results, although on account of reduced appropriations
many activities carried on in previous years had to be curtailed or
definitely eliminated.

The death rate in North Carolina for 1932 was 9.6 per 1,000 popu-
lation. This is the lowest death rate ever before recorded in North
Carolina. The trend in typhoid fever death rates has been consist-
ently downward from 1914 to 1930. This year there were three more
deaths than in 1931, there occurring a total of 158 deaths from
typhoid fever. The increase in population, however, offset the slight
increase in number, and the rate recorded was slightly lower than
in 1931. The cases and deaths from diphtheria this year were also
the lowest of any previous year, although progress in the elimina-
tion of these diseases has not been so satisfactory as it should have
been. Deaths from pellagra continue to show a marked decline.

This year is the third year of the so-called financial depression,
and it is too early to record any opinion as to what effect unemploy-

North Carolina Board of Health 29

ment, decreased income and rather widespread suffering may have
on the health of the people of the state. It is not too much to say,
however, that the effect will be felt more severely by the children
than by any other class of the population.

The infant mortality this year was 66.4 per 1,000 live births. This
is so far the best record the state has ever made. The maternal
mortality remains high, and indications are that with decreased ex-
penditures for maternal and infant hygiene the rate, particularly for
infant deaths, will rise again, pushing the state back among those
having an excessive infant death rate.

Expenditures for this year for all purposes by the Board were
$315,276, of which amount $262,438 represented appropriations. This
amount was just a little more than half the total expenditures made
by the Board of Health for the fiscal year ending June 30, 1930.

1933. The event of outstanding importance to the Board of Health this year
was the death of Dr. C. A. Shore, which occurred on February 10.
For twenty-five years Doctor Shore had been director of the State
Laboratory of Hygiene. He had built the work of the Laboratory
during these years up to a point where its prestige and usefulness
were equal to that of any other public health laboratory in America.

Doctor Shore served longer as a member of the executive staff
than any other man who has ever been connected with the State
Board of Health with the exception of Drs. R. H. Lewis and Geo.
M. Cooper. He held the confidence and esteem of the medical pro-
fession as well as the general public to a marked degree. He was
a man of extraordinary ability, and much of the success of the public
health work in North Carolina may be attributed to his fine and
wholesome service.

Suitable tribute has been paid to Doctor Shore and recorded in
other publications of the Board and of the State Medical Society.
One event in this connection, however, should be recorded here, and
that is that by legislative action all buildings of the State Laboratory
of Hygiene are hereinafter to be known as the Clarence A. Shore
Laboratory, in memory of his distinctive service.

A few weeks after the death of Doctor Shore, Dr. John H. Ham-
ilton, director of County Health Work, of Vital Statistics, and of
Epidemiology, was made director of the laboratory work. Doctor
Hamilton, on assuming his duties as director of the Laboratory,
resigned the duties of director of County Health Work and of Epi-
demiology, but retained, however, with the assistance of Dr. R. T.
Stimpson as statistician and field director, the Bureau of Vital Sta-
tistics. Dr. D. F. Milam, a consultant assigned to the State Board
of Health by the International Health Board, was made acting director
of the Bureau of Epidemiology in place of Dr. Hamilton. Dr. Milam
had as his assistant Dr. J. C. Knox. Dr. M. V. Ziegler, consultant
assigned to the Board by the United States Public Health Service,
assumed the duties of acting director of County Health Work to
succeed Doctor Hamilton. During this year Mr. W. D. Riley, assigned
to the work as Venereal Disease Control Officer by the United States

30 Thirty-Fourth Biennial Report

Public Health Service, organized his work and succeeded in making
an important contribution to the work of the Venereal Disease Con-
trol in North Carolina.

The following changes in personnel of the State Board of Health
took place during this year: Dr. W. T. Rainey, of Fayetteville, was
elected by the State Medical Society for a four-year term to succeed
Dr. L. B. Evans, of Windsor, whose term expired this year. Dr.
S. D. Craig was reelected for a term of four more years. The Govv-
ernor reappointed Dr. J. N. Johnson, dental member of the Board,
for another term, which will expire in 1937. The Governor appointed
Dr. Hubert B. Haywood, of Raleigh, for a four-year term to take the
place of Dr. J. T. Burrus, of High Point. The Governor also appointed
Mr. James P. Stowe, a druggist of Charlotte, for a four-year term,
expiring in 1937. Mr. Stowe succeeded Mr. J. A. Goode, a druggist
of Asheville. Dr. Carl V. Reynolds succeeded Dr. Burrus as Presi-
dent of the Board. On July 1, Drs. Knox and Stimpson returned to
the Board work and resumed their places after satisfactorily con-
cluding their year's scholarship work at Harvard and Hopkins, re-
spectively.

The year was not marked by any widespread outbreak of epidemic
disease, and notwithstanding a continuation of the financial de-
pression, the work of the State Board of Health held up fairly well.
The appropriations being lower this year than before for many years,
much of the personnel service had to be reduced. A material reduc-
tion in state aid to County Health Work caused considerable con-
traction of the activities of County Health Department Work, but
for the most part the morale of State Board of Health employees as
well as the county health employees held up remarkably well.

The Legislature, meeting for an extended session following its
opening in January, made drastic reductions in appropriations to
all state health work and reduced the salaries of all state health
employees. This was said to be necessary in order to balance the
state budget and to maintain the state's credit.

The total expenditures for the Board of Health this year, that is,
for the fiscal year ending June 30, were $291,786. Of this amount
$225,274 was appropriated by the Legislature. It will be noted that
this sum was less than half the amount appropriated and spent for
the fiscal year ending June 30, 1930.

1934. The event of greatest importance to the State Board of Health and
to the health work throughout the state in this year was the death
of Dr. James M. Parrott and the election of Dr. Carl V. Reynolds
as his successor. Dr. Parrott assumed the duties of State Health
Officer on July 1, 1931. He had thus served a little more than
three years and four months at the time of his death. Dr. Parrott
was the first State Health Officer to serve under the new, or reor-
ganized, Board of Health. He was stricken with an attack of
angina pectoris early in December, 1933. The last eleven months
of his life, therefore, were ones of recurring illness and courageous
fortitude in remaining at the helm of the Board of Health work.
On the occasion of the first illness, with the consent of the mem-

North Carolina Board of Health 31

bers of the State Board of Health, he designated Dr. G. M. Cooper
as Acting State Health Officer to be the responsible head of the
work in such periods as he was physically unable to attend to the
duties of the office. The following sketch concerning Dr. Parrott
and his work, written by the Editor, was published in the Health
Bulletin.

"The death of Dr. James M. Parrott, State Health Officer of North
Carolina, occurred on Wednesday evening, November 7, 1934. Doctor
Parrott had been health officer of North Carolina for a little more
than three years. He was so active mentally and so near and dear
to his co-workers here at the office that to me, even yet, it seems
impossible and unbelievable to think that he is dead. Nearly thirty
years ago I 'took' the State Board examination for license to practice
medicine. He was a member of that board. From then on I looked
on him as one of the big men in the medical profession. He held
every office within the gift of his profession and loved it and served
its interests with a passionate devotion.

"He took over the direction of the work of the State Board of
Health in one of the darkest hours in the history of the Board. He
brought to the affairs of the Board a new kind of leadership, a fresh
outlook, a new viewpoint, and a breadth of vision which served notice
on the world that the Board had a resourceful and able executive
in charge. Although he came to the Board work without previous
experience in an administrative capacity of this type, and knowing
little or nothing of the practical workings of a modern public health
organization, his chief contribution which will be duly recorded in
the history of this period, to the cause of public health advancement
was his stand for the professionalization of public health work.

"Before he had been here sixty days, he realized that all depart-
ment divisions as well as all county health offices should be manned
by physicians technically trained and experienced in public health
work. It became necessary for him to oppose the ambitions of some
of his lifelong friends in the medical profession, which hurt him;
but it may be said to his credit that he stood four-square for compe-
tently trained men as public health officials.

"On assuming office, he realized that he had some very unpleasant
duties confronting him in reorganizing the work of the Board. He
soon demonstrated that he had convictions and the courage to back
them up. When he laid down his armour for the great adventure,
he left an organization of his own building functioning at top speed.
He proved to his fellow workers here that he was tolerant to every-
thing but laziness and lying and inefficiency. Being a man of clean
personal life, and governed in all his actions by a strict sense of
honor, he naturally expected such qualities in his staff and other
subordinates.

"For the past year he struggled against the malady which finally
ended his life, and at the same time he felt keenly his official re-
sponsibility. He knew all during that last year that, in justice to
himself and his family, he should resign and be relieved of the extra
tax on his failing strength. On the other hand, he felt that his work

32 Thirty-Fourth Biennial Report

was not quite done. He saw many essential features of public health
work sacrificed to a program of questionable economy. He did not
question the good intentions of the Governor, the Budget Bureau,
nor the Legislature, but he felt that the time had come to put an
end to the further needless sacrifice of human life for the lack of
intelligent preventive efforts. He had a conviction that the incoming
General Assembly would see eye to eye with him. He was ready to
submit a program of far-reaching importance to the people of the
state. It could not be. His big brain is forever inactive. His pro-
found knowledge of the public health needs of the people is left for
his successor to acquire for himself.

"No man could build for himself a better monument than Doctor
Parrott did in the record of worth-while work well done. In his
death the state loses an honest public servant, and I lose a warm
and understanding friend whose confidence was more precious to
me than the riches of Araby."

Following Dr. Parrott's death, the State Board of Health assem
bled in Raleigh on November 10, 1934, and unanimously elected Dr.
Carl V. Reynolds, who at that time was serving as President of the
Board, to the position of State Health Officer and Secretary and
Treasurer of the State Board of Health. Dr. Reynolds immediately
accepted and assumed his duties at once. The following Editorial
appeared in the Health Bulletin in January, 1935, concerning Dr.
Reynolds and his work. It is herewith reproduced in order that this
chronological record may be complete.

"Dr. Carl Vernon Reynolds, of Asheville, on November 10, took
the oath of office and immediately assumed his duties as Acting
State Health Officer, succeeding Dr. James M. Parrott, who died
November 7. Doctor Reynolds was unanimously elected to the posi-
tion by his fellow members on the Board.

"Doctor Reynolds is a native of Asheville. His father was a suc-
cessful Asheville physician who died when Doctor Reynolds was
only three years old. Dr. Reynolds obtained his literary education
in the private schools of Asheville and Wofford College, Spartanburg,
South Carolina. He received his medical education at the college of
the City of New York, graduating in medicine there in 1895. After
his graduation he took a postgraduate course in London, England.
Doctor Reynolds located in Asheville for the practice of medicine,
specializing in pulmonary tuberculosis. His skill in combatting that
disease has been widely recognized by the medical profession. An
example of their confidence was his election as president of the North
Carolina Medical Society, in which place he served with distinction
in 1920.

"On beginning practice he at once became interested in health work.
His first connection was with the city health department in 1896.
Following that period, for more than twenty years he served as city
health officer of Asheville, in which capacity he rendered his city
and the whole state important and permanent service. Some of his
contributions to public health may be cited as follows:

North Carolina Board of Health 33

"He organized the first crusade against the common housefly ever
undertaken anywhere.

"He assisted in drafting the first milk ordinance for Asheville.

"He secured progressive sanitary laws.

"He put through the compulsory vaccination law requisite to school
attendance.

"He secured the adoption of a bread-wrapping ordinance and one
requiring the tuberculin testing of cows.

"He saw typhoid fever drop from an average of two hundred and
seventy cases a year in the city of Asheville to about five while he
was city health officer, and saw smallpox practically eliminated.

"We enumerate these things so that the people of the state may
know they have a well-trained health officer at the head of the
State Health Department — one fully worthy of confidence and sup-
port."

The general routine work of the State Board of Health during
this year was satisfactory and successful in every way. Dr. D. F.
Milam, who had been loaned to the State Board of Health by the
International Health Board and who had been acting as State Epi-
demiologist, was transferred to other fields and on the first of July
Dr. J. C. Knox, who had been Assistant in the Division of Epidemi-
ology, became State Epidemiologist.

Dr. M. V. Ziegler, of the United States Public Health Service,
who had also been loaned by that organization as a consultant in
the Division of County Health work and who had been Acting Director
of that Division, was transferred back to Washington about the first
of September. Dr. R. E. Fox, who had completed a postgraduate
course in the Public Health School of Harvard University, was made
director of the Division of County Health Work.

Dr. R. T. Stimpson, who had also successfully completed a post-
graduate course in the School of Public Health of Johns Hopkins
University, and who had been acting as Assistant in the Department
of Vital Statistics, was made Director of that Division.

On November 10, at the time Dr. Reynolds was elected State Health
Officer, Dr. G. M. Cooper was elected Assistant State Health Officer.
Dr. Reynolds, of course, had to resign from his place on the board
in order to accept the office of State Health Officer. To succeed him
as President, Dr. S. D. Craig of Winston-Salem was elected to that
position. Dr. J. N. Johnson of Goldsboro, dental member of the
Board of Health, was elected to the place of Vice President of the
Board. The law provides that in case of a vacancy occurring on the
State Board of Health among the membership elected by the State
Medical Society, that the Executive Committee of the Medical Society
of the State of North Carolina shall have the authority to appoint a
successor to serve until the next ensuing meeting of the State So-
ciety. In this case, the vacancy coming so close to the annual meet-
ing of the State Society and the Board of Health on the following May
1 and there being no regularly scheduled meeting of the Executive

34 Thirty-Fourth Biennial Report

Committee of the State Medical Society, it was decided to defer the
election of a successor to Dr. Reynolds to the meeting of the Society
the following May 1.

1935. Dr. Carl V. Reynolds served as Acting State Health Officer, the Gov-
ernor having deferred the approval of his election the previous
November 10, 1934, but at the annual meeting of the State Board
of Health, which was held in Pinehurst May 7, 1935, Dr. Reynolds
was unanimously elected State Health Officer. His election was for
a full four-year term to begin on the first of July following. The
Governor immediately approved the election of Dr. Reynolds to be
State Health Officer for the full term as stated.

At the meeting of the conjoint session at Pinehurst on Wednesday,
May 8, Dr. Grady G. Dixon was reelected to succeed himself to mem-
bership on the State Board of Health for a term of four years.

Dr. J. LaBruce Ward of Asheville was elected for the four-year
term to succeed Dr. Carl V. Reynolds, resigned.

In this year an important development in public health work was
the experimental course put on in the school year of 1934-1935 at the
University of North Carolina, under the auspices of the Public Health
Administration, of a course of instruction designed to prepare physi-
cians for positions as health officers. The courses in this school met
with such success, plans were perfected to enlarge the scope of this
new school as a part of the Medical School at the University. A
fuller description of the inauguration of this school will be found
under the records for 1936.

During this year following the enactment of the National Social
Security law, plans were worked out for an expansion of the work
of all the divisions of the State Board of Health, through financial
aid coming through the Children's Bureau and the United States
Public Health Service at Washington. It was a year which noted
much activity in public health work all throughout the state, and
the perfection of plans, state and local, for extending health depart-
ment activities.

A Division of Industrial Hygiene was tentatively established in
September of this year. The organization of this division resulted
from an amendment to the Compensation Laws of the state by the
1935 General Assembly. This legislation made disablement or death
by occupational disease interpretable as an injury by accident and
thus compensable. For the execution of this legislation a sum of
$10,000 was appropriated by the Legislature. The Industrial Com-
mission appreciating that a problem of preventive medicine was in-
volved, engaged in a series of conferences with the State Board of
Health and Officers of the United States Public Health Service.
The discussions culminated in the $10,000 appropriated for the ad-
ministration of the occupational disease legislation being placed at
the disposal of the State Health Officer. With this money, an Indus-
trial Hygiene program was inaugurated as an activity of the State
Board of Health. This arrangement was made with the understand-
ing that the work would be subsidized by the United States Public

North Carolina Board of Health 35

Health Service when Social Security funds should become available.
To begin the work of this division and to prepare the program for
enlargement to its full scope, Dr. H. F. Easom of the State Sana-
torium for Tuberculosis Medical Staff was selected as the Director
of the division. Mr. M. P. Trice, formerly in the Division of
Sanitary Engineering of the State Board of Health, was made
Engineer of this new division.

1936. What may be termed the outstanding event of importance for the
first half of this calendar year covered in the period of this report
may be said to be the definite establishment of the new public
health department at the University of North Carolina and the
selection of Dr. Milton J. Rosenau as its director. This new de-
partment, of course, is an integral part of the School of Medicine
of the University of North Carolina. The March issue of the Health
Bulletin published the following descriptive news item of the inaugu-
ration of this department:

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

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

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

"In the opinion of Drs. Mangum and Reynolds the development
was in part made possible by the success of the course put on in the
school year of 1934 and 1935 at the University under the auspices
of the School of Public Administration. The first course put on with
the teaching aid of the Schools of Medicine and Engineering of the
University and members of the staff of the State Board of Health
comprised a course of instruction for physicians in public health
administration and extended over a period of twelve weeks. The
work was so excellently done that they received recognition from the

36 Thirty-Fourth Biennial Report

United States Public Health Service which assigned several of its
applicants for postgraduate work to take the second course.

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

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

On February 1 of this year, funds from the Social Security Act
became available to the State Board of Health through the Public
Health Service and the Children's Bureau at Washington. In addi-
tion to adding a division of field training of public health nursing
in connection with the new department of public health at the State
University, a department of Public Health Dentistry was also
established in connection with the Public Health School at Chapel
Hill. This is said to be the first school of like character in the
country. The County Health Department was enabled through the
Social Security subsidy from Washington to aid all the whole time
county health departments in an expansion of their work. The
Division of Preventive Medicine employed Mrs. J. Henry Highsmith
to begin work on February 20 as an Assistant in the field of health
education. The work of this division, of course, took on enlarged
activities. Plans were immediately set in motion to establish special
county nurses in counties having no whole time health organization
as special demonstration service for such counties. Plans were also
launched to establish Maternity and Infancy Centers in many sec-
tions of the state as Demonstration Centers, looking toward an
eventual lowering of the infant and maternal death rates in this
state.

A sum of 17,500 of Social Security money was appropriated by the
United States Public Health Service for the Division of Industrial
Hygiene. Dr. M. T. Plyler was employed as an Assistant Medical
Director in that division and Mr. C. R. Matheson as a Medical Tech-
nician. Both of these men had been employed on the staff of the North
Carolina Tuberculosis Sanatorium. Up to the first of July more than
150 plants involving siliceous dust hazards had been surveyed. The
entire asbestos industry in the state involving five plants had been
studied, in cooperation with the United States Public Health Service,
a granite cutting establishment investigation made, and a foundry
study inaugurated. There were 525 asbestos textile workers and
46 granite cutters examined during the investigatory work. In addi-
tion, preemployment examinations have been made of approximately
400 workers. All persons examined have X-ray films made of their
chests. During this work nearly 300 atmospheric dust samples were

North Carolina Board of Health 37

analyzed. During the period, the physician and the engineer at-
tended a four weeks' special course on Industrial Hygiene given by
the Public Health Service in Washington. The division has installed
a complete office equipment, as well as portable equipment necessary
for successful execution of this important work. The new division
is housed in the basement of the State Board of Health Building.

On April 1 of this year, the State Board of Health established
a service for crippled children. This followed the approval in late
March of the North Carolina Plan for Crippled Children prepared
by the State Board of Health and submitted to the United States
Children's Bureau. This plan was a prerequisite of the Children's
Bureau toward participation by the state in the distribution of
Social Security appropriations for this purpose. Dr. G. M. Cooper
of the Division of Preventive Medicine was designated as Medical
Director of this service, and Mr. J. T. Barnes was employed by
the State Board as State Supervisor in charge of administrative
duties of this service. An advisory committee representative of
the medical, health, welfare, and lay interest of the state in the
problem of the crippled child was formulated to advise in the execu-
tion of this program. Prior to June 30, public clinics were arranged
in various centers of the State under the direction of the State Board
of Health. Cooperation had been arrange with the North Carolina
Orthopedic Hospital and was being carried out satisfactorily.

Under the provision of the Children's Bureau regulations, an
advisory .committee was secured by the Director of the Division of
Preventive Medicine for the purpose of advising from time to time
on the general program of maternal and child health service work.
This committee held its first meeting on March 27 at the State Board
of Health in Raleigh. Representatives from the following organiza-
tions were present: State Medical Society, State Dental Society,
State Public Health Officers Association, State Nurses Association,
State Federation of Women's Clubs, State Parent-Teacher Associa-
tion, State Welfare Department, Division of Pediatrics and Obstetrics
of the State Medical Society. On or before June 30, the enlarged
program of all the divisions of the State Board of Health was well
underway.

1937. There was no event of outstanding importance occurring in the year
1937. Few changes in the staff or in the sub-staff of the State Board
of Health have occurred. Following the expansion of service through-
out the year 1936 with the aid of Social Security funds coming
through the United States Children's Bureau and the United States
Public Health Service at Washington, a tremendous amount of work
was done during the entire year 1937 in expanding the work of the
health department throughout the State, an increased number of
nurses were employed, additional county health departments were
established and more intensive efforts were made along all lines than
in any previous year. The new School of Public Health Administra-
tion at the University of North Carolina under the direction of Dr.
Milton J. Rosenau, aided materially by Dr. Carl V. Reynolds, State
Health Officer, and the faculty of the Medical School of the State

38 Thirty-Fourth Biexxial Report

University, made substantial and satisfactory progress. An increas-
ing number of sanitary engineers, sanitary inspectors, and health
officers from this State and other states in the southeastern regional
territory were trained at Chapel Hill.

An Advisory Committee of leaders in different organizations in
North Carolina, including such organizations as the State Medical
and Dental Societies, Public Health Association, Parent-Teacher
organizations, Women's Clubs, and the State Nurses Association, to-
gether with some independent members of the medical profession
in the field of pediatrics and obstetrics and orthopedic surgery, was
organized and held its first satisfactory meeting during this year.

Dr. T. C. Worth joined the staff of the Division of Preventive
Medicine on September 21, 1936, and served until April 15, 1937, in
the capacity of assistant to Dr. Cooper. Dr. Worth aided materially
in assisting in the organization of Maternity and Infancy Centers
in some forty counties of the State and contributed a great deal
toward strengthening the department work. Upon Dr. Worth's de-
parture on April 15 to continue his postgraduate education in Boston,
Dr. Roy Norton, who had been with the Division of County Health
Work for about a year, and was formerly health office of Rocky
Mount, succeeded Dr. Worth. Miss Mabel Patton, a qualified nurse,
joined the staff of the Division of Preventive Medicine as a consult-
ant nurse representing the Children's Bureau. Dr. W. J. Hughes, a
colored physician whose services for work in the health education
field in the Department of County Health Work was made possible
through contribution by the Rosenwald Fund and who joined the staff
on January 1, 1936, was able to achieve substantial progress in his
work with the colored population of the State. This was the first
time a colored physician had been admitted to membership on the sub-
staff of the State Board of Health, and the result of work in 1936
and 1937 have fully justified his employment. Dr. R. L. Robinson
joined the sub-staff of the Division of Industrial Hygiene on April 1,
1937, to succeed Dr. M. T. Plyler of that Division. Mr. W. H. Rich-
ardson, an experienced newspaperman who at one time was Secretary
to Governor Morrison for his four years in the Governor's office,
joined the Administrative Staff in the department exclusively con-
ducted by the State Health Officer. Mr. Richardson has been a
valuable addition to the staff and he has succeeded remarkably well
in interpreting technical problems to the lay readers in hundreds of
articles in the daily and weekly press of the State. Dr. G. M. Leiby,
who had been Assistant District Health Officer in the Haywood-
Jackson-Swain District with headquarters at Bryson City, joined
the sub-staff of the Department of Epidemiology in the fall of 1936
and after some field experience was sent to the Hopkins School of
Public Health for a year's special studies in syphilology. Dr. F. S.
Fellows of the United States Public Health Service was loaned to the
State Board of Health as consultant in the Department of Epidemi-
ology in the field of venereal disease control. Miss Margaret Thomp-
son, who holds a master's degree in home economics and nutrition
work from the University of Iowa, joined the sub-staff of the
Division of Preventive Medicine in October, 1937. On March 15,

North Carolina Board of Health 39

1937, Miss Frances R. Pratt, a specially trained nurse under the
auspices of the State Maternal Health League, joined the sub-
staff of the Division of Preventive Medicine. Miss Pratts' work
was financed by an individual contribution from an outside agency.
Her work has been to organize through the medical profession and
the local health officers on a voluntary basis a system of contracep-
tive control work when based on medical needs. Her work has
been very successful and it has been a welcome and needed addition
to the staff work.

On December 16, 1937, following Legislative Provision in the 1937
session of the Legislature, $160,000 in bonds were sold for the pur-
pose of building a new plant for the State Laboratory on the grounds
adjacent to the present State Board of Health building on Caswell
Square, Raleigh. A PWA grant of about $130,000 additional was
received and work on the building was expected to be completed
within the year 1938. A farm of 280 acres on the Raleigh-Cary paved
highway was purchased and provision made for farm buildings to
care for the animals used in the production of vaccines and serums.

On December 17, a conference of Public Health Officers was called
at Raleigh for the purpose of discussing and making decisions con-
cerning various field work, jointly affecting the State and local health
departments. This conference was so successful that it was voted to
make it an annual affair.

During the year a central general filing system was established
and put into effect under the direct supervision of the State Health
Officer and the Administrative Division of the Board of Health.
This is proving to be a very satisfactory and progressive step.

Malaria was made a reportable disease and a malaria inspection
and control unit was established in the Department of Epidemiology
July 1, 1937. Effective also in 1937 was the new plan of the Division
of Vital Statistics with reference to the notification of birth regis-
tration certificates to parents. Instead of waiting for a parent to
write to the department to inquire if the birth has been reported
and to send 50c for certificate, the plan was adopted of sending to
each parent whose baby's birth was reported properly a small neat
certificate of the baby's birth. This was through an arrangement
with the Bureau of the Census of the United States Government.
Franking privileges are allowed in this work. It simply informs
parents that their babies' births have been properly recorded and
the idea is through this method to reach many of those parents
whose babies' birth have never been reported and get them to send
in the reports.

There were no changes in the membership of the State Board of
Health this year. All members whose term expired were re-elected
by the State Medical Society or re-appointed by the Governor, for
additional four-year terms.

The total expenditures for the State Board of Health during the
fiscal year ending June 30, 1937, were $8S1,484.01. Of this amount
$287,747.04 was appropriated by the Legislature, $191,943.85 was by
the United States Children's Bureau, $312,210.42 by the United States

40 Thirty-Fourth Biennial Report

Public Health Service, and Anally $89,582.70 from fees received by
the Laboratory in water taxes, etc., and other miscellaneous items.

1938. During 1938, the extension and consolidation of health work in all
departments of the State Board of Health was further accomplished.
This year two outstanding events may be recorded. First, the Zach-
ary Smith Reynolds Foundation decided to donate its income from
a fund of about seven million dollars to the State Board of Health
to aid in a long time program of syphilis control. The initial dona-
tion from this fund by the officials of the foundation to Dr. Reynolds
was a check of $100,000. This philanthropy will bring to realization
one of the finest dreams of Dr. Carl V. Reynolds, State Health Officer.
It promises to enable the State Board of Health to accomplish in
the near future some of the objectives that have sometimes seemed
to be long years off. A long time before the Government began to
realize its responsibility in the prevention of disease and the preserva-
tion of the health of its citizens as a means of bringing about better
social and economic conditions and the promotion of human happi-
ness, philanthropists such as Rockefeller led the way. This gift of
enabling the State Board of Health to organize in collaboration with
the Reynolds Foundation, however, affords the practical means of
the various city and county health departments of the State an
effective system through which the venereal diseases may be
eventually controlled in this State.

The other event in the same connection was the passage by the
United States Congress early in 1938 of a bill known as the LaFol-
lette-Bulwinkle Bill, sponsored and carried through the lower House
of the United States Congress by Representative A. L. Bulwinkle
of Gastonia, who has long represented his district in the lower House
of Congress. Through the provision of this bill the State was able
to receive during the year about $80,000 additional funds for work
in syphilis control. The proceeds of these funds enabled the State
Board of Health to attack the ravages of syphilis even in the pre-
natal stages by treating syphilitic mothers early enough in preg-
nancy to prevent the birth of hopelessly syphilitic babies. It is prob-
ably a fact that the benefaction of the Smith Reynolds Foundation
is the largest single gift for this particular purpose that has ever
been made by any public or private organization in this country.
The cause is not only a worthy one but a pressing one. It takes
money to control and eliminate such diseases as yellow fever, typhoid
and syphilis.

The School of Public Health Administration of the State Uni-
versity at Chapel Hill has made such material progress that it
became necessary on the first of September this year to employ an
additional full-time professor in that department. Dr. Roy Norton,
who for the preceding fifteen months had been an assistant in the
division of Preventive Medicine where he has done excellent work,
was persuaded to accept the professorship. The State Board of
Health reluctantly agreed to Dr. Norton's transfer in view of the
fact that the School of Public Health Administration is of such far-
reaching importance that it should have the services of the very

North Carolina Board of Health 41

best available talent in the medical profession of North Carolina.
Dr. Norton is admirably equipped for this important work. There
are now five full-time professors in this division of the University.

Under the persistent work of Dr. Reynolds a stationary exhibit
had been erected in the large halls of the central building of the
State Board of Health, at Raleigh, an exhibit which is an education
in itself. It demonstrates the work of all the departments. Some
of the State's foremost artists were called into the work and the
officials of the National Youth Administration provided a great
deal of the actual work at little cost to the State Board of Health.
It would pay any citizen of North Carolina who is interested in the
State's progress to visit this exhibit sometime during the year.

With the exception of the loss of Dr. Norton, there have been
few staff changes of importance. Dr. R. L. Robinson who came with
the Industrial Hygiene Division as a field worker in April, resigned
and returned to his home to engage in private practice on the first
of August. Mr. C. D. King. Jr., an Industrial Hygiene man, came
with the Board in the Industrial Hygiene Division on June 15 as an
assistant to Mr. M. F. Trice. Dr. G. M. Leiby returned at the com-
pletion of his course in Johns Hopkins University and assumed his
duties as field director of the syphilis control program. Dr. Fellows
still remains wit hthe board and continues to render valuable assist-
ance.

The officials and employees of the Department of Preventive
Medicine were saddened this year on account of the death of two
veteran nurses. Miss Katherine Livingston died on May 26 and
Mrs. Margaret Sloan died on July 12. Both of these nurses had
rendered valuable service in this Division for many years.

There was no expiration of terms of service of the membership of
the State Board of Health this year, therefore no changes in per-
sonnel occurred.

In March, 1938, the Board received a report from a committee
previously appointed to study pneumonia. The committee headed
by Dr. H. B. Haywood of Raleigh as chairman, Drs. W. T. Rainey
and G. G. Dixon from the Board, with Doctors Fred Hanes, C. T.
Smith, as consultant, and C. V. Reynolds, ex-officio, made a full
report. Arrangements were made through Dr. Hanes of the Duke
Medical faculty for a special course to train local technicians which
was largely attended.

An important piece of field work which met with wide-spread
appreciation throughout the State this year was a series of 34
health institutes for teachers and principals of schools in as many
places representing the State. Eight thousand teachers and prin-
cipals attended these Institutes which were of a practical char-
acter. The Institutes were conducted under the joint auspices of
the State Board of Health, State Department of Public Instruction
and the Extension Service of the North Carolina State College.
The officials who executed this piece of work were Dr. Roy Norton
and Mrs. H. P. Guffy, nurse, of the State Board of Health, Miss
Mary Thomas, nutrition specialist of the State College Extension

42 Thirty-Fourth Biennial Report

Service, Mr. H. A. Perry and Mr. Charles E. Spencer of the State
Department of Public Instruction. This work was under the gen-
eral supervision of Doctors Reynolds and Cooper of the State Board
of Health, and it was carried out under the health education division
of the Board, and Dr. J. Henry Highsmith of the State Department
of Public Instruction.

The total expenditures for the State Board of Health for the
fiscal year ending June 30, 1938, were $1,041,895.98. Of this amount
$353,953.55 was appropriated by the Legislature, $226,297.57 by the
United States Children's Bureau, $337,914.39 by the United States
Public Health Service, and $123,730.47 from fees received by the
Laboratory in water taxes, etc., and other miscellaneous items.

Dr. Roy Norton, who for nearly two years had been assistant
director in the Division of Preventive Medicine, resigned to accept
the position of Professor of Public Health Administration in the
School of Public Health in the University of North Carolina. Dr.
Norton's resignation was effective September 1. A successor to Dr.
Norton was not appointed during the remainder of the year.

Beginning with July 1 of this year, the following counties set
up whole time health department organizations: Alamance, Alle-
ghany, Ashe, Davie, Polk, and Union. On September 1, Catawba,
and September 16, Cleveland. On November 1, Currituck became
a member of the district health department with Dare and other
counties.

1939. In the Division of Sanitary Engineering, John D. Faulkner returned
to the department to resume his work after taking a year of public
health engineering training at the University of Michigan.

Mr. James P. Stowe of Charlotte, for many years a member of
the State Board of Health, died on February 12. The Governor
later appointed Mr. C. C. Fordham, Jr., a Greensboro druggist who
promptly qualified as a member of the Board. During the year there
were no other changes in the personnel of the Board. All members
whose term expired were either reelected by the State Medical
Society or reappointed by the Governor.

On August 7, Dr. John S. Anderson was appointed as a member
of the staff as consultant in public health administration in the
Division of County Health Work. Dr. Anderson had previously
served as county health officer in Craven and Cabarrus counties.

On December 31, Miss Josephine Daniel resigned as consultant
in public health nursing in the Division of County Health Work
and accepted an appointment as director of public health nursing
with the Oklahoma State Department of Health.

On December 15, Dr. George M. Leiby, venereal disease consultant,
resigned his position with the Division of Epidemiology to accept
the position of director of venereal disease control in the City of
Washington, D. C.

On June 13, Dr. H. F. Easom resigned as director of the Division
of Industrial Hygiene to return to the North Carolina Sanatorium
as clinic physician. He was succeeded effective October 15, by Dr.

Nokth Carolina Board of Health 43

T. P. Vestal, a native of Randolph County, formerly a member of
the Sanatorium clinical staff.

During the year, construction work was started on the new cen-
tral Laboratory on Caswell Square adjoining the administrative
building of the State Board of Health. Also, construction work
was begun on the buildings on the State Laboratory farm between
Raleigh and Cary.

In the Division of Preventive Medicine, Mrs. J. Henry Highsmith
resigned her position as health educator, effective October 1. Mrs.
Highsmith's resignation was very reluctantly accepted. Off and on
Mrs. Highsmith had been connected with the State Board of Health
for many years. She has rendered invaluable service in the health
education work of the Board.

In the early months of the calendar year of 1939, plans were
matured after two or three years' efforts, attended by frequent con-
ferences of all concerned, by the State Health Officer and the State
Superintendent of Public Instruction, for the establishment of a
service through which the facilities of the State Department of
Education and the State Board of Health for the execution of a
unified health service in the public schools of the State might be
further integrated. Inauguration of this plan was made possible
by a supplementary grant of $50,000 by the Rockefeller Foundation
and the General Education Board to be spent over a five-year period,
commencing July 1, 1939. The official designation of this organiza-
tion is the North Carolina School Health Coordinating Service. The
organization as a whole consists of an Advisory Committee and a
full-time operating staff. The Advisory Committee consists of five
members: namely, Dr. J. Henry Highsmith, Dr. G. M. Cooper, Dr.
C. F. Strosnider, Dr. R. J. Slay, and Dr. Oliver K. Cornwell. The
operating staff consists of the following seven members: Dr. Walter
Wilkins, Coordinator; Miss French Boyd, nutritionist; Mr. Charles
E. Spencer, physicial education; Miss Olive Brown, physical educa-
tion; Miss MacVeigh Hutchinson, nurse; Dr. Walter Hughes, Negro
physician; Mrs. Irma N. Henry, Negro health educator. In addition
to these regular staff members several nurses from the Division of
Preventive Medicine have been assigned to work with the organiza-
tion for varying periods of time.

Dr. John F. Kendrick was lent to the State by the Rockefeller
Foundation to serve temporarily as administrative adviser to this
school health coordinating unit. Preliminary plans involving the
selection of trained personnel and numerous other organization
preparations were undertaken during the months of July and Aug-
ust, 1939, and initial field operations commenced in Stanly County
in September. In addition to Stanly, cooperative work was under-
taken in Person, Orange, Chatham, and Wayne counties during the
year.

This was the first full fiscal year in which the sum of $100,000
donated by the Zachary Smith Reynolds Foundation to aid the Board
of Health in its syphilis control work was available. This initial
donation of $100,000 in cash to the State Health Officer to be used

44 Thirty-Fourth Biennial Report

without strings attached, represents one of the largest gifts ever
received by the Board of Health. It has enabled the State Board
of Health to put into effect many necessary requirements in the
State-wide work control of the spread of syphilis. This money has
been used for the specific purpose for which it was alloted. It has
been used to employ additional men and women who are experts in
their field and for the training of other nurses and physicians to
become experts in the work necessary to deal with this enormous
problem. This trust fund has enabled the Board to extend its activ-
ities in almost every direction and to keep up the official work in
such a manner as to make sure a long time successful program
which will be necessary to reduce the prevalence of syphilis in this
State to a minimum.

The total expenditures for the State Board of Health for the fiscal
year ending June 30, 1939, were $1,215,056.80. Of this amount $364,-
506.25 was appropriated by the Legislature, $232,993.80 by the United
States Children's Bureau, $311,859.00 general and $51,829.11 venereal
disease by the United States Public Health Service, $130,290.49 by
the Zachary Smith Reynolds Foundation, and $123,578.15 from fees
received by the Laboratory in water taxes, etc., and other miscel-
laneous items.

In this year no changes in the personnel of the State Board of
Health occurred. Every member continues to serve to the full
extent of his ability, giving unstintedly of his time and efforts to
the constructive work of the State Board of Health.

1940. The most important item in the field of public health in this State
in 1940 was the completion and dedication of the central building
known as the Clarence A. Shore Laboratory of Hygiene. As stated
before in this chronology, this new plant costing about $311,000
was made possible by the selling of revenue bonds and the alloca-
tion of a PWA grant and in the acquisition of funds from various
sources. The total outlay of $311,000 represents the cost of the
central plant on Caswell Square, completed and equipped, and the
cost of the buildings on the Laboratory farm located six miles west
of Raleigh. The Shore Memorial Building was dedicated with ap-
propriate ceremonies on February 21, 1940. There were addresses
by Governor Clyde R. Hoey, Dr. S. D. Craig, President of the State
Board of Health, Dr. Carl V. Reynolds, State Health Officer, Mr.
J. W. Kellogg, assistant director of the State Labroatory of Hygiene,
Dr. George M. Cooper, Assistant State Health Officer, and Dr. John
A. Ferrell, Associate Director of the International Health Division
of the Rockefeller Foundation. Dr. John H. Hamilton, Director of
the Laboratory, presided over the exercises. Greetings from neigh-
boring and friendly organizations and institutions were brought by
Dr. M. J. Rosenau, Division of Public Health of the University of
North Carolina, Dr. W. C. Davison, Dean of the Medical School of
Duke University, Dr. W. deB. MacNider, Dean of the Medical School
of the University of North Carolina, Dr. E. S. King, Professor of
Preventive Medicine of Wake Forest College, Dr. Hubert B. Haywood,
President-elect of the Medical Society of North Carolina, Mr. E. C.

North Carolina Board of Health 45

Derby, Resident Engineering Inspector of the Public Works Ad-
ministration, Dr. M. V. Ziegler, Senior Surgeon of the United States
Public Health Service, Washington, and Dr. John M. Saunders,
Regional Medical Consultant of the Children's Bureau, Washington.
The entire issue of the April 1940 number of the Health Bulletin
was devoted to the description of the dedication of the Shore Memo-
rial Building. The issue was increased from the normal sixteen
pages to a thirty-two page volume.

The central Labortory building consists of four stories and is
modern in every detail. The State Labortory of Hygiene farm con-
sists of approximately 280 acres of which 100 acres is under culti-
vation, the balance in woodland. The farm has a frontage of fifteen
hundred and fifty feet on the great United States national highway
number one. Both the Seaboard and Southern railways also front
it. The buildings on the farm consist of the farm laboratory build-
ing, horses and sheep barns and buildings for the production of
smallpox vaccine and other biologic products, as well as the buildings
for the housing of small animals needed in this work.

On April 1, John D. Faulkner was transferred from the Division
of Sanitary Engineering to the Division of Epidemiology to have
charge of rodent control work.

John Andrews who had effectively headed the milk sanitation
program in the Division of Sanitary Engineering resigned to ac-
cept an important position with the United States Health Service
in Washington. R. F. Hill, Jr., finished his year of specialized train-
ing in sanitary and public health engineering at the University of
North Carolina and returned to his duties with the Sanitary Engi-
neering Division.

Effective work has been carried on with the aid of the WPA
and United States Public Health Service in the malaria control
drainage and community sanitation. Milk sanitation was advanced
with a marked increase in the number of pasteurization plants.
With the assistance of the aforementioned organizations and the
PWA, the installation of new public water systems was brought
up to a total of 52 installed during a four-year period ending June
30, 1940. Improvements, additions and extensions were made to a
great many of the water and sewage systems of the state.

In the Division of Vital Statistics, there was closer cooperation
with the local health departments in an effort to be of mutual
assistance in registration. Social Security benefits requiring proof
of number and age dependents and necessitating the presentation
of the birth and death certificates has increased the number of
verifications and copies of the certificates issued by the division.
There were no material changes in the division during the first
half of 1940.

On March 1, 1940, Miss Amy L. Fisher succeeded to the vacancy
left by Miss Daniel as a consultant nurse in the Division of County
Health Work. Miss Fisher had been supervising nurse in the
Durham Health Department. Gates County joined the district to

46 Thirty-Fourth Biennial Report

be composed of Hertford and Gates, the work to become effective
July 1, 1940.

In the Division of Industrial Hygiene, there was issued a pro-
fusely illustrated one hundred page printed report presenting the
results of a study of effects of exposure to dust in the mining and
milling of pyrophyllite, the field work for which was done during
the previous biennium. One of the outstanding achievements of this
division was the design of seven industrial exhaust ventilation
systems for the control of dust. Three of these had already been
completed by June 30 and the installation of the others was already
underway.

With the closure of the public schools for the summer holidays,
preparations were made for health courses to be given thirty white
and thirty colored teachers at the University of North Carolina
and the North Carolina College for Negroes at Chapel Hill and
Durham, respectively. These courses covered a six weeks period
ending approximately July 20, 1940, and were made possible by
a grant of $4,700 by the General Education Board. While it would
be premature to attempt an appraisal of what was accomplished
by this organization during its first year of existence, it may be
stated that educational and health personnel alike cooperated gen-
erously, that certain procedures were found to be satisfactory while
practical considerations necessitated the modification of others, and
that progress was made toward the maturation of a generally accept-
ed school health program.

On January 1, 1940, Dr. Ralph J. Sykes assumed the duties of
venereal disease consultant in the Department of Epidemiology.
Dr. Sykes had previously served for several years as county health
officer first in Surry and later in Halifax. Dr. Frank S. Fellows,
Surgeon with the United States Public Health Service who has
been assigned to North Carolina for several years, continued to
render valuable service in the capacity of venereal disease con-
sultant.

The main accomplishment in the Division of Epidemiology was the
great expansion of venereal disease control program. This was
largely as a result of financial aid from the Zachary Smith Rey-
nolds Foundation and the United States Public Health Service. In
June, 1936, there were 120 clinics in operation. They treated 13,304
patients. In June, 1940, as a result of the aforementioned financial
aid, the number of clinics have been increased to 255 in which 27,814
patients received treatment in a single month. The system of
mechanical tabulation set up in a central tabulating unit under the
direction of this division reached its full stride in the early months
of 1940. A complete progress record is kept on every patient receiv-
ing treatment. The central tabulating unit renders valuable assist-
ance to other divisions of the State Board of Health.

The Manual of Minimum Standards for conducting venereal dis-
ease clinics prepared by Drs. Fellows and Leiby still continues to
be very helpful to physicians and nurses and others concerned with
the conduct of venereal disease clinics. Financial aid was given

North Carolina Board of Health 47

through this department to all organized counties in the State. Fifty-
one clinics were supplied with combination darkfield and general
purpose microscopes and sixteen of the largest clinics were given
fluoroscopes.

On January 1, Dr. Emmett S. Lupton was employed as assistant
director in the Division of Preventive Medicine. Dr. Lupton had
just completed his internship in pediatrics at the Duke Hospital.
In the Division of Preventive Medicine, organized maternal and
child health clinics were being operated in 55 counties. An increas-
ing number of infants and expectant mothers among the poor
classes were in attendance on these monthly clinics. A total of
approximately 250 physicians were cooperating on a part-time basis
at the close of the fiscal year, June 30.

The circulation of the Health Bulletin increased from about 52,000
to 60,000 monthly copies during the year.

In the Division of Oral Hygiene, there were no material changes
except some expansion and expenditures of additional funds in the
work of that division, necessitating the employment of an additional
number of dentists.

At the beginning of the calendar year 1940, the question of
adoption by the State Board of Health of a so-caleld merit system
as required by some sections of the Federal Government at Wash-
ington loomed as an important item for consideration during the
year. Early in January it was required by the Children's Bureau
that standards to form the basis of a merit system should be sub-
mitted before the allocation of Children's Bureau funds for the
winter would be forthcoming. By the middle of January, therefore,
Doctors G. M. Cooper and Emmett S. Lupton, working in consulta-
tion with Dr. Carl V. Reynolds, State Health Officer, worked out
and submitted a seventeen-page typewritten document setting up
standards acceptable to the State Board of Health. These standards
with a few minor modifications were immediately accepted by the
Children's Bureau. Later in the winter the Regional Medical Con-
sultant of the United States Children's Bureau spent several days
in Raleigh discussing with Dr. Reynolds and the represeneatives of
the Children's Bureau in the State Board of Health plans for further
development of the merit system, the next requirement being the
setting up of a merit system council with a supervisor and submis-
sion of classification plans for all State Board of Health workers.
At this time the State Health Officer appointed the Director of the
Division of County Health Work to be the responsible official to
work out further plans. At a meeting of the State Board of Health
on November 29, 1940, that body considered a new draft of what it
termed "A Rule for a Merit System of Personnel Administration in
North Carolina. Much discussion on the subject was indulged in
by various members of the Board at this meeting. A suggestion of
Dr. H. G. Baity, a member of the Board, at this time deserves par-
ticular emphasis. Dr. Baity made the suggestion that a general
statement be placed somewhere in the compensation plan to the
effect that the "duties outlined for each position classified were not

48 Thirty-Fourth Biennial Report

to be considered as comprising all the duties that might be required
by the State Health Officer or the Division Director would be in-
cluded."

Later in the year 1940, the war clouds over the world were gath-
ering with such an ominous outlook that the United States Army,
Navy, and Public Health authorities were busy laying the ground-
work for a mighty army and navy to defend the country. One of the
first considerations by the United States Public Health Service and
the North Carolina State Board of Health in the fall of this year was
an effort to detect the presence of syphilis in as large a section of
the population as possible, especially those liable for military service.
On October 16, 1940, which was registration day under the Selective
Service Draft, the North Carolina State Board of Health utilizing
the services available in its 265 venereal disease clinics then estab-
lished in the State offered to take blood samples from all registrants
on a voluntary basis. Consequently, 132,671 blood specimens were
taken and examined. This accomplishment was one of the most
widespread efforts ever made in the State up to that time to locate
by serological examination the presence and distribution of syphilis
in North Carolina.

The Federal Government proposed to set up what they call a
"Firing Area" in Pender and Onslow counties. It became necessary
for the State Board of Health to insist on the organization first of
a whole time health department in each of these two counties, neither
one having ever had such department before. This was arranged on
a joint financial basis between the counties and the State and Federal
Government, and a district health department was set up.

The total expenditures for the State Board of Health for the fiscal
year ending June 30, 1940, were $1,380,174.90. Of this amount $370,-
057.67 was appropriated by the Legislature, $162,813.81 by the Zach-
ary Smith Reynolds Foundation for syphilis control work, $229,872.28
by the United States Children's Bureau, $318,148.38 general and
$175,557.72 venereal disease by the United States Public Health
Service, and $123,465.04 from fees received by the Laboratory in
water taxes, etc., and other miscellaneous items.

1941. The imminence of war all through the early part of that year over-
shadowed all other questions. The establishment of Camp Davis
in Pender and Onslow counties, the Marine Base there and later in
Craven County and the expansion of the facilities of Fort Bragg in
Cumberland County, together with the enormous shipbuilding activi-
ties underway at Wilmington gave a wartime color to most all health
work in the State during 1941.

The Legislature reduced somewhat its appropriation to the State
Board of Health for public health work but this was offset by
increased appropriation by the United States Public Health Service
and the Children's Bureau at Washington. The Legislature also near
the close of the session enacted a State Merit System Law to apply
conjointly with the Federal requirements to those departments par-
ticipating in the Federal organization.

North Carolina Board of Health 49

At the several meetings of the Board this year the question of
better and more widespread utilization of the Laboratory facilities
were discussed and provision was authorized for further distribution
of various biologicals. The Legislature had been asked for the sum
of $7,000 to provide for free diphtheria toxoid to be dispensed through
the Laboratory for the use of all the physicians in the State just as
typhoid vaccine and smallpox vaccine have been distributed for
many years. The Legislature refused the appropriation and there-
fore, the only free toxoid that has been provided has been from the
Maternal and Child Health Service of the Division of Preventive
Medicine from funds allocated by the U. S. Children's Bureau. Five
thousand dollars was spent for this purpose.

At practically every meeting of the Board this year there was
much discussion on the question of the Merit System. In October
of this year the first Merit System examinations were held for
certain types of classified service. This included stenographic and
clerical positions. Some confusion prevailed throughout the year
as to how far the requirements should be extended to include local
employees of the various county and city boards participating in
State and Federal funds.

Some changes were made in milk distribution regulations and
the regulations governing the control of venereal diseases.

The following motion was adopted by the State Board of Health
at a meeting in Raleigh on September 12, 1941: That the Board
endorse the policy of its Secretary, Dr. Carl V. Reynolds, in his
efforts to suppress venereal diseases and prostitution not only around
the military areas in North Carolina but also among its civilian
population. V. D. Control in North Carolina is a public health prob-
lem and it is a fixed policy of the Board to give all of its efforts
to the improvement of this situation. We feel that progress is being
made and we assure Dr. Reynolds of our full cooperation in the
continuance of this program."

On July 1, 1941, Mr. D. S. Abell who had been an assistant engineer
in the Sanitary Engineering Department, resigned to become chief
sanitary engineer of the Alabama State Board of Health. There
were few other changes in personnel during the year except the
resignation of Dr. Emmett S. Lupton as Assistant Director of the
Division of Preventive Medicine. Dr. Lupton resigned after twenty-
one months' faithful service to the Board for the purpose of engaging
in private practice at Graham, North Carolina. Dr. Lupton was a
valuable worker and contributed very much toward the success of
the work in his division during his short term of office.

The Legislature also adopted during the year two laws regarding
the registration of delayed birth certificates and a third law legit-
imatizing births to illegitimate babies born out of wedlock, provided
the parents were subsequently married. The Vital Statistics De-
partment all through this year was overwhelmed with requests for
birth certificates on account of the widespread employment demands
and military service, all of which require birth certification in order
to establish citizenship.

50 Thirty-Fourth Biennial Report

An important expansion in the work of the State Board of Health
was the erection of an Oral Hygiene Building on Caswell Square,
adjacent to the administration building of the State Board of Health.
The new building was designated as the Oral Hygiene Building and
is entirely devoted to the work of that division. Ground was broken
for this building on January 1, 1941, and on the last Thursday in
November the division moved into its new home. WPA assisted in
the erection of this building.

Miss Carolyn Mercer, educational consultant on the staff of the
Oral Hygiene Division prepared for distribution in the schools a
handbook for the use of elementary teachers of our State. This hand-
book is entitled "Teaching Mouth Health in North Carolina." It
has been wlel received, and as a recognition of this contribution,
the North Carolina Dental Society at its meeting this year conferred
the honor of making her an honorary member of the North Carolina
Dental Society, the first woman layman to receive such an honor
in the State Society.

In the Division of Industrial Hygiene, the year 1941 witnessed
the completion of an examination of some two thousand men em-
ployed to drive nine miles of tunnel in connection with the construc-
tion of two hydro-electric power plants in Western North Carolina.

A profound influence on all public health activity in North Caro-
lina at the close of 1941 was the treacherous attack by Japan on
the United States by a stab in the back without declaration of war
at Pearl Harbor on December 7. This yellow act of treachery nat-
urally has had a profound influence on all public health activities
in the State from the first moment that the people received infor-
mation of this treachery.

At the annual conjoint session of the State Board of Health and
the North Carolina Medical Society held in Pinehurst, the terms
of office of Doctors S. D. Craig and W. T. Rainey having expired,
both were unanimously reelected for an additional term of four
years.

The total expenditures for the State Board of Health for the
fiscal year ending June 30, 1941, were $1,596,038.31. Of this amount
$390,916.50 was appropriated by the Legislature, $19,000 of which
was a special appropriation to the Laboratory, $173,398.34 by the
Zachary Smith Reynolds Foundation for syphilis control work,
$387,912.36 in general and $200,749.20 V. D. by the United States
Public Health Service, $185,356.56 Maternal and Child Health and
$111,509.78 Crippled Children by the United States Children's Bureau,
and $146,195.27 miscellaneous items for Laboratory fees, etc.

1942. Early this year arrangements were made through a meeting called
by the Governor, of the county school superintendents and other
interested persons to have a physical examination made of all the
high school students particularly in the last two grades of the
high schools. After several committee meetings the officials of the
State Medical Society, the State Dental Society, the State Depart-
ment of Public Instruction, the school and health officials of the

North Carolina Board of Health 51

county and with the representatives of the State Board of Health,
this plan was carried out.

Dr. D. F. Milam, who had been carrying on with his assistants
some interesting surveys in the community around Bynum in
Chatham County, completed that service and early this year moved
on to Wayne County for more intensive activities in the field of
nutrition there. Dr. Milam, who is a loan to the State Board of
Health by the Rockefeller Foundation, has a personnel of about five
people and is conducting a splendid program in nutrition. His office
is located at Duke University, his home is in Chapel Hill, and he is
therefore in close contact with both institutions.

In this connection, one of the most significant moves made in
the State Laboratory of Hygiene has been the setting up of a
nutrition department under the direction of Dr. Bailey Webb. The
work in nutrition has received tremendous impetus on account of the
food situation throughout the world as a result of the global war now
enveloping the earth.

Early in January this year, Dr. John F. Kendrick who was a loan
to the State Board of Health also from the Rockefeller Foundation,
retired from his connection heretofore with the School of Health
Coordinating Unit and Dr. Walter Wilkins, the Coordinator, assumed
entire responsibility for the School Health Coordinating program.
This was consummated at a meeting of the Advisory Committee of
that service held in the office of the State Superintendent of Public
Instruction on January 21, 1942. Dr. Kendrick was allowed to con-
tine his service in North Carolina as a consultant in the State Board
of Health in order to complete the nutritional organization through-
out the State. Dr. Reynolds was appointed Chairman of the State
Nutrition Council and Dr. Kendrick is his official assistant. Dr.
Kendrick's work is largely in the promotion of organization of this
work throughout the State on a county basis.

On January 1, 1942, Dr. G. M. Cooper was retired from the editor-
ship of the State Health Bulletin and Dr. John H. Hamilton assumed
the duties of acting editor. Dr. Cooper completed his service of 19
years' editorship of this publication and at his insistent request his
resignation for this service was accepted. Very complimentary
editorials appeared in the Southern Medicine and Surgery and in the
North Carolina Medical Journal concerning his work over the years
as director of health education for the State Board of Health and his
work as editor of the Health Bulletin.

At a meeting of the State Health Coordinating Service in Super-
intendent Erwin's office on May 8 of this year, the resignation of
Dr. Walter Wilkins as Coordinator in the service was accepted to
become effective June 1. A committee composed of Dr. G. M. Cooper,
Chairman, Mr. Charles E. Spencer, and Dr. Oliver K. Cornwell were
appointed to take temporary charge of the work of the dh ision and
to have authority for the conduct of the summer health conferences
to be held in four of the State's institutions. This committee was
able to set up all the machinery for each one of the conferences and
to conclude a most satisfactory summer's health course in the Wo-

52 Thirty-Fourth Biennial Report

man's College of the University of North Carolina at Greensboro,
Bennett College, a Negro institution at the same place, North Caro-
lina College for Negroes at Durham, and the University of North
Carolina at Chapel Hill. All of these conferences comprising a six
weeks' course in each place were concluded with highly satisfactory
results under the direction of the committee and with Mr. Spencer
being in charge of the detailed execution of the plans, assisted in
the Negro institutions by Dr. Walter J. Hughes, a colored physician
on the staff of the State Board of Health.

In May of this year, the maternity and infancy clinics set up
under the Division of Preventive Medicine reached a total of 308
established in 74 counties of the State. Some two hundred private
physicians were participating at intervals in the program of exami-
nation for indigent women and well babies received in these clinics.
Before July 1, however, the department was feeling seriously the
inroads made by so many cooperating physicians both in the division
of Preventive Medicine and in that of Epidemiology, who were as-
suming duties in the military forces of the country. The postgrad-
uate course in Duke Medical School conducted by the Division of
Preventive Medicine had to be discontinued by mid-summer on
account of the shortage of physicians in private practice due to such
depletion of the service, as mentioned before.

In the Division of Industrial Hygiene, the year 1942 was marked
by the receipt of a substantial amount of lend lease equipment from
the U. S. Public Health Service. A full-time well qualified chemist
was also provided on the same basis, and from the same source.

Up to July 1 at the close of the period covered by this chronology,
county health work had been extended to include 84 counties, Pas-
quotank County being the last to come into the service.

On May 31, Dr. Ralph Sykes who had been an assistant in the
department of Epidemiology was commissioned a reserve officer in
the Army with the rank of Captain, and resigned from the State
Board of Health. His place had not been filled up to July 1.

On May 1, Dr. Merl J. Carson of Wilmington, a qualified pedi-
atrician joined the service of the Division of Preventive Medicine
as a consultant pediatrician. On June 1, Robert B. Lawson com-
pleted his assignment of two years with the State Board of Health
in the conduct of the postgraduate courses at Duke and as consultant
in pediatrics to assume his duties by prearrangement as associate
professor of pediatrics in the Bowman Gray Medical School of Wake
Forest College at Winston-Salem. Dr. George K. Anderson of Roch-
ester, New York, a qualified pediatrician, was secured to take the
place of Dr. Lawson.

On June 9, at the annual commencement of the University of North
Carolina, the honorary degree of Doctor of Laws was conferred upon
Dr. George M. Cooper, Director of the Division of Preventive Med-
icine, who had completed at that time twenty-seven years' consecu-
tive service as a member of the executive staff of the State Board
of Health. The first such honor conferred upon a State health official
was a similar degree conferred by the University upon Dr. Thomas

North Carolina Board of Health 53

F. Wood in 1888, four years before Dr. Wood's death and after he had
served for several years as the first State Health Officer. The second
was a similar degree conferred upon Dr. Richard H. Lewis by the
University in 1912, three years after he had terminated his seventeen
years' service as State Health Officer. A third degree of Doctor of
Science was conferred by the University upon Dr. Clarence A. Shore
in 1929 after he had concluded twenty-one years' service as Director
of the State Laboratory of Hygiene. By the time of his retirement,
or soon after, as State Health Officer in 1925, Wake Forest College
and Duke University each conferred an honorary degree upon Dr.
W. S. Rankin. About a year later, Davidson College conferred a
similar degree.

The total expenditures for the State Board of Health for the
year ending June 30, 1942, were $1,791,878.11. Of this amount
$370,150.59 was appropriated by the Legislature, $65,403.89 of which
was for the State Laboratory, $178,405.32 by the Zachary Smith
Reynolds Fund for syphilis control work, $418,515.61 general and
$317,280.68 venereal dosease fund by the U. S. Public Health Service,
$227,703.77 maternal and child health and $120,121.24 crippled chil-
dren's funds by the U. S. Children's Bureau, and miscellaneous
receipts consisting of bedding, dental and Laboratory fees totaling
$159,700.90.

There were some staff changes during the latter part of the year
1942. Following the resignation of Dr. Walter Wilkins, who re-
signed from his position as head of the School Health Coordinating
Service, Dr. W. P. Jacocks, a native of North Carolina who had
served as a staff officer of the International Health Board mostly in
foreign service for the past thirty years, and who was retired from
that service, was induced to accept the place vacated by Dr. Wilkins.
Dr. Jacocks assumed direction of the department on October 5 of
this year. He immediately proceeded to reorganize the School Health
Coorodinating Service and later on in the year a complete staff was
secured. By the late Autumn work was fully under way in that
department in a number of counties.

In July of this year a joint State-Federal project for the production
and evaluation of venereal disease educational materials was spon-
sored by the U. S. Public Health Service and the Zachary Smith
Reynolds Foundation as an adventure in this specialized field of
venereal disease education. The institute was set up to originate
educational materials, to demonstrate them and to evaluate their
impact under the direction of Mr. Capus M. Waynick. Mr. Waynick
is an experienced newspaper editor and a former high official of
the State Highway Commission.

During this year the Division of Public Health Nursing in the
School of Public Health at the University of North Carolina got
underway with a full class who received degrees at the June com-
mencement. The Public Health Nursing Division under the direc-
tion of Miss Ruth W. Hay as Professor of Public Health Nursing
and with the assistance of Miss Margaret Blee as Assistant Pro-

54 Thirty-Fourth Biennial Report

fessor and Assistant Director completed a most successful scholas-
tic year. Thirty-eight nurses were enrolled in the year's course.

In the Autumn of this year the employees of the State Board of
Health organized and established what is officially known as the
North Carolina Academy of Public Health at the State Board of
Health. All employees of the State Board of Health are members of
this Academy and are required to attend monthly meetings. The
objective is to review the entire program of the various divisions
in order that each employee may have a general knowledge of the
coordinated whole. This organization endeavors to act as a con-
tinuous refresher course and is designed to promote closer coopera-
tion and social interest through the occasional gatherings for that
purpose. The usual attendance is about 125. The officials of this
organization elected at its organizational meeting were Dr. George
M. Cooper, President, Dr. E. A. Branch, Vice President, and Mrs.
Anne B. Edwards, Secretary and Treasurer.

The total expenditures for the State Board of Health for the
year ending June 30, 1942, were $1,791,878.11. Of this amount
$370,150.59 was appropriated by the Legislature, $65,403.89 of
which was for the State Laboratory, $178,405.32 by the Zachary
Smith Reynolds Fund for syphilis control work, $418,515.61 gen-
eral and $317,280.68 venereal disease fund by the U. S. Public
Health Service, $227,703.77 maternal and child health and $120,-
121.24 crippled children's funds by the U. S. Children's Bureau, and
miscellaneous receipts consisting of bedding, dental and laboratory
fees totaling $159,700.90.

1943. The chronology for this year and the year following will be greatly
condensed. The reason for this is lack of time for proper prepara-
tion on the part of the editors of the chronology who at the time
of the preparation of this manuscript are overwhelmed in duties in-
volved in the administration of the increased work necessitated by
war demands. Another reason is the scarcity of print paper re-
quiring brevity. It is understood that when peace is restored for
the world and the department is able to resume its normal functions
that the very unusual amount of activity carried on by a large number
of persons in this period will be carefully and accurately set forth
in the next volume of these reports which should be issued two years
from now.

During this year, the work of the Board of Health was expanded
in every direction. During 1943, the terms of Drs. G. G. Dixon and
John LaBruce Ward as members of the State Board of Health ex-
pired. They were reelected by the State Medical Society to succeed
themselves, each to serve an additional four-year term which will
expire in 1947. Dr. H. Lee Large, whose term expired in 1943, was
reappointed by the Governor for a term of four years to expire in
1947. Dr. H. G. Baity, whose term as a member of the Board expired
in 1943, was not reappointed by the Governor because of the fact that
he had been given a leave of absence for a period of three years from
his duties as Professor of Sanitary Engineering at the University of
North Carolina for some important work with the U. S. Government

North Carolina Board of Health 55

to be done in South America. Dr. Baity's absence was expected to
cover at least three years. The Governor appointed to serve in his
place Dr. J. O. Nolan, a practicing physician of Kannapolis, his
term to expire in 1947. In 1943, Mr. C. C. Fordham, Jr., of Greens-
boro, whose term was to expire in 1943, resigned to accept a com-
mission in the armed service. The Governor appointed Mr. Larry
I. Moore, Jr., a member of the Legislature from Wilson, North Caro-
lina, to succeed Mr. Fordham, his term to expire in 1945.

During this year, arrangements were made for the establishment
of a chair in the School of Public Health at the State University
to teach a health education training course. Dr. Lucy S. Morgan
was engaged as instructor in this field. Dr. Morgan was assigned to
the State of North Carolina by the U. S. Public Health Service to
inaugurate this work. Through the office of Dr. Mayhew Derryberry,
Chief of Field Activities in Health Education of the U. S. Public
Health Service, twenty fellowships were secured to provide for
courses in this field of health education from the W. K. Kellogg
Foundation of Michigan. Students entering on these fellowships
come from all parts of the United States. These fellowships pay
the recipients tuition and allow them a stipend for living expenses.

During this year, Mr. Warren H. Booker, who had been director
of the Division of Sanitary Engineering since 1931, was placed on
the retired list and Mr. J. M. Jarrett was appointed as his successor.

In the department of Central Administration, Miss Sara Wilk-
erson was employed as Personnel Officer and in charge of the enforce-
ment of the Merit System regulations in so far as employment of
workers in the State Board of Health is concerned. After several
years' efforts and pressure from the Federal Government, a system
of merit examinations was set up. All employees of the State Board
of Health beginning with this year, except strictly professional
service which has had to be deferred until the end of the present
war, are selected. Any new places or any replacements must be
filled from the list provided by the Merit System Supervisor. This
covers all of the department personnel except, as just stated, the
professional personnel.

In November of this year, the administrative supervisor of the
crippled children's department in the Division of Preventive Medi-
cine resigned after a little more than seven years' service. Fol-
lowing his resignation, there were some personnel changes in that
department resulting from resignations. The department was prac-
tically reorganized but the work is conducted under the medical
direction of the Division of Preventive Medicine .

Following some experimental work, which began in September,
1942, with funds allotted by the U. S. Children's Bureau, one of the
largest and most difficult programs ever undertaken by the State
Board of Health was expanded early in this year. Reference is
made to what is termed the EMIC program, the Emergency Ma-
ternity and Infant Care program, launched by the Federal Gov-
ernment for the purpose of providing free medical, nursing and
hospital care in maternity cases for the wives of the men in the

56 Thirty-Fourth Biexnial Report

four lower pay grades of all the armed services and to provide for
such care as the infants under one year of age of the same pay
grades of the same classes of service men. This work has been
a responsibility of the Division of Preventive Medicine in the de-
partment of material and child health services. It has necessitated
meticulous contracts between the Board of Health, the cooperat-
ing hospitals who accept these patients, the physicians who attend
them and any special nurses whose services are needed. Aid has
been provided for women in every county of North Carolina. The
work has been particularly heavy in this State because of the fact
that a number of camps training soldiers for overseas duty were
located here. Many of these young wives came to the vicinity of
the camps to be near their husbands. Some of these lived in
trailers, in crowded boarding houses and other undesirable places.
It has been the duty of this department to secure the services of
a physician who will accept the fees allowed by the government
for complete maternity service, then to secure the contracts from
hospitals who would accept these patients on the government
terms which provide first class ward care. It has involved cor-
respondence entailing thousands upon thousands of individual let-
ters and much complicated financial and clerical work. As the year
closed, this problem was growing bigger and bigger. More will be
said about it and some of the results which have been accomplished
will be mentioned in the chronology for 1944.

A division of consultant nurses was enlarged and expanded by
which the State was divided into districts and the administration
of public health nursing from the State level was carried on by
these consultant nurses under the general supervision of the local
health administration. This service does not include the highly
specialized service necessary in the department of crippled chil-
dren. The nurses in that department, two at present, carry on
the highly specialized nursing required in the conduct of the
clinics for the examination and later treatment of crippled chil-
dren.

One of the new installations in this year was the establishment
of a multilith department under a competent operator. This has
relieved to some extent the demands on our printing as well as
mimeographing.

The total expenditures for the State Board of Health for the fiscal
year ending June 30, 1943, were $1,880,230.62. Of this amount
$406,993.29 was appropriated by the Legislature, $67,432.62 of which
was for the State Laboratory, $179,883.10 by the Zachary Smith
Reynolds Fund for syphilis control work, $289,981.30 general and
$463,125.09 general disease fund by the U. S. Public Health Service.
$184,807.17 maternal and child health and $123,538.79 crippled chil-
dren's funds by the U. S. Children's Bureau, and miscellaneous re-
ceipts consisting of bedding, dental and Laboratory fees totaling
$132,901.88.

Two Rapid Treatment Centers for the cure of venereal diseases
were opened in North Carloina during the year. One is located

North Carolina Board of Health 57

in Charlotte, the other in Durham. The Charlotte Center, opened
August 13, is financed out of Lanham Act funds, provided by
Congress, and certain funds at the disposal of the State Board of
Health, and is operated as a State enterprise, though staffed largely
by United States Public Health Service officers. The Durham
Center, also supported by Lanham Act funds, is operated by the
United States Public Health Service, in cooperation with the State
Board of Health. It was opened November 16.

1944. The summary of activities which may be recorded this year is
simply a statement of the continuation of activities in every de-
partment of the State Board of Health which was underway in
1943. No new work has been established during the first six
months period of 1944 covered by this report, except the enlarge-
ment and continuation of work heretofore carried on. It should be
noted here that one of the employees, Mr. James Cooper of the
Laboratory of Hygiene, who was on leave of absence to serve in
the U. S. Air Corps, was killed over Rumania while performing his
duties as a member of the crew of one of the big bombers attack-
ing the Ploesti oil field. Another young engineer, Mr. Charles H.
King, who was for seevral years employed in the Industrial Hygiene
Division, died of meningitis while serving in the Army in Italy.
Mr. King had left the service of the Board a few months before
going into the armed services. He left the Board to accept service
as an engineer in another State Health Department. These young
men were valued employees of the State Board of Health and so
far as is known were the only employees so far killed in the armed
service.

Early this year, the State Board of Health inaugurated a rather
drastic change in the local administration of health work. Hereto-
fore this work was grouped under the Division of County Health
Work with a single director in charge. The department was re-
organized on a basis of divisional representation. Three districts
were set up, the eastern district in charge of Dr. Joseph C. Knox,
the middle district in charge of Dr. R. E. Fox, and the western dis-
trict in charge of Dr. J. Roy Hege. The purpose is to have more
direct representation between the representatives of the State Board
of Health and the local health authorities and to expedite the
solution of the problems arising on the basis of administration.
This arrangement was particularly deemed necessary on account
of the problems related to the enforcement of venereal disease
control through the entire State, as well as the many financial
problems arising continually.

Dr. J. C. Knox resigned and left the service of the State Board
of Health on June 30 for the purpose of entering private practice
as a pediatrician in the City of Wilmington. Dr. Knox had been
with the Board since he completed his postgraduate work in public
health at Harvard University in 1931 and 1932. He was one of
the most popular officials of the State Board of Health organiza-
tion, and his departure was greatly regretted by everybody connected
with the organization.

58 Thirty-Fourth Biennial Report

During this biennium, Dr. Carl V. Reynolds, State Health Of-
ficer, completed his term of office as President of the State and
Territorial Health Authorities of North America. Dr. Reynolds
served this term during the most hectic period of the preparation
for war work when a great many public health measures were
adopted and put into effect.

In the Division of Preventive Medicine, the administration of
the Emergency Maternity and Infant Care Program continued to
absorb most of the energies and resources of that department.
Authorizations for medical care and hospitalization of maternity
cases continued at between thirteen and fourteen hundred women
a month as the biennium closed. Up to the end of the year, nearly
one-half million dollars have been paid out for the completion of
the care for more than five thousand women and several hundred
infants of eligible service men. It is now clear that had Congress
not made provision for this program and if the different States
had not arranged for its prompt administration, literally thousands
of women throughout the country would not have been able to
procure medical or hospital care during confinement. The law has
been impartially administered in this State. The wives and babies
of service men of the four lower pay grades of any of the armed
services who wanted to avail themselves of this aid have had it
provided, regardless of social or financial standing. Funds to carry
on this work, as above stated, were appropriated by Congress, at
the beginning of the fiscal year, and the money is allotted on indi-
vidual states by the U. S. Children's Bureau of Washington. Nat-
urally, in any program involving the expenditure of as much money
and requiring the cooperation of practically all the practicing physi-
cians in the country who do general practice, including obstetrics,
and with the pediatricians, as well as the hospitals and nursing
profession, has resulted in the establishment of a great many rules
and regulations by the Washington bureau, some of which have
been inflexible and which caused some friction in the administra-
tion. However, for the most part practically all the hospitals in
North Carolina with two or three notable exceptions have cooperated
wholeheartedly and several hundred practicing physicians have also
participated in the service.

On September 1, 1944, Dr. William P. Richardson, District Health
Officer of the Chapel Hill District, succeeded Dr. J. C. Knox, re-
signed, as Director of the Eastern District of the Local Health
Administration Division. On September 1, Dr. William D. Hazel-
hurst of the U. S. Public Health Service joined the staff of the
Division of Local Health work as a consultant in the V. D. program.
Miss Mary Batchelor, field representative with the Division of Local
Health Administration, which position she had most acceptably
filled for many years, resigned her position effective September 30
of this year. Miss Batchelor was a very popular representative
of the Board and resigned to marry a member of an old Kentucky
family. Miss Batchelor was succeeded by Miss Sarah Goggans as
field representative. Miss Goggans being transferred from the posi-

North Carolina Board of Health 59

tion as head of the Central Filing System, and assumed her new
duties on January 1, 1945.

Early this year Governor Broughton appointed a Commission of
State-wide significance, known as the "Hospital and Medical Care
Commission," composed of fifty citizens of the State. Dr. Clarence
Poe of Raleigh was made Chairman. Doctors Carl V. Reynolds and
George M. Cooper were appointed to serve on this Commission along
with several physicians including Dr. Hubert B. Haywood, a member
of the State Board of Health. The purpose of this Commission was
to make a careful study of the existing medical and hospital facilities
and the lack of such facilities in all parts of the State, and to make
recommendations to be presented to the incoming Legislature of
1945. The Commission did a thorough job and recommended that the
two-year medical school of the University of North Carolina at
Chapel Hill be expanded into a four-year school, and that the school
be provided with a large central teaching hospital, and that several
hospitals be built in areas of the State now without any facilities
at all.

The total expenditures for the State Board of Health for the year
ending June 30, 1944, were $2,203,805.31. Of this amount $439,213.47
was appropriated by the Legislature, $65,240.38 of which was for
the State Laboratory, $178,188.05 by the Zachary Smith Reynolds
Fund for syphilis control work, $391,043.73 general and $424,064.75
venereal disease fund by the U. S. Public Health Service, $524,228.04
maternal and child health and $124,035.65 cripple children's funds
by the U. S. Children's Bureau, and miscellaneous receipts consisting
of bedding, dental and Laboratory fees totaling $123,031.62.

1945. Dr. J. Roy Hege resigned his connection with the Division of Local
Health Administration as of June 30, 1944, to return to Winston-
Salem as District Health Officer for Forsyth, Stokes, Davie, and
Yadkin counties. After serving in this capacity for one year he
returned to the State Board of Health July 1, 1945, and resumed his
old position as Director of the Central District of the Division of
Local Health Administration. Miss Mary Louise Hewitt resigned
from the staff as a consultant in public health nursing connected
with the Local Health Administration Division effective March 31,
1945. Miss Lila Anderson of the U. S. Public Health Service was
assigned to the State Board of Health in the capacity of consultant
nurse effective December 15, 1945.

On September 1, 1945, Dr. W. P. Jacocks resigned as Director
of the School Health Coordinating Service and was succeeded by
Dr. E. H. Ellinwood effective on the same date. Miss Bessie Beale,
colored nutritionist, was appointed to the staff of the Coordinating
Health Service effective June 1, 1945. On May 15, 1945, Mrs. Anne
Cain became a member of the nursing staff of the Coordinating
Health Service. Miss Jennie L. Douglass, colored health educator,
resigned her position with the Coordinating Health Service July
1, 1945.

In 1945 Dr. John F. Kendrick, who had organized the Nutrition
Division as early as 1942, was recalled in August of this year by

60 Thirty-Fourth Biennial Report

the Rockefeller Foundation for foreign service. Dr. W. P. Jacocks
succeeded him as Director of the Nutrition Division effective Sep-
tember 1, 1945, on the same day he resigned from the Directorship
of the School Health Coordinating Unit. During this year Miss
Mary Parks Bell was appointed to one of the positions of nutritionist
and assumed her duties in August. Mrs. Mary W. Thrasher resigned
her position as nutritionist in the department in July. The prin-
cipal development in the year in the Nutrition Division was the
organization of nutrition consultant service to health and school
administrations and community organizations.

At a meeting in Pinehurst on May 2, 1944, the State Board of
Health authorized the creation of a Bureau of Tuberculosis Con-
trol to be set up as a part of the State Board of Health. At this
time no funds had become available for the administration of such
new activities. However, the Division of Industrial Hygiene had
been operating in this capacity on a part-time basis as a pilot plant.
This experiment had been carried on with aid and assistance from
the U. S. Public Health Service, and as early as January, 1944, some
forty-two thousand industrial employees had been examined. The
findings had been such that the need for this new work was unques-
tionably great. The Bulwinkle Bill proposing Federal grant-in-aid
funds for the control of tuberculosis had already been introduced.
The State Health Officer requested the 1945 General Assembly to
make an appropriation with which to administer such grant-in-aid
funds as might be forthcoming. House Bill No. 11, Chapter 279,
Section 18 — 1945 Session Laws of North Carolina authorized the
appropriation . . . "to supervise the Federal tuberculosis program
in this State. . . ." The first monies actually became available for
this purpose late in the spring of 1945. Dr. T. F. Vestal, Director of
Industrial Hygiene since 1939, was made director of the new Bureau
of Tuberculosis Control, and has since been diligently engaged in
securing the necessary equipment and personnel, and in getting the
program under way. The Bureau is operating this year with a
budget of two hundred seventy-one thousand dollars and to date has
made chest X-ray examinations on aprpoximately one hundred and
fifty thousand citizens of the State.

On January 1, 1945, Dr. T. F. Vestal, who was transferred to head
a new Bureau of Tuberculosis Control, was succeeded as Director
of the Division of Industrial Hygiene by Dr. C. B. Davis of Wil-
mington.

On October 1, 1945, Dr. R. T. Stimpson, Director of the Division
of Vital Statistics, resigned to enter private practice. The Division
of Vital Statistics was on that date combined with the Division of
Epidemiology with Dr. C. P. Stevick as Director. Dr. Stevick has
been Director of the Division of Epidemiology since December 15,
1943 at which time Dr. J. C. Knox, former Director of that Division,
had been made a District Director of the Division of Local Health
Administration. The newly organized Division of Vital Statistics
and Epidemiology offers an opportunity for the development of
graphic statistical data regarding morbidity and mortality with

North Carolina Board of Health 61

which to educate the public regarding the needs of approach to the
public health problems of the State.

The 1945 Legislature established a State Stream Sanitation and
Conservation Study Committee. The Chairman of that Committee
was Mr. J. M. Jarrett, Director of the Division of Sanitary Engineer-
ing of the State Board of Health. It is hoped that this action of the
Legislature will eventually result in abatement of stream pollution
in North Carolina which has been for some years a serious problem.
A survey of the waste problem is also under way by this Committee.
During this year, the Public Health Service expanded its endemic
typhus fever control program and considerable work has been done
in the ratproofing of buildings and dusting with DDT. Typhus mor-
bidity has shown a great decrease, which is attributed to the DDT
dusting program, as well as other measures of control. A milk
laboratory was established at Lexington for control purposes in that
area of the State. This laboratory has been placed under the super-
vision of the Division of Sanitary Engineering. Complete bacterio-
logical and sanitary surveys were made of all shellfish growing
areas in the State, in cooperation with the Public Health Service,
over 5,000 water samples being examined. Through cooperation with
the State Department of Conservation and Development and the
U. S. Geological Survey, the Laboratory of the U. S. Geological Survey
was moved from State College to the Laboratory of Hygiene Build-
ing and complete chemical and mineral analyses are being made of
all public water supplies in the State.

In this year, the Division of Preventive Medicine was overwhelmed
with work in connection with the administration of the Emergency
Maternity and Infancy Care Program. About one million dollars
was expended during the year in payment for hospitalization and
medical service for maternity care of wives of servicemen in the
lower four pay grades of the armed service. This work continued
to require an immense amount of personal correspondence and at-
tention to thousands of administrative details. The accounting de-
partment was perfected early in the year under the direction of Mr.
B. P. Pearson, aided by the stenographic and other personnel of the
office. By the end of the year this department was functioning
smoothly, bills were being paid both to hospitals and physicians as
rapidly as possible. In June of this year, Dr. Merl J. Carson who
was for more than three years a consultant in pediatrics attached to
the Division resigned to become associated with the faculty of Wash-
ington University Medical School in St. Louis. Dr. Carson's leaving
left the Director of the service as the only physician connected with
the entire program including that of crippled children's work. This
placed a heavy burden upon the shoulders of the lone Director, but
owing to scarcity of physicians and war service and otherwise, it was
not possible to secure a successor for Dr. Carson or a senior physi-
cian in the Crippled Children's Department so badly needed.

For the first year since the State Board of Health was organized
in 1877 there was no annual meeting of the North Carolina State
Medical Society, and hence no report of the Board to a Conjoint

62 Thirty-Fourth Biennial Report

Session. This was because of war emergency and restrictions on
conventions and travel.

The Legislature enacted some laws toward the close of the ses-
sion "accepting in principle" the report of the Broughton Medical
Care Commission. Governor Cherry, upon whose recommendation
the Legislature acted, appointed a new and smaller Commission
endowed with extensive powers to make new studies of the needs
for medical care, etc. Among other powers given to this Commission,
whose Chairman is James H. Clark of Bladen County, is the sole
power to administer the funds appropriated by the Legislature for
aid in hospital care for those who need and claim it. They also
have the sole responsibility for deciding what areas of the State may
have aid from Federal funds as well as State, in building new hos-
pitals and expanding present facilities.

The total expenditures for the State Board of Health for the
year ending June 30, 1945, were $2,807,963.50. Of this amount $430,-
827.80 was appropriated by the Legislature, $66,545.75 of which was
for the State Laboratory, $171,948.80 by the Zachary Smith Reynolds
Foundation for syphilis control work, $384,220.61 general, $377,570.23
venereal disease and $1,937.56 for tuberculosis by the U. S. Public
Health Service, $153,722.78 maternal and child health, $990,129.61
emergency maternity and infant care, and $119,144.95 crippled chil-
dren's service by the U. S. Children's Bureau, and miscellaneous
receipts consisting of bedding, dental, V. D., printing, and Laboratory
fees, totaling $178,461.16.

1946. Dr. E. H. Ellinwood resigned his position as Coordinator of the School
Health Coordinating Service effective June 30, 1946.

On January 30, 1946, Dr. C. B. Davis resigned his position as
Director of the Division of Industrial Hygiene. He was succeeded
by Dr. Otto J. Swisher, who assumed his duties February 1, 1946.
Early in this year, Mr. W. E. McCormick, who was with this Divi-
sion on a lend-lease basis from the U. S. Public Health Service, re-
signed and left the Division to join the Georgia State Department
of Health. The activities of this Division despite the numerous
personnel changes have gone along in about the usual manner. The
major portion of the time and effort is necessarily spent in dusty
trade activities. However, the entire time of the mobile X-ray unit
is not taken up with this type of work and has assisted on numerous
occasions with tuberculosis surveys in various industries throughout
the State. During the early months of this year, efforts have been
exerted to bring up-to-date the work in the foundries throughout the
State. This particular phase of the work, during the war years, had
been allowed to assume a minor role due to the stress placed upon
the various mining industries, chief among which was the mica
mining which was such an important war material.

Miss A. Helen Martikainen of the U. S. Public Health Service,
who joined the staff of the Division of Local Health Administration
as assistant director of health education as of December 1, 1944,
was recalled by the Public Health Service effective June 30, 1946.
Miss Martikainen's contribution to public health education work in

North Carolina Board of Health 63

North Carolina was of- material value. Mr. Horace Holmes, Jr.,
of the U. S. Public Health Service, became a member of the staff of
the Local Health Administration Division January 1, 1946. Mr.
Holmes' work has largely been in dealing with surplus property and
studies in connection with V. D. control. In his work dealing with
surplus property, Mr. Holmes has assisted Dr. S. D. Craig who for
several months of this year had charge of the surplus property dis-
posal work for the State Board of Health. Miss Idell Buchan was
transferred from the staff of the Division of Preventive Medicine to
the position of consultant public health nurse in the Division of
Local Health Administration on January 15 of this year. On June
30, the Local Health Administration Division lost a valuable con-
sultant in public health nursing when Miss H. Lillian Bayley resigned
her connection with the Division to accept a position as supervising
public health nurse in New Hanover County.

A trailer laboratory has been constructed for use in the Division
of Sanitary Engineering for work in the milk, municipal, water,
shellfish, and sewage disposal problems connected with the Division.
The program of abattoir construction has developed satisfactorily
during 1945 and the early portion of 1946. There are now, as of
June 30, 1946, over one hundred approved abattoirs in the State.

On January 15, Dr. John W. Mahoney, obstetrician connected with
the Gallinger Hospital in Washington for several years, joined the
staff of the Division of Preventive Medicine as a consultant in ob-
stetrics. Miss Jean Donald was employed as a medical social worker
and assumed her duties on May 1 with the Department of Crippled
Children.

During this year Mr. Capus M. Waynick resigned as head of
the Division of Venereal Disease Education Institute and was suc-
ceeded by Mr. T. C. Johnson acting. Miss Maggie Blackburn, a trusted
employee of the State Board of Health for more than twenty years,
continued ill and a patient in the Wake County Sanatorium. Mrs.
Mary Cross, an employee of the Vital Statistics Department for more
than twenty years, was retired.

The whole State public health service suffered a serious blow in
the death of Dr. Milton J. Rosenau, since 1936 head of the Public
Health School of the University of North Carolina, which occurred
at his home in Chapel Hill, April 19, 1946.

As of June 30, the members of the State Board of Health in office
were: Dr. S. D. Craig, President, Winston-Salem; Dr. J. N. Johnson.
Vice-President, Goldsboro; Dr. G. G. Dixon, Ayden; Dr. H. Lee Large,
Rocky Mount; Dr. W. T. Rainey, Fayetteville; Dr. Hubert B. Hay-
wood, Raleigh; Dr. John LaBruce Ward, Asheville; Dr. James O.
Nolan, Kannapolis, and Mrs. Casper C. Jackson, Lumberton.

The total expenditures for the State oBard of Health for the year
ending June 30, 1946, were $2,901,386.60. Of this amount $510,504.65
was appropriated by the Legislature, $75,879.63 of which was for
the State Laboratory, $179,593.90 by the Zachary Smith Reynolds
Fund for syphilis control work, $414,501.42 general, $384,633.85 vene-
real disease and $49,396.23 tuberculosis control fund by the U. S.

64 Thirty-Fourth Biennial Report

Public Health Service, $151,212.21 maternal and child health,
452.47 emergency maternity and infant care, and $120,445.64 crippled
children's funds by the U. S .Children's Bureau, and miscellaneous
receipts consisting of bedding, dental and laboratory fees totaling
$142,646.23.

1947. The principal item of interest worth recording in this chronology
during the year 1947 was the biennial meeting of the State General
Assembly. The session lasted for about three months and was marked
by about the usual interest in a General Assembly which meets in
the mid-term of a Governor. The appropriation made to the State
Board of Health remained about the same as allocated by the pre-
vious Legislature. Not many changes were made in the laws con-
cerning State health work. The State Health Officer submitted some
legislation for the purpose of conferring authority on the State Board
of Health to regulate the milk industry of the State. The Legislature
refused to enact the requested legislation made by the State Health
Officer.

For at least a quarter of a century, the State Board of Health
had repeatedly sought legislation conferring definite authority on
the Board for the purpose of assuring a safe milk supply to the
people of the State. The sole interest of the Board of Health at
all times in this matter was to protect the public from the pur-
chase of unsafe milk. The General Assembly had never conferred
the required authority on the State Board of Health in this field
and so the General Assembly of 1947 followed the action of most
of its predecessors and refused to enact this legislation. As the
legislation requested by the Board of Health was turned down by
the General Assembly, the State Commissioner of Agriculture set
up regulations under the general authority of law possessed by the
Department of Agriculture, especially under the authority conferred
by the Federal and State Pure Food and Drug Laws which the De-
partment of Agriculture is charged with enforcing. The Governor
and Commissioner of Agriculture appointed a commission to make
further studies of the milk industry and the marketing of milk from
the standpoint of safety. This commission had not made a report
prior to June 30, 1948, which is the period covered by this report.

During the fiscal year ending June 30, 1947, very few material
changes took place in the administration of the State Health Depart-
ment. The Legislature of 1947 enacted some other laws which affected
certain administrative procedures of the State Board of Health. The
most important were the following:

The existing laws permitting the organization of district boards
of health were revised to permit the State Health Officer to appoint
ex-officio members in cases of vacancies. This further strength-
ened the district board of health plan so as to permit more satis-
factory function of health departments covering two or more counties.

The existing statutes pertaining to the State Stream Sanitation
and Conservation Committee were revised so as to permit more
effective function in solving the serious problems existing in the
State with regard to stream pollution.

North Carolina Board of Health 65

The State Board of Health was authorized to issue photostatic

copies of birth certificates to have full legal value as certified copies.

The State laws pertaining to examination of school employees was

revised so as to require a more complete examination and that the

examination be performed annually.

One important arrangement perfected during the year was the
provision of photostatic copies of every maternal death certificate
coming to the State Board of Health from anywhere in the State
promptly on receipt of the monthly reports from the local registrars
throughout the State. This provision was made through contribution
of funds from the U. S. Children's Bureau sufficient to employ an
extra clerical worker in the Department of Vital Statistics to go
through all of the death certificates each month and to select these
items. The photostatic copies are sent monthly to Dr. Frank R.
Lock, chairman of the Maternal Welfare Committee of the North
Carolina State Medical Society. Dr. G. M. Cooper, Director of the
Maternal and Child Health Service of the State Board of Health,
is a member of that committee and through his office and the Depart-
ment of Vital Statistics this arrangement was perfected. The work
of the Maternal Welfare Committee under the very able chairman-
ship of Dr. Lock has already demonstrated what can be done toward
a further lowering of the maternal death rate in the State. This
was one of the most important features of the Maternal and Child
Health Service carried out during this year.

Dr. Paul E. Jones, a dentist of Farmville, Pitt County, North Caro-
lina, was appointed to membership on the State Board of Health
following the recommendation of the North Carolina Dental Society.
Dr. Jones' appointment was to fill the vacancy left by the death of
Dr. J. N. Johnson, long time member of the Board of Health who
died at his home in Goldsboro on December 2, 1946.

During this year Mr. M. M. Melvin, an employee of the Department
of Sanitary Engineering for twenty-seven years, resigned and left
the department for other work in the State.

As of June 30, 1947, the members of the State Board of Health
in office were Doctors S. D. Craig, Paul E. Jones, G. G. Dixon, H. Lee
Large, Hubert B. Haywood, W. T. Rainey, John LaBruce Ward, James
0. Nolan, and Jasper C. Jackson.

The State Board of Health and the N. C. Medical Society met in
annual session May 14, 1947, at Virginia Beach, Virginia. At the
meeting of the Board of Health at Virginia Beach, Dr. Carl V.
Reynolds was re-elected for a term of four years as State Health
Officer to begin July 1, 1947. Dr. George M. Cooper was re-elected
at the same time as Assistant State Health Officer for the same four
year period of service beginning July 1.

Miss A. Helen Martikainen, Health Education Consultant with
the U. S. Public Health Service, who was transferred from the
North Carolina State Board of Health to District No. 2 Office, Rich-
mond, Virginia, on August 1, 1946, was transferred to North Caro-
lina again on August 1, 1947, assigned to the Division of Local Health

66 Thirty-Fourth Biennial Report

Administration to assist with the development of a statewide health
education program.

Miss Lila Anderson, Nursing Consultant with the U. S. Public
Health Service assigned to North Carolina to assist with nursing
aspects of tuberculosis control program, was transferred from Nortb
Carolina on September 13, 1948.

Dr. J. Roy Hege, formerly connected with the Department of Local
Health Administration, was transferred to the Directorship of the
Department of Vital Statistics and Epidemiology. After a few
months' service, he resigned to accept the position of County Health
Officer for Cabarrus County.

The total expenditures for the State Board of Health for the year
ending June 30, 1947, were $2,814,937.00. Of this amount $561,996.00
was appropriated by the Legislature; $117,132.00 by the Zachary
Smith Reynolds Foundation for syphilis control work; $372,511.00
General, $351,033.00 Venereal Disease, $233,997.00 Tuberculosis Con-
trol, and $2,220.00 for Cancer Control by the U. S. Public Health
Service; $210,461.00 Maternal and Child Health, $663,520.00 EMIC,
and $168,350.00 Crippled Children's Service by the U. S. Children's
Bureau, and miscellaneous receipts consisting of bedding, dental and
laboratory fees totaling $133,717.00.

1948. The principal difficulty encountered by the State Board of Health
during this period, namely, the first half of the calendar year end-
ing June 30, 1948, has been the difficulty of obtaining necessary
professional help, such as physicians, physiotherapists, engineers,
dentists, medical social workers, etc., to carry on the work of the
State Board of Health. For the first time in the history of the
State, a large nuumber of county health officers today are receiving
much larger salaries than the top bracket staff officers of the
State Board of Health. This is not a healthy condition for the
State Health Department and it is to be hoped that the Legislature
of 1949 will make some provisions to remedy this situation. Nat-
urally, with the top bracket help held on a lower salary schedule
than similar professional people in other lines of activity, it results
in depressing the pay of the rank and file of the employees who are
suffering great hardship at this time on account of the inflation and
the comparatively low salaries paid. Much hardship is experienced
by some of these employees, many of whom have given faithful
service for many years.

There have been no changes in the membership of the State
Board of Health as recorded last year. Teh same personnel are
in office today that were in office a year ago. The most conspicu-
ous event taking place during this part of the biennium was the
resignation of Dr. Carl V. Reynolds as State Health Officer effec-
tive June 30. Dr. Reynolds retired after serving a little more
than 13^ years. As recognition of the work of Dr. Reynolds, the
State Board of Health at its meeting in Pinehurst May 5 voted a
bonus of $2,000.00 in cash to Dr. Reynolds to be paid from the
Reynolds Foundation administration fund, of which Dr. Reynolds
has been custodian for some years. In addition to this, the State

North Carolina Board of Health 67

Board of Health later on provided $1,000.00 additional bonus to Dr.
Reynolds from the Reynolds Foundation fund for his service as
a consultant for a few weeks following the assumption of office of
Dr. J. W. R. Norton on July 1.

The following changes in the staff took place during this period:

Dr. T. F. Vestal, Director of the Bureau of Tuberculosis Control,
having resigned, Dr. William A. Smith, a retired officer of the U. S.
Army Medical Corps, accepted the appointment as Director of that
Division.

Dr. Ivan Procter also accepted appointment as Director of the
Division of Cancer Control. Doctor Procter's appointment became
effective March 1, 1948, at which time the Division began an active
plan of statewide cancer control. Assisting Doctor Procter as Di-
rector, Mildred Schram, Ph.D., became Field Director.

At the meeting of the State Board of Health in Raleigh on Feb-
ruary 24, President Craig read Dr. Reynolds' letter of resignation
as Secretary and State Health Officer effective June 30, 1948. The
Board accepted Dr. Reynolds' resignation with sincere regrets. Fol-
lowing the acceptance of Doctor Reynolds' resignation, Doctor Nolan
of Kannapolis, member of the Board, moved that the President of
the North Carolina State Board of Health offer the position of Sec-
retary and State Health Officer to Doctor Thomas Parran, Surgeon-
General, U. S. Public Health Service. This was a few days after the
appointment of a successor to Doctor Parran by President Truman.
On March 31, 194S, having been informed by Dr. Parran that he
could not accept the appointment as State Health Officer, there was
a special call meeting of the State Board of Health which met in the
auditorium of the State Laboratory of Hygiene in Raleigh for the
purpose of electing a Secretary and State Health Officer, the appoint-
ment to become effective July 1. At a previous meeting of the Board,
a nominating committee had been appointed with Doctor Hubert
B. Haywood, member of the Board of Health from Raleigh, as chair-
man. Doctor Haywood reported that the committee had had a
difficult task to obtain the services of a successor to Doctor Reyn-
olds. Several names of physicians with their qualifications were
submitted to the Board at this time, some of them recommended by
friends and colleagues. At this meeting the Board of Health obtained
the cooperation of the State Budget Bureau in increasing the salary
of the State Health Officer to become effective July 1 to $10,000
annually. In the final balloting of the Board of Health, three
names were presented. Doctor J. W. R. Norton, native of Scotland
County and Chief Health Officer of the TVA of Chattanooga, Ten-
nessee, received a majority of the votes. Hence, Doctor Norton's
election was made unanimous. After the election of Doctor Norton,
Governor Cherry was notified, and the Governor immediately ap-
proved the election of Doctor Norton as required by law.

Effective June 24, Doctor R. Eugene Fox and Doctor William P.
Richardson, who had been Director and Associate Director, respect-
ively, of the Division of Local Health Administration, resigned.

The total expenditures for the State Board of Health for the year
ended June 30, 1948, were $2,648,277.00. Of this amount $794.77 1. no

68 Thirty-Fourth Biexnial Report

was appropriated by the Legislature; $11,981.00 by the Zachary
Smith Reynolds Foundation for syphilis control; $424,576.00 gen-
eral, $335,700.00 venereal disease control, $250,079.00 tuberculosis
control, and $35,794.00 cancer control by the United States Public
Health Service; $250,028.00 Maternal and Child Health, $206,183.00
EMIC, and $258,017.00 Crippled Children's Service by the U. S. Chil-
dren's Bureau, and miscellaneous receipts consisting of bedding,
dental and laboratory fees totaling $117,145.00.

On July 1, 1948, Dr. J. W. R. Norton assumed his duties as State
Health Officer. Induction ceremonies were held in the auditorium
of the State Laboratory of Hygiene. The oath was administered by
Chief Justice W. P. Stacey of the North Carolina Supreme Court and
the invocation was delivered by the Reverend Dr. Howard P. Powell,
Pastor of Edenton Street Methodist Church.

On July 17, 1948, the Executive Committee of the State Board of
Health reduced the period of quarantine of poliomyelitis patients
from three weeks to two weeks.

The State Board of Health met August 31, 1948. Dr. Ivan M.
Procter, Director of the Bureau of Cancer Control, gave an outline
of work accomplished up to that time. Dr. G. M. Cooper discussed
the proposed program for the care of premature babies. Dr. Charles
P. Stevick, Director of the Division of Epidemiology, appeared be-
fore the Board with spot maps showing the poliomyelitis epidemic
situation. He estimated that approximately 2,500 cases would be
reported by the end of the year.

There was a call meeting of the State Board of Health October 7,
1948. Matters pertaining to sanitation and milk production were
discussed.

1949. The year 1949 was destined to become a turning point in the Public
Health program in North Carolina. The Legislature of that year
did more for Public Health than any of its predecessors. There was
a spirit of close cooperation between Public Health officials, the
Governor and members of the General Assembly. As an outcome
of this, approximately $800,000 in new money was voted for each
fiscal year of the new biennium for local health work, which had
only been receiving $350,000 a year. This meant an increase to
$1,150,000 in State funds for local health during the biennium.
This legislative session passed various laws beneficial to Public
Health. Among other things, it established a single health depart-
ment in Guilford County in place of the three, namely, Guilford
County, Greensboro and High Point. Laws improving the vital
statistics procedures also passed by the 1949 Assembly.

It was during 1949 that provision was made to extend Public
Health services to every county in the State. Brunswick, Jones and
Madison counties came in on March 1, while Pamlico came in on
July 1 as the 100th county.

The State Board of Health met in conjoint session with the North
Carolina Medical Society at Pinehurst, May 11, as required by law.
The oath was administered to Dr. Hubert B. Haywood, who had

North Carolina Board of Health 69

been re-appointed by the Governor. The terms of Doctors S. D. Craig,
of Winston-Salem, and W. T. Rainey, of Fayetteville, having expired,
each expressed the wish that he be not re-elected by the State
Medical Society. Hence, Dr. John R. Bender, of Winston-Salem,
was elected to succeed Dr. Craig, and Dr. Ben J. Lawrence, of Ral-
eigh, was elected to succeed Dr. Rainey.

The terms of Dr. James O. Nolan, of Kannapolis, and Dr. Paul
E. Jones, of Farmville, dental member of the Board, both of whom
were appointed by the Governor, expired in 1949. To succeed them.
Governor Scott named Mrs. James B. Hunt, of Lucama, Route 1,
and Dr. A. C. Current, Dentist, of Gastonia.

On May 24, 1949, Dr. C. C. Applewhite became Director of the
Division of Local Health Services. During the interim between the
resignation of Dr. R. E. Fox, who became County Health Officer in
Albemarle and the appointment of Dr. Applewhite, Dr. John H.
Hamilton was in charge of this Division in addition to his duties as
Director of the Laboratory. Dr. Applewhite came to Raleigh from
New Orleans, where he had been stationed as Regional Medical Direc-
tor for the U. S. Public Health Service.

On June 30, 1949, Miss Helen Martikainen, who had been in charge
of the Public Health Education Section, severed her relations with
the North Carolina State Board of Health to accept an assignment
on the Public Health Education Staff of the World Health Organ-
ization in Geneva, Switzerland. She was succeeded here on July 1
by Miss Elizabeth Lovell. Effective July 1, 1949, mental health
activities were transferred from the Hospitals Board of Control to
the State Board of Health by order of the Governor. At that time,
a Mental Health Section was set up under Miss Dorothea Dolan, who
was loaned to the State Board of Health by the U. S. Public Health
Service.

July 1, 1949, not only marked the completion of arrangements for
Public Health services in all the counties, with the entrance of
Pamlico, but was the beginning of a new era in financial support.
As previously stated, State aid for local health work was increased
by legislative appropriations from $350,000 to $1,150,000. Funds
allocated for the coming fiscal year included $2,693,246 in funds
represented by the counties themselves. This was an increase of
$225,386 over the amount of local money available at the beginning
of the previous year. The General Assembly of 1949 made an ap-
propriation in its permanent improvements bill of $600,000 for the
erection of a building to house the State Health Department. How-
ever, various complications arose which necessitated a series of
delays.

On September 15, 1949, the State Board of Health met in the
O'Henry Hotel in Greensboro during the meeting in thit city of the
North Carolina Public Health Association. At this meeting, atten-
tion was called to the fact that North Carolina had been granted
$65,000 in Federal funds for a study of diseases of the heart. It was
decided to give attention to a plan whereby this money might be
spent in accordance with basic rules and regulations of the U. S.

70 Thirty-Fourth Biennial Report

Public Health Service. At this same meeting, the proposed new
health building was discussed and the Board went on record as
favoring Caswell Square where the present building is located as a
suitable site.

On November 3, 1949, the State Board of Health voted membership
in the North Carolina Health Council. Dr. Hubert B. Haywood and
Dr. John H. Hamilton were named as associate members of the
Council to represent the Board. Dr. Norton is on the Executive
Committee. •

1950. The year 1950 saw not only increased expansion in local health work,
but also re-organization of the State Health Department so as to
make operations less cumbersome. Several plans were submitted,
but the one finally agreed upon, which was made effective as of
February 1, reduced the number of divisions to six, placed in charge
of a director and designated the subdivisions as sections. Central
Administration is directly under the State Health Officer. Public
Relations, Budgets, Personnel, Printing, Mailing and Filing were
placed in the group of activities directly under the Health Officer.
Other divisions were set up as follows:

Personal Health, Dr. George M. Cooper, Director. This includes
the following sections: Maternal and Child Health, Crippled Chil-
dren, Nutrition, Cancer and Heart Diseases.

Local Health, Dr. C. C. Applewhite, Director. Under this official,
the following sections operate: Administrative, Public Health Nurs-
ing, Mental Health, Health Education and School Health.

Epidemiology, Dr. Charles P. Stevick, Director. This division
includes the following sections: Public Health Statistics, Com-
municable Diseases, Venereal Diseases, Tuberculosis, Industrial Hy-
giene, Accident Prevention.

Sanitary Engineering Division, Mr. J. M. Jarrett, Director. Sec-
tions: Sanitation, Environmental, Public Eating Places, Milk, Bed-
ding, Shellfish, Engineering, Insect and Rodent Control, Stream
Sanitation.

Laboratory Division, Dr. John H. Hamilton, Director. This di-
vision includes biologies, microscopy, cultures, serology, water chem-
istry and approved laboratories.

Oral Hygiene Division, Dr. Ernest A. Branch, Director. In this
division, we find Visual Education, Lectures, literature, Consultation,
Correction and Prevention.

On May 3, 1950, the State Board of Health met in Pinehurst. It
was stated at this meeting that progress was being made to bring
about a better understanding with members of the North Carolina
Optometric Society. While several problems remained to be solved,
it was evident that a spirit of mutual respect had been in evidence
at conferences previously held. Still no decision had been reached
as to the location of the new health building, Dr. Norton told the
Board. He again emphasized the advantages of the site on which
the building is now located and reported to the Board that other
sites, including the one on New Bern Avenue, formerly occupied by

Nokth Carolina Board of Health 71

the Confederate Soldier's Home had been considered and found to
be undesirable. At this meeting, a resolution was adopted extending
the boundaries of the Catawba Heights Sanitary District in Gaston
County.

The fiscal year of 1949-50, which also concluded the biennium,
ended with increased Public Health activities all over the State.
Unfortunately, however, the clouds of war again were gathering
and Public Health was beginning to give thought to the possible
mobilization of its forces for any eventuality which might ensue.

A detailed account of the organization work of each one of the
divisions covering the activities of this biennium will be found in
the pages to follow.

On December 18, 1950, Dr. George M. Cooper, who had been asso-
ciated with the State Health Department in almost every key posi-
tion, died. He was buried in his native county of Sampson. At the
time of his death, Dr. Cooper was the Assistant State Health Officer
and Director of the Personal Health Division. Dr. Cooper assumed
his duties with the Department on May 1, 1915 and was one of the
best-known and best-loved public health workers not only in North
Carolina, but throughout the United States. Upon his death, there
were many tributes and editorial comments printed throughout the
State. We find a typical tribute in the words of Governor W. Kerr
Scott, who said: "Dr. Cooper was able to place himself alongside
those he served; to interpret their problems and minister to their
needs in a sympathetic and effective manner. He was able to serve
his State over a period of many years without assuming any attitude
of proprietorship. On the contrary, he remained a faithful servant
of the people. He occupied a place in North Carolina history which
was unique. In his relationship to Church and State, Dr. Cooper
gave his best." Upon the death of Dr. Cooper, Dr. Norton named
Dr. John H. Hamilton, Director of the State Laboratory of Hygiene,
as the Assistant State Health Officer, subject to confirmation by the
State Board of Health.

1951. The General Assembly, which met early in January, increased the ap-
propriations for Public Health to $2,214,591 for the fiscal year of
1950-1952 and $2,224,982 for the fiscal year of 1952-1953. An addi-
tional annual appropriation of $86,500 was provided for work among
crippled children, $25,000 of which was earmarked each year for the
Asheville Orthopedic Hospital. The General Assembly also passed
a resolution providing that the new $600,000 State Health Depart-
ment Building be erected as a memorial to the late Dr. Cooper. In
January, without a special appropriation, a home and field accident
program was set up in the State Health Department's Public Health
Statistics Section. The purpose of this was to provide for securing
additional facts with regard to persons who are killed in accidents
other than those occurring on our highways.

On January 19, the State Board of Health confirmed the appoint-
ment of Dr. John H. Hamilton as Assistant State Health Officer, his
term to run concurrently with that of Dr. Norton.

72 Thirty-Fourth Biennial Report

On February 1, Dr. A. H. Elliot, who previously had served as
County Health Officer in New Hanover, assumed his duties as
Director of the Personal Health Division of the State Health De-
partment. In that capacity, he succeeded the late Dr. Cooper.

On May 9, the Board unanimously re-elected Dr. J. W. R. Norton
as State Health Officer, for a four-year term in his own right, begin-
ning July 1. Dr. Norton was elected in 1948 to fill out the unexpired
term of Dr. Carl V. Reynolds, resigned. He assumed his duties on
July 1 of that year. When Dr. Norton was re-elected in 1951, Dr.
Hamilton was also re-elected Assistant State Health Officer for a
four-year term.

1952. The beginning of 1952 found the State Health Department able to con-
tinue its work of expanding Public Health services throughout the
State, through the various local departments which now had been
given full powers in administering Public Health at the grass roots.

On January 1, Dr. R. E. Coker, formerly Health Officer in Ala-
mance County, assumed his duties as Assistant Director of the Local
Health Division, headed by Dr. C. C. Applewhite.

On February 1, Dr. M. P. Rudolph assumed his duties as Assistant
to Dr. Elliot, and was placed in charge of the Section through which
the work for crippled children and maternal and child health services
is carried on. Dr. Rudolph formerly was in charge of the Health
District composed of Catawba, Lincoln, and Alexander Counties.

On May 7, the State Board of Health met in annual conjoint ses-
sion with the Medical Society of the State of North Carolina at
Pinehurst. Instead of making a lengthy report, Dr. Norton gave
a summary of the previous year's activities and provided detailed
documents for study by those affected, after returning to their
homes.

REPORT OF THE SECRETARY-TREASURER AND
STATE HEALTH OFFICER

July 1, 1950— June 30, 1952

Excerpts of the activities of the State Board of Health as recorded in the
Minutes:

August S, 1950. The first meeting of the North Carolina State Board of
Health for the biennium beginning July 1, 1950 — June 30, 1952, was a regu-
lar quarterly session held in the auditorium of the State Laboratory of
Hygiene with President Dixon presiding.

Minutes of the Board meeting held on May 3, 1950 and of the Executive
Committee meeting of May 17, 1950, were approved as read.

Mr. J. M. Jarrett, Director of Sanitary Engineering Division, presented a
request from the Town of Apex, North Carolina, for permission to allow fish-
ing in the municipal water supply lake. He stated that all documents and
regulations had been carefully gone over by his division and were in accord-
ance with the rules and regulations relating to fishing in public water supply
lakes and reservoirs as adopted by the State Board of Health under authority
of Section 130-109 of the General Statutes of North Carolina. On motion of
Dr. Large, seconded by Mr. Jackson, the resolution authorizing the Town
of Apex, North Carolina to permit fishing in the municipal water supply lake
was unanimously adopted.

Mr. Jarrett also reported on the insanitary conditions resulting from inade-
quate and unsatisfactory sewage disposal facilities in the Town of Kure
Beach, North Carolina. He discussed a proposed plan of financing the sewer
system by issuance of necessary bonds, etc., and said that he had been
assured that the amount needed could be approved. In view of these facts,
Mr. Jarrett presented a resolution to be adopted by the Board in the event
it was deemed advisable to issue the requested order. On motion of Dr. Large,
duly seconded by Mrs. Hunt, the resolution was unanimously passed directing
the installation of a sewerage system in the Town of Kure Beach, N. C.

Secretary Norton informed the Board of Dr. G. M. Cooper's illness and a
letter was drafted and signed by each individual member present, and for-
warded to Dr. Cooper, expressing regret at his indisposition and wishing for
him a speedy and complete recovery.

Dr. Haywood, a member of the Emergency Medical Council of the AMA,
reported on a conference held in Washington, D. C. on July 29, 1950. He
stated that North Carolina had been placed in a strategic area in the event
of an atomic war, and that the State Board of Health and local health depart-
ments would be asked to take steps to assume considerable leadership. Such
leadership, he said, would require careful planning and organization and
definite progress in caring for casualties following raids, including blood
banks and blood typing of all persons, and the advisability of each carrying
cards stating his or her blood type, to be carried on their persons. After a
general discussion of the matter, Dr. Haywood presented the following
resolution:

"WHEREAS, the North Carolina State Board of Health finds:

74 Thirty-Fourth Biennial Report

"THAT, since it is the sense of the Emergency Medical Council of the
American Medical Association, which met in Washington, D. C. on July 29,
1950, with higher officers of the United States Army, Navy, Air Force, Public
Health Service, Red Cross and accredited l'epresentatives of the State of
New York, New Jersey, Pennsylvania, Delaware, Maryland, District of Co-
lumbia, Virginia and North Carolina, that a definite program of immediate
planning for relief and medical services from casualties following bombing
raids on strategic areas in these and other states, and

"THAT, it was stated that state and local health departments should play
an important part in the periods both before and after raids by an enemy.
Definite courses are being given by the Army, Navy and Public Health Service
Officers to enlighten health officers in the latest methods of meeting catas-
trophes resulting from enemy bombings, and

"THAT, it is felt that the Red Cross and other agencies of this type en-
dorsed by the government should set up blood banks to meet such situations
as would arise in a war of this type, and

"WHEREAS, it was discussed and received at least the tacit endorsement
of the group that all individuals should have their blood typed and carry
with them at all times a certification stating their blood group, and

"WHEREAS, it was further felt that teams of physicians and other rescue
workers from one state would and should cooperate with those of other states
whose catastrophic needs are urgent.

"NOW, THEREFORE, Be It Resolved, That the North Carolina State
Board of Health endorse this urgent program and participate in it with its
guidance and assistance when required and asked for:

"THAT, it participate in the training of its personnel for such types of
defensive action and war fare as may face us. It is felt that the State Board
of Health and its constituent local health departments can furnish the neces-
sary leadership in protection and aiding the people of North Carolina should
such calamities befall them.

"IT IS FURTHER RESOLVED, That we will participate fully in State and
National Defense programs of this type."

Dr. Haywood moved the adoption of the above resolution. The motion was
seconded by Dr. Lawrence and carried unanimously.

In the absence of Dr. Cooper, Secretary Norton presented the need of re-
questing the Legislature for an appropriation of $50,000 to $100,000 for an
emergency health fund to be of assistance in taking care of epidemics, or
other urgent health emergencies. At the present time the Board has no
State fund available for a poliomyelitis outbreak or any other epidemic. Dr.
Lawrence moved that the Legislature be requested to appropriate $50,000
to $100,000 to be used as an emergency health fund to be of assistance in
taking care of epidemics or other urgent unforeseen emergencies. Motion
seconded by Dr. Large and carried.

Following a general discussion of funds earmarked for certain definite
purposes, a directive to the State Health Officer was presented which is
designed to establish a definite policy for the disposition of said funds. Dr.
Large moved the adoption of the following directive, which was seconded by
Dr. Lawrence, and passed unanimously:

North Carolina Board of Health 75

"It is the sense of the State Board of Health that any funds appropriated
to the use of the State Board of Health, including the crippled children's sec-
tion, for the alleviation of emergency or other health welfare needs, be dis-
bursd by the Department of Health in such manner as not to mitigate against
any qualified physicians or group of physicians who are duly licensed to
practice medicine and surgery in North Carolina, and are qualified to render
such service."

Dr. C. P. Stevick, Director of the Epidemiology Division, presented a sug-
gested revision of the communicable disease regulations reducing the periods
of quarantine and isolation for poliomyelitis. He reported on a meeting with
the State Poliomyelitis Planning Committee and representatives of the Na-
tional Foundation for Infantile Paralysis relative to the isolation period
required, etc. Dr. Haywood moved the adoption of a revision in the polio-
myelitis isolation period from fourteen (14) days to seven (7) days or for
the duration of fever if longer than seven (7) days. The quarantine period
has been reduced from fourteen (14) days to seven (7) days from the day
of last exposure. Motion seconded by Mr. Jackson, and carried.

Secretary Norton discussed a number of items of proposed legislation which
might be brought up before the General Assembly but on which no action was
required at this time by the Board, namely: (1) the possibility of legislation
being required in order to bring about removal of present State Board of
Health Building in order to erect the new building on this sfte; (2) an
amendment to the sterilization law by the Eugenics Board to include visually
handicapped people suffering from hereditary eye diseases; (3) a State
Stream Sanitation law; (4) the Board may need an appropriation and legis-
lation for codification of health laws; (5) possibility of needing some legis-
lation in connection with civilian defense emergency from standpoint of
medical and sanitation matters.

Also, the following items of general information were brought to the at-
tention of the Board: (a) that the President of the State Medical Society
had appointed a new Cancer Committee with Dr. James F. Robertson of Wil-
mington as Chairman; (b) that a letter had been received from the Veteran's
Administration Hospital at Oteen asking for a list of local health officers
so that when a person is discharged from the hospital the local health officer
could follow up the case thereby cooperating with local health departments
in a very fine way; (c) Dr. Norton told the Board that he was in the Reserve
Corps but having served in two World Wars and being on the Governor's Civil
Defense Committee and on the Military Service Committee of the State
Medical Society that he did not anticipate being called in the near future,
and if that time should come, we have an Assistant State Health Officer, Dr.
Cooper, to take over as he has done so well several times previously; (d) that
the Personnel and Budget Offices have been contacted again about trying to
arrange for raises for the division directors but the study that is being made
for all State workers has not been completed, however, just as soon as they
can, this matter will be given consideration; (e) and, of a joint meeting of
the Executive Committee of the State Medical Society and State Dental So-
ciety for a discussion of the school health program probably early in
September.

The proposed budget changes for the 1951-1953 biennium, a copy of which
is attached, were presented by Miss Mae Reynolds, Budget Officer. Each

■'01

76 Thirty-Fourth Biennial Report

item was presented, following which there was brief discussions by the
Board members.

Secretary Norton announced that the public hearing on the request of the
State Board of Health before the Advisory Budget Commission would be held
on Wednesday, September 20, 1950 at 2:00 p.m., Room 513 of the Revenue
Building, and that he would appreciate having as many of the Board mem-
bers present as possible for this hearing.

There was a full and lengthy discussion by all members of the Board
regarding plans for the new State Board of Health Office Building. They
were in agreement with the joint decision of the Committee from the State
Board of Health and the Council of State which met on May 17, 1950 that
unless they heard officially from the Committee of the Council of State they
would assume that the joint committee's recommendation of May 17, 1950,
still stood.

September 8, 1950. A regular meeting of the State Board of Health was
held in Winston-Salem, North Carolina, Friday, September 8, 1950, in the
Robert E. Lee Hotel, — this being at the same time and place of meeting as
the 39th Annual Session of the North Carolina Public Health Association,
to which the Board members were formally presented later in the evening.

The meeting was called to order by President Dixon, and Secretary Norton
read the Minutes of the meeting held on August 3, 1950, which were approved
as read.

The Secretary read a telegram from Dr. A. C. Current expressing his regret
of being unable to attend on account of illness.

As a matter of information, Dr. Norton told the Board that he had been
appointed to serve on the North Carolina Military District Committee. The
duty of this Committee of three physicians and a dentist, is to review and
study, and make recommendations on the application for deferment of Re-
serve Officers.

Dr. Norton reported that the joint meeting of the Executive Committees
of the Medical Society and Dental Society had been called for Sunday, Sep-
tember 17, 1950, at the Sir Walter Hotel, Raleigh, and that one of the items
to be discussed is the school health program. He also announced the hearing
before the Director of the Budget and the Advisory Budget Commission on
requirements for the biennium 1951-1953, Wednesday, September 20, 1950,
2:00 p.m., Room 513, Revenue Building, Raleigh, and urged that as many
of the members be present as possible to make comments and back up the
budget request. Dr. Dixon, the President, will present the budget at the
hearing.

The Secretary made a further oral report relative to the State Board of
Health Building. He read an article which appeared in the News and
Observer, Thursday morning, August 31, 1950, to the effect that the State
Board of Buildings and Grounds had authorized the construction of a $300,000
State warehouse on Caswell Square, fronting on Lane Street. After con-
siderable discussion, it was decided that no action was needed.

The Secretary was requested to (a) work with Mr. Deitrick and his staff
and Mr. George B. Cherry, Supt., Board of Public Buildings and Grounds, for
information which the Board will present to the Advisory Budget Commission

North Carolina Board of Health 77

on September 20, 1950; (b) to secure estimates on demolition of the present
Health Building and the construction of a new building on present site as
planned in 1937, with increased floor space, and estimate of same, and (c)
estimate of cost of moving from the present site and rebuilding the entire
unit on another location.

Secretary Norton further discussed the tentative proposal, which had been
briefly discussed some months ago, relative to moving the office of industrial
hygiene engineering nearer to the center of the industrial areas in the State.
The City Health Department in Charlotte has now offered adequate space,
without cost to the State, in order that they might have better industrial
hygiene facilities in that area for correcting hazards to employees and air
pollution affecting the general population. This transfer will save time,
travel back and forth to this office, per diem, and therefore provide more
time for plant visits in the industrial areas. Also, there will be immediate
administrative supervision of the engineering group. Upon motion of Dr.
Haywood, seconded by Dr. Lawrence, approval was given to the transfer of
the industrial hygiene engineering office from Raleigh to Charlotte, with
headquarters located in the Charlotte City Health Department.

Secretary Norton reported on plans for a course in radiological defense for
health officers at the School of Public Health in Chapel Hill, October 4-5, 1950,
and possibly several later on similar to those in obstetrics and pediatrics
previously held for physicians in private practice. He stated that Dr. John
J. Wright of the School of Public Health, had been to Washington, D. C, to
interview officials of the Public Health Service, the Armed Forces, and all
offered their cooperation and assistance in giving the course. Mr. Steve
Marsh, Industrial Hygiene Engineer of the Board, who has recently returned
from Chicago where he attended the Illinois Institute of Technology for a
5-weeks' course in radiological monitoring, will also assist with the course.

The Secretary called attention of the Board to a proposed revision of the
Constitution and By-Laws o fthe NCPHA, the purpose of which is to make it
possible for the NCPHA to become eligible and apply for affiliation with the
APHA. The principal advantages of affiliation would be that the NCPHA
would become entitled to a representative on the governing council for the
APHA, and the APHA would remit to the Treasurer of the NCPHA $1.00 for
each Member and Fellow, of which we now have 216 in the State. The
present dues for APHA Members amount to $7.00 and for Fellows $12.00
annually.

December lit, 1950. The Executive Committee of the State Board of Health,
composed of Dr. G. G. Dixon, Dr. Hubert B. Haywood and Dr. H. Lee Large,
met Thursday, December 14, 1950 at 10:00 in the office of the State Health
Officer.

The meeting was called to order by President Dixon.

Mr. E. C. Hubbard of the Sanitary Engineering Division presented resolu-
tions for three Sanitary Districts which are now in the process of being
created, and asked that the Board designate the time and place of a public
hearing concerning the creation of the proposed Districts. The petitions
were read requesting the creation of the East Erwin Sanitary District,
Harnett County, the Parkwood and Royal Oaks Sanitary Districts in Cabar-
rus County. Following the reading of these petitions and due consideration

78 Thirty-Fourth Biexnial Report

of the actions thus far taken by the County Boards of Commissioners in said
counties regarding the creation of said districts, the following resolutions
were read and unanimously adopted by the Executive Committee of the State
Board of Health. Resolutions as adopted appear as follows:

"RESOLUTION NAMING THE TIME AND PLACE OF THE PUBLIC
HEARING CONCERNING THE CREATION OF THE PROPOSED EAST
ERWIN SANITARY DISTRICT IN HARNETT COUNTY, NORTH CARO-
LINA.

"Be it resolved by the Executive Committee of the North Carolina State
Board of Health:

"SECTION I. That the Public Hearing to be held by a representative of
the State Board of Health in accordance with the requirements of Chapter
100, Public Laws of 1927, and all subsequent amendments for the purpose of
considering the creation of the proposed East Erwin Sanitary District in
Harnett County, North Carolina, shall be held on Thursday, the 1st day of
February, 1951, at 2:00 P.M.

SECTION II. That said hearing will be held at Shug's Restaurant located
within the proposed district on the date and at the time set forth in Section
I."

Thereupon, upon motion of Dr. Large, seconded by Dr. Haywood, the reso-
lution was unanimously carried.

"RESOLUTION NAMING THE TIME AND PLACE OF THE PUBLIC
HEARING CONCERNING THE CREATION OF THE ROYAL OAKS SANI-
TARY DISTRICT IN CABARRUS COUNTY, NORTH CAROLINA.

"Be it resolved by the Executive Committee of the North Carolina State
Board of Health:

"SECTION I. That the public hearing to be held by a representative of
the State Board of Health in accordance with the requirements of Chapter
100. Public Laws of 1927 and all subsequent amendments for the purpose of
considering the creation of the proposed Sanitary District in the Royal
Oaks Community of Cabarrus County, North Carolina shall be held on Tues-
day the 23rd day of January, 1951 at 4:00 P.M.

"SECTION II. That said hearing shall be held at the Royal Oaks School
Building located within the district on the date and at the time set forth
in Section I."

Thereupon, upon motion of Dr. Large, seconded by Dr. Haywood, the reso-
lution was unanimously carried.

"RESOLUTION NAMING THE TIME AND PLACE OF THE PUBLIC
HEARING CONCERNING THE CREATION OF THE PARKWOOD SANI-
TARY DISTRICT IN CABARRUS COUNTY, NORTH CAROLINA.

"Be it resolved by the Executive Committee of the North Carolina State
Board of Health:

"SECTION I. That the Public hearing to be held by a representative of the
State Board of Health in accordance with the requirements of Chapter 100,
Public Laws of 1927 ana all subsequent amendments for the purpose of con-
sidering the creating of the proposed Sanitary District in the Parkwood
Communitv of Cabarrus County, North Carolina, shall be held on Tuesday
the 2Srd day of January. 1951, at 7:00 P.M.

North Carolina Board of Health 79

"SECTION II. That said hearing shall be held at Martin's Grill located
within the district on the date and at the time set forth in Section I."

Thereupon, upon motion of Dr. Large, seconded by Dr. Haywood, the reso-
lution was unanimously carried.

Mr. Hubbard also discussed with the Executive Committee the advisability
of requesting the Attorney General to prepare a bill to be introduced at the
next General Assembly for the purpose of amending the present sanitary
district law to the extent that the State Health Officer will be authorized
to designate the time and place of a public health hearing to be held by a
representative of the State Board of Health. After discussion, the Executive
Committee suggested that the matter be discussed further with the Attorney
General and that he be requested to prepare a bill amending the present
sanitary district law as indicated above.

Dr. Norton brought to the attention of the Executive Committee resolutions
passed by the County Medical Societies of Guilford, Forsyth and Surry- Yadkin
relative to what each defined as proper activities of local health departments.
There was much discussion and the suggestion was made that the State
Health Officer make use of every opportunity to discuss public health work
with local medical societies.

Dr. V. M. Hicks, of Raleigh, who has been designated Chairman of a Com-
mittee representing the State Medical Society in discussions relative to eye
examinations, appeared before the Executive Committee and discussed a
proposed bill designed to regulate advertising in the Healing Arts. The State
Medical Society plans to prepare for submission to the present General As-
sembly a bill designed to curb indiscriminate advertising by radio, newspapers,
and otherwise by opticians, and the committee wished to familiarize the
Board with the general features of this proposed bill recommended by the
Executive Committee of the State Medical Society.

Dr. C. P. Stevick of the Division of Epidemiology, presented information
relative to a bill being considered by the Eugenics Board and the Commission
for the Blind, to permit voluntary sterilization of persons likely to transmit
to their offspring hereditary eye disease. Dr. Stevick reported that he had
talked with Dr. Nash Herndon, Professor of Medical Genetics at the Bowman
Gray School of Medicine, who suggests that such legislation would be help-
ful. A tentative bill incorporating the important features was reviewed
and a few changes were suggested and these will be transmitted to the
Eugenics Board. No motion was necessary as the Board has not been formally
asked to approve the bill.

Dr. Stevick also presented a resolution requesting the appointment of
health officers as local registrars of vital statistics in their health districts,
each appointment to become effective at the discretion of the State Health
Officer. On motion of Dr. Large, seconded by Dr. Haywood, the following
Health Officers were appointed as registrars of vital statistics for their re-
spective jurisdictions, such appointments to become effective at the discretion
of the State Health Officer:

Dr. James A. Fields Alamance

Dr. Carl C. Janowsky Alleghany-Ashe-Watauga

Dr. R. J. Jones Avery-Yancey-Mitchell

80 Thirty-Fourth Biennial Report

Dr. S. V. Lewis Caldwell

Dr. Eleanor H. Williams Cleveland

Dr. 0. D. Garvin Craven-Pamlico

Dr. B. B. McGuire Guilford

Dr. G. Fletcher Reeves Haywood

Dr. R. E. Fox Hertford-Gates

Dr. S. B. McPheeters Jackson-Macon-Swain

Dr. H. W. Stevens Lenoir-Jones

Dr. R. E. Coker McDowell

Dr. M. B. H. Michal Onslow-Pender

Dr. Cameron F. McCrae Orange-Person-Chatham-Lee

Dr. William Happer Pasquotank-Perquimans-Camden-Chowan

Dr. Z. P. Mitchell Richmond

Dr. E. D. Hardin Stanly

Dr. E. H. Ellinwood Wayne-Greene-Sampson

Dr. Irvin M. Weir Wilson

Motion was unanimously adopted.

Secretary Norton told the Executive Committee about receiving a letter of
complaint from Dr. J. T. Marr, President of the North Carolina Radiological
Society, Winston-Salem, N. C, regarding the fee schedule for indigent cancer
patients. Several months ago the fee schedule recommended by a subcom-
mittee of the Cancer Committee of the State Medical Society was approved by
the State Board of Health, the Cancer Committee, and by the Executive Com-
mittee of the State Medical Society. The subject was discussed but no action
necessary. The Radiological Society is to submit a letter proposing specific
changes in the fee schedule.

Secretary Norton also read a telegram sent to President Truman and others
by the State and Territorial Health Officers Association endorsing in principle
H. R. 9798 "Federal Civil Defense Act of 1950."

It was moved by Dr. Haywood, and seconded by Dr. Large, that the Secre-
tary write a letter of sympathy to the family of Dr. George M. Cooper, who
is critically ill at the present time in Rex Hospital. Motion carried unani-
mously.

January 19, 1951. The State Board of Health met in regular quarterly ses-
sion Friday, January 19, 1951, in the Library Room at the State Laboratory
of Hygiene Building, with President Dixon presiding. The meeting was
called to order, and Secretary Norton read the Minutes of the Board Meeting
of September 8, 1950, and of the called Executive Committee meeting on De-
cember 14, 1950. Both were approved as read.

Secretary Norton reported to the Board that the North Carolina Public
Health Association failed to pass the proposed revision of the Constitution
and By-Laws presented at its annual meeting in Winston-Salem on September
9, 1950. The matter was discussed as to the advantages of the amendments
and changes in the Constitution in order for the Association to affiliate with
the American Public Health Association. On motion of Dr. Lawrence, sec-
onded by Dr. Haywood, the Executive Committee of the Board, along with
the Secretary of the State Board of Health, was requested to make a study,
or a resurvey of the said Constitution and By-Laws of the NCPHA, so that

North Carolina Board of Health 81

the matter could be presented again to the N. C. Public Health Association
this year. Motion carried.

As a further report on the question of the complaint by the N. C. Radio-
logical Society, relative to the fee schedule, Secretary Norton stated he had
written to Dr. J. T. Marr, the President, asking that he nad his committee
submit a recommendation as to the fee schedule for the treatment of cancer
patients, in order that it be presented to the Board. Dr. Marr replied by
stating that a meeting would be held for this purpose later on this month.

Secretary Norton presented Mr. George B. Cherry, Superintendent, Board
of Public Buildings and Grounds, and Mr. Wm. H. Deitrick and Mr. Jones,
Architects. Further discussion of the proposed new Health Building was
entered into relative to the plans, location and appropriation. The 1949
General Assembly appropriated $600,000 for the building but that would allow
only very slight expansion and prices have advanced so it now is deemed
advisable by the Board for the Council of State to ask the Legislature for an
additional $350,000, making a total of $950,000 for the erection of the building
and on the site of the present Health Building. It was pointed out that in-
creased floor space is needed.

Mr. Jackson moved that the Board again go on record as favoring wrecking
the old building in order to place the new building on the present site, and
that an additional sum of $350,000 be requested from the General Assembly
for that purpose. Motion seconded by Dr. Current, and unanimously carried.

Dr. Norton stated that quite a number of private physicians, dentists,
health officers, and others had suggested that the new building be named the
GEORGE MARION COOPER HEALTH BUILDING as a memorial to the late
Dr. Cooper, and that the local health officers, at their meeting here on Tuesday
of this week, passed a resolution in favor of it. If naming of the building
requires a legislative act, Dr. Bender moved that the Board of Health ask
the Attorney General to draw up this bill and recommend it to the Council of
State. Motion seconded by Mr. Jackson and carried unanimously.

Dr. Norton submitted a draft of a resolution of respect for Dr. George
Marion Cooper. Mr. Jackson moved that the following resolution be adopted
and that a copy be spread on the Minutes of this Board, and that copies be
sent to the State Archives and to the family of Dr. Cooper. Motion seconded
by Dr. Lawrence and carried unanimously.

"WHEREAS Almighty God, in His infinite wisdom and mercy, has called
our beloved friend, colleague and wise counselor, Dr. George Marion Cooper,
from active duty here on earth, unto Himself, we yield to the will of that
Divine Providence which permitted him to work with us until the sunset of
a long and useful career, dedicated to humanity and its needs; now, there-
fore, be it

"RESOLVED: That the North Carolina State Board of Health, in formal
session, on this, the nineteenth day of January, 1951, express a sense of deep
loss at the passing of this noble spirit. North Carolina has lost its greatest
Public Health Official of all time.

"Dr. Cooper served longer, engaged in more activities, and did more for
the Public Health needs of more people than any man in the history of his
State. He pioneered in Public Health services, not only in North Carolina,
but in the nation. His was constantly an up-hill fight against Ignorance,
misinformation, indifference and short-sighted selfish interests. Yet, his love
for humanity compelled him to fight against any and all odds, for the princi-
ples in which he believed. He was not only a good fighter, but a fearless

82 Thirty-Fourth Biennial Report

fighter. The two greatest groups of his beneficiaries were underprivileged
mothers and children. For their relief he secured in appropriations and
administered millions of dollars in public funds. During his administration
of health services for the mothers and infants of North Carolina, he saw
maternal death rate reduced to one-quarter and the infant death rate to one-
half of those prevailing when his service began. This program was due to
the fact that Dr. Cooper was able to secure the cooperation of assisting per-
sonnel, both in Public Health circles, and among the private practitioners of
medicine. A striking example of this cooperation is shown in his organiza-
tion of the orthopedic surgeons of North Carolina for work among crippled
children. He was the patient planner, the dauntless, unselfish and resource-
ful leader, the tireless worker. The above represents only a fragment of
what was accomplished through his work and influence, during his thirty-five
years of service with the North Carolina State Board of Health. Official
North Carolina has lost a faithful worker, humanity a faithful friend, the
church a zealous worker in the cause of righteousness, and his children a
loving faithful and devoted father. His noble wife preceded him to her
reward in 1948.

"BE IT FURTHER RESOLVED, That a copy of this resolution be sent
to each of Dr. Cooper's immediate survivors and also to such medical journals
as may seem fitting."

The secretary also told the Board that a joint resolution was introduced
in both the Senate and House paying respect to the late Dr. Cooper, which was
passed and ratified by the General Assembly and that both houses adjourned
in his memory on January 17, 1951.

Secretary Norton announced that Dr. John H. Hamilton had been designated
Acting Assistant State Health Officer, with the approval of the Executive
Committee since the death of Dr. Cooper, pending action by the full Board.
Dr. Lawrence moved that in view of the passing of Dr. Cooper which had
left the Assistant State Health Officer's position vacant, Dr. John H. Hamilton
be elected and continued at the will and pleasure of the State Health Officer
and the Board, for the remainder of Dr. Norton's present term of office. Motion
seconded by Dr. Haywood and unanimously carried.

The Secretary announced that Dr. A. H. Elliot, Health Officer of New Han-
over County, on approval of the Executive Committee, had been tendered, and
had accepted, the position as director of the Personal Health Division, effective
February 1, 1951.

A letter was read by Dr. Norton which he had prepared to send to all local
health officers regarding Military Deferment Policies. This was discussed and
Dr. Large moved that the Board go on record as approving and adopting this
policy and procedure with regard to deferment from active duty in the Armed
Forces. Motion seconded by Dr. Haywood and carried unanimously.

The subject of mileage and per diem for members of the Board was dis-
cussed. Dr. Lawrence moved that the Secretary examine the present law and
recommend that an increase in per diem from $7.00 to $25.00 be paid members
of the State Board of Health for meetings. Motion seconded by Mrs. Hunt and
carried.

Mr. J. M. Jarrett, Director of the Sanitary Engineering Division, presented
and discussed, at length, a policy regarding the fluoridation of communal
water supplies "where there if a strong public demand, and where the de-
cision to add fluoride to the water supply is concurred in by the local dental
society, the local medical society and the local or district board of health,
provided the conditions set forth" ... are strictly carried out On motion

North Carolina Board of Health 83

of Dr. Large, seconded by Dr. Haywood, the policy and required procedure
for the fluoridation of public and institutional water supplies was approved.
Motion carried unanimously.

Mr. Jarrett also discussed, in detail, developments in connection with the
problem and control of stream pollution. He reviewed the proposed bill
relating to Stream Sanitation prepared by the Stream Sanitation and Con-
servation Committee which is to be introduced in the General Assembly in
a few days. No action necessary.

Secretary Norton discussed the following additional tentative proposed
legislation to be brought up before the General Assembly:

1. A bill to amend Section 130-35 of the General Statutes to make it pos-
sible for the State Health Officer to name the time and place of hearing in
the formation or dissolution of sanitary districts.

2. A bill to be entitled an act to amend Chapter 48 of the General Statutes
of North Carolina relating to birth certificates for adopted children.

3. A bill to be entitled an act to amend Chapter 130 of the General Statutes
of North Carolina relating to vital statistics laws.

4. A bill pertaining to the institutionalizing of tuberculous patients.
No changes were suggested.

Miss Mae Reynolds, Budget Officer, briefly summarized the 1951-1953 budget
proposal, giving a brief detailed breakdown and outlining the justifications
for requests for restoration of certain "cuts" by the Advisory Budget Com-
mission. Special attention was called to the $100,000 request for Crippled
Children's work, which is necessary to match Federal "A" funds, the point
being made that unless the State supplies the Board with matching funds
there is danger of Federal funds being withdrawn since approval of State
funds to the Gastonia Orthopedic Hospital may not be given for matching
as in the past. A copy of the digest was given to each member as informa-
tion and for further study. The Board members will be notified so they
can be present when the Secretary appears before the Joint Appropriations
Committee.

Dr. Hamilton, who had been elected Assistant State Health Officer earlier
in the meeting, appeared before the Board and expressed his sincere appre-
ciation of the honor which had been conferred upon him and assured the
members that he would do his best to fulfill the trust placed in him.

In a brief manner, the Secretary reported on a few items of interest per-
taining to the health program as follows:

1. Reviewed a list of various boards, committees, etc. that he serves on.

2. Reported on expiration of Board members' terms, and expressed the hope
tbat each would stand for re-election.

a. North Carolina Medical Society

Dr. G. G. Nixon, May 1951

Dr. John LaBruce Ward, May 1951

b. Governor appointees

Dr. H. Lee Large, May 1951

Mr. Jasper C. Jackson, May 1951

3. Presented a letter from Mr. B. J. Lindley, Vice-President, Central Caro-
lina Veterinarians Association, Winston-Salem, N. C, stating that a resolution

84 Thirty-Fourth Biennial Report

had been adopted by that Association resolving to combat diseases of animals
which are transmissible to man with especial emphasis on a uniform rabies
program in the State, and requesting that a qualified veterinarian be employed
in the Epidemiology Division of the State Board of Health.

4. Secretary Norton also reported on the current influenza situation in
England and the Scandinavian Countries, and referred to the information
received in Washington recently stating that localized epidemics of influenza
occur at this season in the United States every year. None has had the char-
acteristics of the 1918 pandemic of influenza, and there is no reason to believe
that the present epidemic in England necessarily indicates that there will be
a serious outbreak in the United States this year. The present outbreak has
been chiefly of a mild type except in aged and debilitated, and is of the
A-prime type. Any severe pandemic would be expected to be caused by B
type virus. There is no vaccine that can be expected to protect with certainty,
however, this situation indicates the necessity for continuing controlled studies
of the efficacy of influenza vaccine in man.

March 6, 1951. There was a called meeting of the State oBard of Health
held in Durham, N. C, Duke University Medical School in the Dean's Office,
Tuesday, March 6, 1951, to transact some urgent matters in connection with
the formation of sanitary districts.

The meeting was called to order by President Dixon.

Dr. Haywood made a motion, which was seconded by Dr. Large, that read-
ing of the minutes of the Board meeting held on January 19, 1951 be postponed.
Motion carried.

Secretary Norton made a progress report relative to the radiologists. He
presented a copy of letter received from Dr. Roscoe D. McMillan, President
of the North Carolina Medical Society, Red Springs, N. C, quoting the new
resolutions drawn up and passed by the N. C. Radiological Society which had
been transmitted by the President, Dr. J. T. Marr. After the letter was read
and discussed, and since only State funds are used in paying for treatment
of indigent cancer patients, and Federal funds used only in case-finding, it
was decided that no recommendations were necessary on the part of the Board,
and too, since the letter was addressed to Dr. McMillan, that his reply would
cover the matter. However, it was suggested that Secretary Norton advise
Dr. McMillan that the subject had been presented and discussed with the
Board.

Mr. J. M. Jarrett was present and discussed the petitions for consideration
in creating the Royal Oaks and Parkwood Sanitary Districts in Cabarrus
County, Concord, N. C, which was presented to the Board at its meeting on
January 19, 1951. Mr. Jarrett presented various transactions and documents,
and stated that thus far all of them had been examined by his office, and in
their opinion, were in order, and that the area to be included in the proposed
sanitary district had been examined and that his office recommended that
the Board create the proposed districts. Dr. Bender moved that the resolu-
tions creating the Royal Oaks and Parkwood Sanitary Districts in Cabarrus
County, North Carolina be adopted in accordance with the provisions of
Chapter 100— Public Laws of 1927. Motion seconded by Dr. Large and unani-
mously carried.

North Carolina Board of Health 85

Mr. Jarrett also explained the request for a new resolution naming the
time and place for another public hearing for the East Erwin, Harnett County,
Sanitary District in Erwin, N. C. stating that since the notice regarding the
public hearing of this district had failed to appear in the newspaper five
separate times as required by statute, thereby not being properly publicized,
it was necessary to have a new hearing. Dr. Large moved that a new resolu-
tion of notice of public hearing concerning the establishment of the East
Erwin Sanitary District in Harnett County be adopted. Motion seconded by
Dr. Haywood and unanimously carried.

Secretary Norton discussed further the subject of employing a veterinarian
in the Division of Epidemiology to work on problems of disease that might
be transmitted from animals to man, and presented a copy of resolution passed
by the North Carolina Veterinarian Medical Association. Dr. Norton stated
that this matter had been discussed with a number of people, and that it is
a good idea, however, he would suggest that due to the fact that there are
more important positions to be filled on the staff just now and by continuing
the close and cordial relations with the veterinary staff of the Agriculture
Department, the Board could get along without securing the services of an
additional State employed veterinarian for the present. Dr. Lawrence moved
that the recommendation of the Secretary relative to not securing the services
of a veterinarian at the present, be accepted. Motion seconded by Dr. Large,
and carried.

Dr. Norton gave a brief resume of the activities of the group appointed last
summer by the Governor known as the STATE COUNCIL OF CIVIL DE-
FENSE which consists of the Commissioner of Motor Vehicles, Executive
Vice-Chairman; Executive Secretary of the State Board of Health; Chancellor
of State College; Director of the State Bureau of Investigation, and the
General Counsel for the N. C. League of Municipalities. Mr. E. Z. Jones is
the Executive Director of the N. C. Council of Civil Defense. Dr. Norton also
stated that Mr. Steve P. Marsh, Principal Industrial Hygiene Engineer of
the Board of Health, had taken a five-weeks radiological monitoring course nad
that Mrs. Louise P. East, Consultant Nurse of the Board and five other regis-
tered nurses of the State had attended a course given at Emory University,
Atlanta, Ga. on the NURSING ASPECTS OF ATOMIC WARFARE. The in-
formation gained from these nurses will be passed along to others through
classes at eight or ten places throughout North Carolina so that the entire
State may have the benefit. Also, the local health officers have had a two-day
intensive training course in Civil Defense and radiological defense. The
President of the State Medical Society has appointed Dr. W. W. Kitchen
Chairman of Emergency Medical Service and that he and his committee are
doing a fine job getting together information on treatment facilities and hos-
pitals, etc. and that all are working together from the standpoint of public
health with our group, that of local health officers, medical societies, Red
Cross and other interested agencies.

The Secretary reported progress on budget requests but no final actions
have been taken as of this date. Also, nothing further has developed on the
request for the increase in appropriation for the new Health Building.

A discussion was brought up relative to motor vehicle accidents and wrecks
caused by buses and trucks and what action the Board should take if the
size of said vehicles is brought up at the present Legislature. Dr. Large

86 Thirty-Fourth Biennial Report

moved that the State Health Officer cooperate with the Director of the Motor
Vehicle Bureau and State Highway Patrol in opposition to any move offered
to approve an increase in the size or weight of trucks, etc. Motion seconded
by Dr. Lawrence, and carried unanimously.

Dr. Norton brought to the attention of the Board some of the very nice and
interesting annual reports put out by several of the local county health de-
partments. These are distributed to local citizens, legislators, etc. in order
that the public may have a better understanding of just what is being done
in their respective health departments.

Secretary Norton told the oBard that he has begun work on his conjoint
report and that he intended to try to emphasize the joint responsibility be-
tween those in public health work and the private practitioners. Dr. Lawrence
suggested also that he thought it would be a good idea to state that if any
member of the medical profession had any criticism, etc. of the activities of
the State Board of Health that each feel free to come to the Board with their
complaints as the Board desires the full and hearty cooperation of the medical
profession at all times.

April 18, 1951. A called meeting of the Executive Committee of the North
Carolina State oBard of Health was held in the office of the State Health
Officer on Wednesday, April 18, 1951.

This meeting was held in preparation for a joint meeting with the Board
of Public Buildings and Grounds with regard to the selection of a site for
the new State Board of Health Building.

May 9, 1951. The annual meeting of the North Carolina State Board of
Health, as required by law to meet on the second day of the annual meeting
at the State Medical Society, was held at Pinehurst, May 9, 1951, in the Caro-
lina Hotel with President Dixon presiding.

Secretary Norton read the Minutes of the Board meeting held on January 19,
1951, and March 6, 1951, both of which were approved as read.

Secretary Norton reported that Dr. H. Lee Large of Rocky Mount had been
re-appointed to succeed himself for another four-year term, and that Mr. H.
C. Lutz, pharmacist of Hickory, had been appointed for a four-year term to
succeed Mr. Jasper C. Jackson of Lumberton. These members are Governor
Scott's appointees and were sworn in at the Governor's office Friday after-
noon, May 4, 1951.

Dr. Dixon and Dr. Norton read letters from Mr. Jackson expressing friend-
ship for, and pleasure at having been associated with the Board and its mem-
bers for six years and offering his assistance in any way and at any time. It
was moved by Dr. Haywood, and seconded by Dr. Ward, that the Secretary
be instructed to write a letter to Mr. Jackson, for the Board, expressing the
Board's appreciation for his loyalty and past service. Motion carried unani-
mously.

Mr. E. C. Hubbard of the Sanitary Engineering Division outlined the legal
steps taken toward the creation of a proposed Sanitary District at East Erwin,
Harnett County, North Carolina, and stated that all documents had been
carefully examined and that, in the opinion of the Sanitary Division, same
was in conformity with all the requirements of Chapter 100, Public Laws
of 1927, and subsequent amendments and were ready for final action. Dr.
John LaBruce Ward moved for the adoption of the resolution of the N. C.

North Carolina Board of Health 87

State Board of Health creating the East Erwin Sanitary District in Harnett
County. The motion was seconded by Mr. H. C. Lutz, and unanimously
carried.

Dr. C. P. Stevick presented to the Board two resolutions received from the
Piedmont Veterinary Medical Association and the Roanoke-Tar Veterinary
Medical Association, recommending that a Veterinary Section be established
in the State Board of Health. Dr. Stevick further reported that Dr. H. J.
Rollins, State Veterinarian, had recently introduced to several staff members
of the State Board of Health, Dr. Martin Hines, who is a member of the
faculty of the Scholo of Veterinary Medicine of the University of Georgia. Dr.
Hines holds a degree of Master of Public Health, and expressed an interest
in applying for a position in North Carolina, should one become available.
His home formerly was in this State. A letter from Dr. Rollins was read
recommending that a public health trained veterinarian be employed by the
State Board of Health. Dr. B. J. Lindley and Dr. Clyde Young, veterinarians
representing the North Carolina eVterinary Medical Association, appeared
before the Board recommending that consideration be given to the establish-
ment of a Veterinary Section to assist local health departments in the control
of animal diseases which may be spread to humans. Secretary Norton sug-
gested that since there would be a Board meeting in the near future, the
matter be taken under advisement for discussion at a later date.

Mr. R. L. Caviness of the Sanitary Engineering Division, presented and
explained some revisions for adoption by the Board of Rules and Regulations
Governing the Sanitation of Itinerant Restaurants. After full discussion
of the revisions in the regulations, on motion of Dr. Haywood, seconded by
Dr. Lawrence, the revised itinerant restaurant regulations were adopted.

President Dixon announced that it was time to elect a State Health Officer,
as Dr. Norton had been filling out the unexpired term of Dr. Carl V. Reynolds,
which ends June 30, 1951. Dr. Ward moved that Dr. J. W. R. Norton be
elected as State Health Officer for the four-year term beginning July 1,1951.
Motion was seconded by Dr. Bender. Mrs. Hunt moved that nominations be
closed, and Dr. Norton was unanimously elected. It is understood that this
election, of course, to become final and official, must have the approval of the
Governor. It was moved by Dr. Current, and seconded by Dr. Ward, that Dr.
John H. Hamilton be elected as Assistant State Health Officer to succeed
himself, for a four-year term beginning July 1, 1951. Motion carried unani-
mously. (Dr. Hamilton was elected Assistant State Health Officer on Jan-
uary 19, 1951 to fill out the unexpired term of the late Dr. George Marion
Cooper. ) Dr. Norton expressed his appreciation and gratitude for the Board's
confidence and action in his re-election.

Dr. Current was recognized by President Dixon and was congratulated on
his having been elected President-Elect of the North Carolina Dental Society
at its recent meeting in Pinehurst.

May 2>f, 1951. The State Board of Health held a regular meeting in the
auditorium of the Laboratory of Hygiene Thursday, May 24, 1951, at 10:00
a. m. The meeting was called to order by Dr. Haywood, Vice-President.

The Oath of Office was administered to Dr. G. Grady Dixon of Ayden and
Dr. G. Curtis Crump of Asheville for four-year terms each. Dr. Dixon was
re-elected as a member of the Board by the North Carolina Medical Society
at its meeting in Pinehurst in May; and, Dr. Crump, a new member, was

88 Thirty-Fourth Biennial Report

elected by the Medical Society to succeed Dr. Ward, who retired from the
Board on account of his health.

On motion of Dr. Large, seconded by Dr. Lawrence, Dr. Dixon was unani-
mously re-elected President of the Board.

President Dixon announced the re-appointment of the Executive Committee
as follows:

Dr. G. G. Dixon, President

Dr. Hubert B. Haywood, Vice-President

Dr. H. Lee Large

Secretary Norton read the Minutes of the Board meeting held on May 9,
1951, which were approved as read.

It was suggested by President Dixon, and approved, that the Assistant
State Health Officer be requested to attend all Board meetings in the future.

In a further discussion of the advisability of employing a veterinarian in
the Division of Epidemiology, the Secretary presented job specifications and
tentative budget to the Board for their information. Also Dr. James H. Steele,
Chief Veterinarian, Communicable Disease Center, USPHS from Atlanta,
pointed out the many advantages and great service that could be rendered
by a public health veterinarian. Dr. H. J. Rollins, State Veterinarian of the
Department of Agriculture, heartily endorsed the employment of a veterina-
rian trained in public health by the State Board of Health. Also present
were Drs. B. J. Lindley and Clyde Young, veterinarians representing the N.
C. Veterinary Medical Association. Secretary Norton told of recent meeting
of local health officers at which this subject was discussed and that they
were very much in favor of having a veterinarian with an M.P.H. degree on
the staff of the State Board of Health and were willing to contribute to this
expense from funds allocated to the counties. Dr. Current moved that the
State Board of Health favor the employment of a veterinarian with a degree
of Master of Public Health. Motion seconded by Dr. Large and carried
unanimously.

Mr. Jarrett gave a further report on the new Health Building. He stated
that as a representative of the Board, he had had conferences with Messrs.
Deitrick and Jones, architects, and displayed plans and diagrams for the
erection of an annex to the rear of the present building with the hope that
later on funds would be available for tearing down the present building and
erecting a front comparable to the general building plan on Caswell Square.
Dr. Large moved that the Board of Health go on record as approving the
site of the present building as the permanent location of the Board of Health
Building, and if approved by the Board of Public Buildings and Grounds, to
proceed with the designing and erection. Motion seconded by Dr. Crump and
carried.

Secretary Norton discussed the policies of the Board for the allocation of
State Aid funds to local health departments for the fiscal year beginning
July 1, 1951. He stated there was only one change in the policies, — this being
in the per capita amount of 9-cents distributed according to the 1940 census
population and that this year the per capita amount of distribution would be
6-cents based on the 1950 census. Dr. Lawrence moved that the Board ap-
prove the "Policies of the North Carolina State oBard of Health for Alloca-
tion of State Aid Funds to Local Health Units" with authority vested in the

North Carolina Board of Health 89

State Health Officer and the Executive Committee to work out the distribu-
tion. Motion seconded by Dr. Large, and carried.

Dr. Norton presented a recommendation from Dr. A. H. Elliot, Director of
the Personal Health Division, relative to physicians and health officers being
permitted to use opthalmic penicillin ointment in the eyes of newborn babies
instead of silver nitrate. After full discussion, Dr. Lawrence moved that the
Board accept the report without prejudice — and to thank Dr. Elliot for same,
and that the Executive Committee, with the Secretary, be permitted to form-
ulate rules and regulations which would permit certain institutions, or indi-
vidual physicians to use these antibiotic measures for clinical observation
without violating the law while doing so. It is intended that midwives and
physicians not carrying on clinical observation work will continue to use
the more stable silver nitrate drops. Motion seconded by Mr. Lutz and unan-
imously carried.

July 10, 1951. A joint meeting of the Executive Committee of the State
Board of Health and the oBard of Public Buildings and Grounds was held
Tuesday, July 10, 1951, in the office of Governor W. Kerr Scott. It was de-
cided at this meeting that a joint meeting between the entire State Board of
Health and the Board of Public Buildings and Grounds should be held in
the near future in order to reach a final decision with regard to the selection
of a site for the new State Board of Health Building.

August 3, 1951. The State Board of Health met in Dr. Norton's office in
the Health Building August 3, 1951, preliminary to a joint meeting in the
Laboratory uaditorium at eleven o'clock with the Board of Public Buildings
and Grounds, with President Dixon presiding.

Dr. Norton read the minutes of an Executive Committee meeting on April
18, of the regular Board meeting held on May 24, and an Executive Commit-
tee meeting with the Board of Public Buildings and Grounds in the Gov-
ernor's office on July 10. The minutes of all three meetings were approved
as read.

Dr. Large stated that the State had lost $200,000 because the Board of
Health had not made its recommendation in conformity with the wishes of
the Board of Public Buildings and Grounds and that it is time that the Boards
get on a solid front on the location of the new building. He was willing to
vote for any measure that would present unanimity of the Boards.

Dr. Lawrence recalled the promise made at the Executive Committee meet-
ing on July 10 by the Governor, the Secretary of State and the Attorney Gen-
eral, that they would ask the next Legislature to appropriate the additional
amount of money needed for completion, if we put the building on the north-
east corner of Caswell Square.

Dr. Large presented the report on the vote of the employees which was
about equal for the northeast corner or for an annex to the old building.

Dr. Large moved that the Board of Health indicate to the Board of Build-
ings and Grounds this morning that we are willing to accept the placement
of the building on any site that it chooses.

After some discussion, Dr. Large changed his motion— that the Board of
Health after considering the recommendations made at the joint meeting in
the Governor's office decided to accept their recommendations and put the
building on the northeast corner of Caswell Square, provided that the Build-

90 Thirty-Fourth Biennial Report

ings and Grounds Committee will begin immediate activity for the erection
of the Building. The motion was seconded by Mr. Lutz. Dr. Bender voted
"no."

Mr. Coltrane presided over the meeting in the Laboratory auditorium.
Mr. Coltrane: The matter under discussion is the location of the Health
Building. The Board of Public Buildings and Grounds and the Board of
Health have been discussing this matter for about two years and probably
we have lost $200,000 in the time which we delayed in the construction of this
important building.

Mr. Cherry: I invited Mr. W. H. Rogers, Jr., from the Highway Commission
and Mr. Stevens relative to the proposed highway to answer questions.

Dr. Dixon: The Governor stated that the City had plans for rearranging
the section. That would perhaps change the Board of Health's attitude on
placement of the building.

Mr. Rogers stated that they hope to be able to let a contract within the next
six months. They propose to make McDowell Street one way north and
Dawson Street one way south. The City of Raleigh Council has not con-
curred. They have two proposals for the relief of inter city traffic and they
are ready to proceed if the plan is accepted.

Mr. Stevens said that Mr. Rogers' comments were correct, the City Council
deferred action but the deferral was due to a debate as to a connection be-
tween this project and Glenwood Avenue. As far as this part of the project
is concerned, there is no debate within City Hall and they consider it neces-
sary for commercial traffic as well as passenger vehicles. He made the point
that they have tried to cooperate with Mr. Cherry and with the State Legis-
lature in trying to create a plan for capital buildings here in Raleigh. Some
of the houses in that section will have to be demolished.

In answer to Mr. Coltrane as to whether this development is going to im-
prove this property, Mr. Rogers said that it was his opinion that that would
eventually become business property.

Mr. Coltrane: At the last meeting with your group, the Board of Public
Buildings and Grounds went on record in favor of the northeast corner of
Caswell Square but your Board did not concur. You had some reservations
about it and you wanted to have this explanation from the Highway Depart-
ment and the City as to the plans for developing the highway.

Dr. Dixon: In making that suggestion, we put it there in view of the fact
that the value of our dollars had shrunk, it was the general opinion that the
moneys appropriated would not be ample to build for our needs. Did I
understand that we would have this building constructed as soon as possible,
an extension to be completed later

Mr. Coltrane: That was my understanding.

Mr. Cherry: That was the understanding with the Board of Public Build-
ings and Grounds, to recommend that the Legislature appropriate the money
to make the building larger than can now be built with available funds. That
is what we went on record as saying.

Mr. Coltrane: I understood that it was the thought of the Boara to go
ahead and put on that location there on the northeast corner a building of
comparable size that you propose to put over here to the rear of the present
building.

North Carolina Board of Health 91

Dr. Lawrence: Dr. Large, they would be interested in the resolution just
adopted by the Board of Health so they can have something definite to carry
back to the full Board of Public Buildings and Grounds.

Dr. Large: As best I can recall, the resolution was to the effect that the
State Board of Health accept the recommendations of the Buildings and
Grounds Committee to locate this building on the northeast corner of Caswell
Square, with this proviso, that in accepting that, we expect that the Buildings
and Grounds Committee take immediate steps to start erection of the build-
ing. We feel that we have lost enough time and money in delaying.

Mr. Coltrane: The Budget Bureau handles these matters and I think we
could give the architect the go ahead signal, and he is the main man to say
when he could complete plans. We could handle it so far as the Budget
Bureau is concerned pretty rapidly. I believe I can safely speak for the
Board of Public Buildings and Grounds if that is your wish, that we can
proceed immediately.

Mr. Cherry: I am sure Mr. Coltrane has authority to accept that resolution
as being acceptable to the Board.

Dr. Dixon: Shall we raise the question now as to whether or not this
building is to be designed for air conditioning?

Mr. Coltrane: All of you know the State's policy with respect to air condi-
tioning, something desirable but something that has not been adopted. It is
a question of cost, and if and when the State decides to embark on that policy
for all State buildings it is going to cost several million dollars, not only the
original cost, but there would be a continuing operating cost.

Dr. Dixon: Mr. Deitrick, in planning this new building, if it was made to
be heated by hot air, could it be so arranged that if and when the State had
sufficient money for air conditioning, the same ducts would be used?

Mr. Deitrick: That is possible, but it would mean a slightly increased cost
in the system.

Dr. Dixon: What would be the extra cost of installing ducts for air con-
ditioning?

Mr. Deitrick: My guess is that the duct system in this building run around
15 or 20 thousand dollars. Mr. Turner could probably answer that better.

Mr. Turner: In terms of cost of building, about five per cent.

Mr. Cherry: I would like to see the ducts put in myself. Circulated air
is probably the very healthiest heat that you could have and it is very ap-
propriate for the State Board of Health to start that thing.

The meeting was then adjourned and the State Board of Health met again
in Dr. Norton's office, with Dr. Dixon presiding.

Mr. Jarrett: In connection with our fluoridation policy, we have had quite
a number of towns that have been interested and have discussed it with us.
and this is the first town that has followed through completely on the policy
as outlined by the Board, the City of Durham.

Dr. Current: Winston-Salem, Greensboro, Rocky Mount are almost to this
point. The town of Gastonia is working on it and the North Carolina Denta?
Society at its Executive Committee went on record as making their major
project for this year an attempt to get as many incorporated cities in North
Carolina as possible to come under proper control.

92 Thirty-Fourth Biennial Report

Mr. Jarrett presented a petition signed by a majority of the resident free-
holders of the Sharon Community, Mecklenburg County, Charlotte, North
Carolina, and other documents pertaining to the proposed Sharon Sanitary
District. Mr. Jarrett explained that all of the legal procedures required by
the sanitary district statutes has been conformed to and that a representative
of his office had held the necessary public hearing for the State Board of
Health, and that the territory proposed to be included within the sanitary
district had been examined as well as all of the documents pertaining to its
creation to determine if they were in order. Mr. Jarrett recommended to
the Board that the necessary resolution creating the sanitary district be
adopted.

Dr. Current moved that the resolution creating the proposed sanitary dis-
trict to be known as the Sharon Sanitary District be adopted. The motion
was seconded by Dr. Large and unanimously carried.

Mr. Jarrett then presented a letter from Mr. R. Mayne Albright, Attorney
representing the Greensboro Memorial Park, Inc., requesting consideration
of a special problem in connection with the development of a cemetery on the
Greensboro Watershed. Mr. Jarrett explained that the 1903 watershed regu-
lation applicable in this case appeared unreasonable after a thorough study
and investigation by his office, and after consultation with the Attorney
General's office and, therefore, probably the regulation would not be upheld
if tested in the courts. Aerial photographs, topographical maps and ground
photos were presented to show the relative location of the proposed cemetery
to the Greensboro water supply lake, which is approximately five miles from
the site in question. Mr. Albright had suggested that his client be allowed
to bury within 50 feet of the "wet weather ditch" which traverses this prop-
erty. After a thorough discussion of all factors involved, it was the opinion
of the Board that the establishment of the cemetery would not jeopardize
the health of the citizens of Greensboro. Dr. Large moved that this request
for burial within 50 feet of the drainage ditch be allowed and that Dr. Norton
prepare for presentation at a later date a revision of the watershed regula-
tions. Motion seconded by Mrs. Hunt and passed unanimously. Dr. Large
also suggested that Mr. Jarrett check with the City of Greensboro and the
Guilford County Health Department as to local regulations. This was done
and there were found to be no complicating regulations in effect.

Dr. Norton called on Dr. Hamilton for suggestions about the new building.
Dr. Hamilton suggested that definite plans be worked out and approved by
the Budget Bureau as to material, whether to have ducts for air conditioning
and the kind of heat that would be acceptable, before investing money in
drawing up plans that might be vetoed by the Budget Bureau.

It was decided that the architectural design be in keeping with the other
State buildings, and that Dr. Norton consult with the architect and other
specialists, if need be, together with Dr. Hamilton Mr. Jarrett, and work out
what can be done with the amount of money, and present what they have at
the next Board meeting. Dr. Dixon suggested that they ask Mr. Deitrick in
drawing plans to sketch what we want as a complete building and show what
it would look like when it is completed.

September 14, 1951. A regular Board of Health meeting was held in the
State Room of the Robert E. Lee Hotel— Winston-Salem, N. C, at 3 : 00 p.m.,
Friday, September 14, 1951, at the time and place of meeting of the 40th

North Carolina Board of Health 93

annual meeting of the N. C. Public Health Association. Dr. Dixon, the Presi-
dent, presided. All members of the Board were present.

The meeting was called to order and Secretary Norton read the Minutes of
the Board meeting held on August 3, 1951, which were approved as read.

Dr. C. P. Stevick, Director of the Division of Epidemiology, was present and
discussed revisions in communicable disease regulations. He stated that for
some time the Public Health Service has been working with representatives
of the states to establish a uniform national system for reporting communi-
cable diseases. One of the reasons for this action, Dr. Stevick stated, was
the need to strengthen facilities for prompt reporting of communicable dis-
ease problems developing in connection with defense activities. Seven new
regulations and three amendments to existing regulations were presented for
adoption. Dr. Large moved for the adoption of the new regulations for the
seven communicable diseases: botulism, hepatitis, leptospirosis, Q fever,
staphylococcus food poisoning, tetanus and trichinosis. Also for the revisions
to the communicable disease regulations governing the three diseases: men-
ingitis, bacillary dysentery and poliomyelitis. Motion seconded by Dr. Crump
and unanimously carried.

Dr. Stevick also presented a revised report card to replace the three com-
municable disease report cards that are now in use. It was explained that
this new card would include provisions for reporting the diseases added to
the reportable disease list by the above regulations. On motion of Dr. Crump,
seconded by Dr. Large, the one new report card was unanimously adopted.

Mr. J. M. Jarrett, Director of the Sanitary Engineering Division, presented
and discussed a proposed extension of the Druid Hills Sanitary District in
Henderson County. He stated that all documents had been carefully exam-
ined and checked and that proper procedures had been followed in accordance
with the requirements of the General Statutes for the extension of the sani-
tary district boundaries. Mr. Jarrett recommended favorable action by the
Board. On motion by Mrs. Hunt, seconded by Dr. Bender, the resolution
extending the boundary of the Druid Hills Sanitary District in Henderson
County, N. C, was approved.

There was discussion of relationships between the State Board of Health
and the State Stream Sanitation Committee. Mr. Jarrett discussed the law
relating to stream sanitation as well as a letter which had been received from
the Personnel Department making inquiry regarding the functions, respon-
sibilities and authority of two organizations and the ruling contained in a
letter from the Attorney General's office on the subject which had been re-
quested by Dr. Norton. The Attorney General's ruling was a clear-cut and
definite statement "that the North Carolina State Board of Health has no
administrative authority whatsoever over the State Stream Sanitation Com-
mittee". Mr. Jarrett expressed the opinion that the members of the General
Assembly did not wish to create a new Board or Commission and therefore
they decided to place the Stream Sanitation Committee inside the State Board
of Health, with independent power being placed in the Committee. No
action on the part of the Board necessary. Mr. Jarrett is Chairman of the
Stream Sanitation Committee and the Board will have no responsibility except
to administer the funds, and to cooperate in any other function which may
be worked out mutually between the State Board of Health and the Stream
Sanitation Committee.

94 Thirty-Fourth Bienxial Report

Dr. Fred C. Hubbard, President of the North Carolina Medical Society, was
introduced. He spoke briefly and brought greetings from the Medical Society
and a desire to cooperate in every way possible.

Secretary Norton made a progress report on the architect's plans for the
new Cooper Health Building and submitted copies of the preliminary plans
of the proposed building to each member of the Board. There was discussion
and the plans were reviewed, — the main points under discussion being the
provision for adequate foundation and supporting columns that would be
adequate for two additional floors, or a total of six. Favor was expressed that
the addition to the west as sketched by Mr. Deitrick be included in the plan
in order to reserve that space for future development.

At Dr. Norton's request, Dr. Stevick reported briefly on one of the activities
of the Accident Prevention Section which is set up in the Epidemiology
Division. Dr. Stevick stated that for a number of years the W. K. Kellogg
Foundation had financed demonstrations in public health projects and that
they are now extending into new fields such as accident prevention. A
descriptive home and farm accident prevention demonstration project has
been drafted and submitted to the Kellogg Foundation through the Public
Health Service, the project to be located in the Durham City-County Health
Department, with a budget of approximately $75,000 per year. It is hoped
that favorable action will be taken by the Kellogg Foundation. The plan
includes certain features not fully studied in previous projects of this type.

A closed brief executive session was held by the Board.

November 15, 1951. The State Board of Health met in regular quarterly
session Thursday, November 15, 1951 at 10:00 a.m. in the auditorium of the
State Laboratory of Hygiene, with President Dixon presiding.

The meeting was called to order by the President. Secretary Norton read
the Minutes of the Board meeting held September 14, 1951, which were ap-
proved as read. President Dixon read a letter from Dr. Current expressing
regret that he would not be able to attend the meeting on account of the
illness of his mother. A telegram was received from Mr. Lutz stating that
he regretted his inability to be present at the meeting.

Dr. John H. Hamilton was asked to give a further progress report on the
"Cooper Health Building." A drawing of the building was presented in color,
and Dr. Hamilton read excerpts from a letter by the Board of Public Buildings
and Grounds to the Wm. Henley Deitrick, Inc. Architects, setting forth the
structural details of the building and incorporating adequate structural and
mechanical features to be extended to provide for the future servicing of two
additional floors. Other features discussed were the electrical design, walls,
watermains and rest rooms, steam heat, air ducts, elevators, etc. Dr. Dixon
suggested that further information be obtained from heating engineers who
would be considered an authority on the subject to determine the cost and
upkeep of hot air as compared with hot water or steam heat. Dr. Haywood
also suggested that aluminum, or other rust-proof materials be used in window
casements.

Dr. Norton reported that at a Board meeting held on May 24, 1951, a pro-
posal to permit certain institutions and private physicians to begin using
opthalmic penicillin ointment instead of silver nitrate in the eyes of newborn
babies, was referred to the Executive Committee and the Secretary of the

North Carolina Board of Health 95

State Board of Health for the formulation of rules and regulations permitting
such use of penicillin. The following proposed regulation was suggested and
forwarded to each member of the Executive Committee to indicate his ap-
proval, or disapproval, or suggestions for change, and the proposed regulation
was signed and returned to this office by each one: —

"Effective November 1, 1951, the North Carolina State Board of Health
approves the use of freshly prepared opthalmic penicillin ointment in
the eyes of newborn babies in place of silver nitrate when these babies
are delivered in approved hospitals or clinics by licensed physicians —
for a period of clinical observation. Such use of penicilin will not
constitute a violation of the present State law on this subject. Mid-
wives will continue to use silver nitrate drops as before."

There was much discussion on the above regulation by the members of the
Board. It was decided to strike out the words "licensed physicians" and
insert in lieu thereof the wording "physicians licensed to practice medicine
in the State of North Carolina."

Dr. Crump reported on an article in the current issue of the American
Journal of Surgery by Dr. Laff. Eyes of newborn babies were flushed out with
three ounces of either sterile water or normal saline with less local reaction
and equal prophylactic effort as compared with cases in which silver nitrate
or penicillin was used.

Dr. Haywood suggested the advisability of getting information from the
maternity and opthalmology departments of Bowman Gray and Duke Hos-
pitals on the use of the various prophylactic procedures used in protecting the
eyes of newborn babies — prophylactic effectiveness, local reactions and allergic
reactions.

Dr. Large moved that the State Board of Health designate and request
Bowman Gray and Duke University obstetrical and opthalmology departments
to make a comparative study of the effectiveness of silver nitrate, penicillin
and sterile distilled water in the control of gonorrheal opthalmia neonotorum
in cooperation with and under the direction of the State Health Officer —
this study to be terminated at the will of the State Board of Health, it being
understood that this study will not be held in violation of the present law
requiring only the installation of silver nitrate solution in newborn babies'
eyes. Motion seconded by Dr. Crump and unanimously carried.

Secretary Norton presented a suggested draft of a resolution for the Board
approving the plan adopted by the Sharon Sanitary District Board for the
installation of a sewerage system. Secretary Norton stated that the resolu-
tion and report were in proper order. On motion of Dr. Lawrence, seconded
by Dr. Large, the resolution approving the plan adopted by the Sharon Sani-
tary District was carried unanimously.

Secretary Norton presented revised "Watershed Regulations for the Pro-
tection of Filtered Surface Water Supplies". These revised regulations had
been sent to members of the Board for review and consideration prior to the
meeting. There were a few minor changes made in paragraphs 5. 10. 11.
and 13. With amendments properly incorporated, Dr. Large moved for the
adoption of the revised Watershed Regulations for the Protection of Filtered
Surface Water Supplies. Motion seconded by Dr. Bender and unanimously
carried.

Secretary Norton brought to the attention of the Board the matter of the

96 Thirty-Fourth Biennial Report

"Citizens Committees" in a few of the states. This is a method of finding
out what the "people" really want and will support in the way of health
programs, and as a method of getting more people planning for and backing
community health activities. From reports, the Citizens' Committee seems
to be getting excellent results in Kentucky.

Secretary Norton read a letter addressed to him from the Cancer Com-
mittee of the "Wake County Medical Society signed by Alexander Webb, M. D.,
President and Lee H. Sanders, M. D., Secretary, which recommended the
establishment of a Cancer Clinic in cooperation with the American Cancer
Society and the N. C. Board of Health, outlining the principles to be followed
as passed by the Wake County Medical Society at its regular meeting in Sep-
tember 1951. Secretary Norton introduced Dr. A. H. Elliot, Director of the
Personal Health Division and who has supervision of the Cancer Section, for
comment. In discussing the proposals, Dr. Elliot stated that some of the
items set forth in this communication are not in keeping with some of the
policies outlined in the present setup for the Cancer Detection and Diagnostic-
Management Centers. Excerpts from the law and policies of the cancer
control program were read and discussed. Dr. Norton read the portion of
the statute that requires the State Board of Health to consult with the
Cancer Committee of the State Medical Society for recommendation. Some
of the proposed principles do not follow the pattern as approved by the State
Board of Health, the Cancer Committee and the Executive Committee of the
State Medical Society. After discussion, Dr. Lawrence moved that the Board
accept the recommendations of the Cancer Committee of the Wake County
Medical Society and that the Board recommend to the Cancer Committee of
the State that the request from the Wake County Medical Society be ap-
proved. Dr. Large suggested an amendment, and Dr. Lawrence accepted
it — that at the same time the Board recommends to the State Committee that
Wake County be allowed to operate under these arrangements that they have
promulgated — that other cancer clinics be allowed the option of adopting any
part of the procedures set forth by the Wake County Medical Society. Motion
seconded by Dr. Crump, and unanimously carried.

Secretary Norton reported to the Board that (1) the North Carolina Public
Health Association had applied for affiliation with the American Public Health
Association and that the request for affiliation with the national organization
has been approved which gives the NCPHA representation on the Governing
Council of the APHA. (2) That he, Dr. Norton, has been appointed to serve
on the N. C. Hospital Study Committee which will carry on a pilot study of
the best means of providing high quality hospital and medical care at the
lowest possible cost to the public. This study is under the general chair-
manship of Dr. Gordon Gray, President of the Consolidated University of
North Carolina, Chapel Hill and Mr. Graham L. Davis, formerly with the
Duke Endowment and at present on leave from the W. K. Kellogg Foundation,
is to direct the study.

March 13, 1952. The State Board of Health met in regular quarterly session
Thursday, March 13, 1952, at 9:30 a.m., in the auditorium of the State Lab-
oratory of Hygiene, with President Dixon presiding, and all members present

The meeting was called to order by President Dixon. Secretary Norton
read the minutes of the Board meeting held November 15, 1951, which were
approved as read.

North Carolina Board of Health 97

Mr. J. M. Jarrett, Director of the Sanitary Engineering Division, was heard
first as he had to leave for another appointment. He presented "Sanitary Rules
and Regulations Governing Beauty Culture Shops, Schools, Colleges and Other
Hairdessing Establishments in North Carolina." These had previously been
sent to the Board members for their review. Mr. Jarrett reminded that the
rules and regulations were approved by the State Board of Health in May,
1942. The Cosmetic Art Law was amended in 1949, and therefore the rules
and regulations had to be changed accordingly, so with the assistance of the
State Health Officer, the Sanitary Engineering Division and the Cosmetic
Art Board, the rules and regulations were greatly improved. These regula-
tions have only recently been approved and forwarded to us by the Cosmetic
Art Board. On motion by Mr. Lutz, seconded by Dr. Crump, the "Sanitary
Rules and Regulations Governing Beauty Culture Shops, Schools, Colleges
and other Hairdressing Establishments in North Carolina", were unanimously
adopted as presented. Mr. Jarrett presented a resolution to amend the plan
of the Sharon Sanitary District which had previously been approved by the
State Board of Health. The revised plan provides for connection of the
homes with the City of Charlotte's municipal sewerage system. Mr. Jarrett
stated that he thought the amendment worthwhile, as it would eliminate all
septic tanks from the District, as well as the problem of maintenance by
providing for Charlotte sewers tie-in. Dr. Current moved that the amended
plan of the Sharon Sanitary District be adopted. Motion seconded by Mrs.
Hunt and unanimously carried.

An Order for the town of North Wilkesboro to install, maintain and operate
an adequate sewage collection system, and an approved sewage treatment
plant also was presented and discussed by Mr. Jarrett. He recommended
favorable action by the Board on this Order. Dr. Crump moved that the
"Order for the Town of North Wilkesboro" to install adequate and necessary
sewage treatment facilities be approved. Motion seconded by Dr. Current
and carried.

Mr. Jarrett made a brief progress report on fluoridation of public water
supplies. He stated that sixteen cities and towns have made application and
fourteen have been approved to date. The cities to which approval has been
given to build fluoridation plants are: — Winston-Salem, Charlotte, Concord,
Durham, Fayetteville, Greensboro, High Point, Reidsville, Roanoke Rapids,
Rockingham, Rocky Mount, Southern Pines, Wilson and Dunn. The applica-
tions of Lincolnton and Salisbury are pending.

In his report, Mr. Jarrett stated that it was almost impossible for the chem-
ical manufacturers to get vegetable dyes used in coloring the fluoride com-
pounds; therefore, the manufacturers have been unable to supply towns with
the colored fluoride compounds to begin fluoridation of their communal water
supplies. In order to alleviate this situation, he suggested that the Board
give consideration to changing Paragraph #7, Section #4 of the Fluoridation
Policy of the State Board of Health involving the kind of dye used in coloring
the fluoride compounds to the following: —

"The fluoride chemical shall be plainly labeled and, if in the dry
form, shall be colored by means of a dye in order that it may be
readily distinguished from other chemicals used in water treatment
processes. The dye used for this purpose when applied to the water
so as to add 1.5 ppm of fluoride (F), shall not in any way be toxic
or detrimental to health and shall not in any way affect the quality

98 Thirty-Foubth Biennial Report

of the water in respect to the U. S. Public Health Service Standards.
The kind of coloring material used for coloring the fluoride shall be
identified by the manufacturer in his proposal."

The changes in the type of dyes used were discussed. On motion of Dr.
Bender, seconded by Dr. Crump, Paragraph #7, Section #4 of the present
Fluoridation policy of the State Board of Health was amended as proposed
above, and was unanimously passed.

Dr. John H. Hamilton, Assistant State Health Officer, made a brief progress
report on the New Health Building and displayed the very latest blueprints
of same. He stated that the architects should be ready to advertise for bids
at least by April 30.

Dr. E. A. Branch, Director of the Oral Hygiene Division, discussed fluorida-
tion of municipal water supplies from the viewpoint of local Dental and
Medical Societies. In his discussion, he stated that inasmuch as the Chapel
Hill water supply is owned and operated by the University and therefore by
the State of North Carolina, the town officials feel that a stronger recom-
mendation from the State Board of Health to the effect that the municipal
water supply at Chapel Hill be fluoridated, is needed to secure the necessary
State funds. Dr. Branch also reviewed the State Board of Health's policy
and the latest information and findings regarding the use of fluoride in
drinking water supplies as a means of reducing dental caries. The following
proposed additional resolution was suggested to the present Board policy: —

"Based on the medical and scientific judgment of the American Med-
ical Association, the American Dental Association, and the U. S.
Public Health Service, all of which organizations endorse fluorida-
tion, the North Carolina State Board of Health believes that the
fluoridation of municipal water supplies is a safe and effective way
of reducing the incidence of dental caries and recommends it to the
cities and towns of the State, as a public health measure."

On motion of Dr. Current, seconded by Dr. Large, the above resolution was
unanimously voted to be added to the present fluoridation of municipal water
supplies policies of the Board of Health.

Secretary Norton made a progress report on the prophylactic procedures
used in protecting the eyes of newborn babies as observed by the faculties
of Duke and Bowman Gray Medical Schools. A letter was read to the Board
from Dr. Banks Anderson, head of the Ophthalmological Division, Duke
School of Medicine. Dr. Norton stated that both Duke and Bowman Gray
would be pleased to cooperate in this study, which would be followed through,
in an attempt to reach definite opinions and recommendations relative to this
subject.

Secretary Norton reported the action on the Wake County Medical Society
proposal to establish a cancer clinic along lines differing in some respects
from previously established policies in cooperation with the American Cancer
Society and the N. C. State Board of Health. The State Board of Health
approved the Society's proposal and passed it on to the Cancer Committee
of the State Medical Society, which also approved. Then the American Cancer
Society, N. C. Division, disapproved the proposal. The Wake County Society
Cancer Committee then proposed the establishment of only a Cancer Detec-
tion Center and this was approved by the American Cancer Society Board
of Directors. This was approved and passed on to the Executive Committee

North Carolina Board of Health 99

of the State Medical Society. The Executive Committee has not acted on the
proposal to date.

Secretary Norton told the Board of a report by the American Public Health
Association, on "a militant religious group which has the purpose of restrict-
ing the teaching of health, sanitation and the biological sciences" in four
states, including New York, and that he wrote to the New York State Health
Officer for additional information. The matter is now in the legislature and
information will be given later, the reply indicated.

Dr. Norton reported briefly on the very fine meeting of the local health
officers held on Monday, March 10, the purpose of which was to talk over
needs in the matter of budgets, legislation in general and other matters of
mutual interest to local health officers.

The question of multigraphing minutes of Board meetings and forwarding
them to the members for their approval, so that time could be saved by not
having to read the minutes at Board meetings, was suggested by the Secre-
tary. Dr. Haywood moved that multigraphed minutes of Board meetings be
circulated among Board members for their approval. Motion seconded by
Mrs. Hunt, and carried.

A preliminary consideration of the budget to be presented to the 1953
Legislature was discussed by Secretary Norton. He discussed the various
items now contained in our budget which are earmarked for specific activi-
ties; of the desirability of requesting a larger general appropriation for
strengthening local health departments, and other additional health measures,
and of the advantage of making as much as possible of the entire appropria-
tion for strengthening generalized services to local health departments.

Dr. Large moved approval of Dr. Norton's budget suggestions. Seconded
by Dr. Lawrence and carried.

Dr. Bender suggested that Dr. Norton present to the members of the Board,
at an early date, a copy of the budget which we are now operating under, and
of a proposed budget, with additional comments as to why the new appropria-
tion should be around $3,000,000 annually.

Dr. Current suggested that all members of the Board be present when the
Secretary presents the 1953 budget to the Advisory Budget Commission and
to the Joint Appropriations Committee.

The Board suggested that Secretary Norton again remind the Board of
Public Buildings and Grounds about the funds needed for the two additional
floors in the new Health Building.

Dr. Norton reported briefly on proposals and bills dealing with the health
situation and better care of Indians on the Reservations.

Both Doctors Norton and Hamilton reported on attending the Personnel
Council meeting this week. The Council was urged to finish its survey and
study of reclassifications of personnel as soon as possible in order to rebuild
lowered morale caused by the long delays.

Following the meeting the Board members and their wives, Dr. and Mrs.
Norton, Dr. and Mrs. Hamilton and Mrs. Edwards, attended a luncheon at the
Governor's Mansion by Governor and Mrs. Scott.

May 7, 19-~>2. The annual meeting of the State Board of Health was held
as required by law, on the second day of the meeting of the Medical Society

100 Thirty-Fourth Biennial Report

of the State of North Carolina, at The Carolina Hotel, Pinehurst, N. C, May
7, 1952. President Dixon presided.

The meeting was called to order by President Dixon. In view of the fact
that the minutes of the Board meeting held on March 13, 1952, had been
distributed to all members, Dr. Bender moved that the minutes be approved
without further reading. Motion seconded by Mrs. Hunt, and unanimously
carried.

For information of Board members, Secretary Norton distributed copies
of the State Board of Health budget 1952-1953.

Dr. Hamilton discussed a proposed change in specifications for the Health
Building in which the Budget Bureau was objecting to the windows in the
new Building being screened. After some discussion, a motion was made
by Dr. Bender, seconded by Mrs. Hunt, that the State Board of Health request
that screens be placed on windows in the new Health Building. Motion was
unanimously carried.

Mr. J. M. Jarrett, Director of the Sanitary Engineering Division, discussed
the insanitary conditions existing in the town of Warsaw, N. C, which have
resulted from inadequate facilities for collection and disposal of domestic
sewage from the community. He stated that a thorough investigation had
been made by his division, and that he recommended that the Board adopt a
resolution ordering the town of Warsaw to install an adequate sewer system
and treatment facilities. Mrs. Hunt moved that the Order to the town of
Warsaw to construct a sewerage system be approved. Motion seconded by
Dr. Bender, and carried.

Mr. Jarrett also discussed a rekuest from the City Manager of Raleigh to
permit fishing in Lake Raleigh,— one of the improved municipal water supply
lakes. Fishing has been permitted in Lake Johnson for a number of years
and this request by the City is an amendment to their present ordinance
relating to fishing in City water lakes. Mr. Jarrett stated that this request
had been given special attention and investigation by his Division, and that,
in their opinion, that properly controlled use of the lake for fishing would
not present any material hazard to the treated municipal water supply. Mr.
Jarrett recommended approval of the resolution for fishing in Lake Raleigh
as requested by the City Manager. On motion by Dr. Current, seconded by
Mr. Lutz, a resolution authorizing the City of Raleigh to permit fishing in
Lake Raleigh was unanimously passed.

ANNUAL REPORT
NORTH CAROLINA STATE BOARD OF HEALTH

CONJOINT SESSION STATE MEDICAL SOCIETY

JOINT RESPONSIBILITIES OF PUBLIC HEALTH AND
PRIVATE PRACTICE

J. W. R. Norton, M.D., M.P., F.A.C.P.
Secretary and State Health Officer

Pinehurst, North Carolina
May 9, 1951

The customary detailed report has been submitted for this Conjoint Session
as has been done previously. It is felt, however, that instead of an annual
review of activities at this time, it would be more helpful to mention, and
comment on, some of the opportunities for constructive joint action by pri-
vate practitioners and public health workers. Let us go into consultation
regarding our North Carolina and our community patient just as we might
determine the essential findings, make a diagnosis and work out a plan of
treatment for an individual patient.

We are often faced with unreasoning and undeserved criticism and with
open attempts to make immediate radical changes by those with selfish mo-
tives or by some with sincere intentions but lacking in basic understanding
of the total problem. It is essential that we who have dedicated our lives
to medical and health care understand each other and give intensive study
to current problems and the best methods for their solution. We must resist
all attempts to drive wedges between those physicians who work for salaries
and those reimbursed on a fee for service basis. Clinicians, researchers, lab-
oratory workers, teachers, and public health physicians seek alike the goal
of constantly improving health for North Carolina. Specialists and general
practitioners benefit themselves and their patients when similarities are
emphasized, rather than differences. In providing modern medical and
health care, it is required that we work in harmony with each and all of the
others. The best treatment includes attention to prevention. Desirable
public health methods assist, and never interfere with ethical private practice.

Our embarrassment and disappointment at unfair criticism and selfish at-
tempts at regimentation must not be allowed to induce a persecution complex
with a resulting tendency toward superficial and emotional striking out
blindly at foe and friend alike. Careful analysis should enable us to determine
basic motives and it should prove helpful to discuss all medical and health
planning with co-workers and with those who pay the bill. Either private
practitioners, public health workers or the public operate under a distinct
handicap when one group assumes that the other groups are not equally
unselfish and are working in opposition. All sound public health programs
have been initiated, and are maintained, under the leadership of public spir-
ited private practitioners. The few short-sighted personalities who would
interfere with a continuation of this sound long-range plan fortunately are

102 Thirty-Fourth Biennial Report

decreasing. Strife and distrust must be replaced everywhere by constructive
and patient understanding.

A year ago attention was invited to the rising toll from diseases of the
heart and blood vessels, cancer, nephritis, diabetes, mental diseases and acci-
dents. Again, there is basis for the confident belief that we can work out
a program in the control of these health problems in the non-communicable
field that will be ethical, acceptable and effective, encroaching upon the pre-
rogatives of none. All public health programs directed against these problems
will have but one objective, that is, to promote early private medical care for
the patient and to insure the success of that care by providing to every phy-
sician, where needed, the services of trained personnel in case-finding, follow-
up, and rehabilitation. We can make full use of lessons learned in developing
dependable control techniques against communicable diseases and attack
health hazards in the non-communicable field with the same vigor, tenacity
and freedom from emotional or personal consideration. Neither the public
health armamentarium nor that of the private practitioner can remain static.
"We must make progress together. The community patient and the individual
patient have each received increasingly prompt, effective and adequate care.
Public Health procedures have successively emphasized quarantine and fumi-
gation, regulatory sanitation, isolation and immunization, chlorination and
pasteurization, epidemiological investigation, nutrition and health education,
prenatal care and family planning, case-finding and working out arrangements
for early treatment by private physicians. There is always resistance to
change and the timid have predicted dire calamity as procedures acceptable
in former days have become obsolete or the emphasis has been shifted.
Private practitioners will have happier and better work when each and
every cancer, heart disease, diabetes and mental disease are found early just
as they did when children became immunized against smallpox, typhoid,
diphtheria, whooping cough and tetanus, and tuberculosis and syphilis were
detected earlier. Prompt elimination of reservoirs of infection and of
influences that undermine individual or community health has become a
recognized necessity.

The field of opportunity for cooperation between public health and private
practice is neither limited to communicable disease control nor to services for
the indigent. Whatever proves most beneficial to the conservation, promotion,
or recovery of health for the individual or the community patient has been
observed to be good for the doctor. There are no exceptions of consequence
to this rule. When we prevent the preventable, provide for universal early
case-finding and arrange jointly for prompt and adequate treatment, no one
suffers. The private practitioner is aided and the public benefited by state
and local health departments that work toward prevention of disease, assist
in case-finding and help to provide expensive equipment and facilities for
treatment. Your public health departments are striving wholeheartedly for
improvement of working conditions for private practitioners and for the
development of voluntary prepayment hospital and medical care plans.

As individuals and as a profession, we must continuously strive to make
good with the public who pay the bill not only for public health but for
private practice as well. Better training in public relations and in our civic
responsibilities is needed for our profession which must be alert to the con-
tinuing necessity for current internal corrections and long-range planning.

Nokth Carolina Board of Health 103

This remains the biggest gap in medical education. It has been said that,
"the public is down on what they are not up on." As individuals and as a
profession we must have said of us that we are earnestly striving to make
good and better, not that we appear as if we think we have arrived. In some
cases private practitioners, while alert to the need for improvements in the
care of individual illnesses and injuries, have overlooked their opportunity
and duty for leadership in planning the provision of efficient local health
departments and hospital and medical care services for their community
to assure prevention, early case-finding and adequate treatment promptly
available. It is desirable that our grievance committees aim toward a basis
for long-range constructive planning as well as delayed corrections. If
physicians fail to lead in community health planning through boards of
health, formation of health councils, rural health conferences, and through
all other means, those who take over this function may even omit medical
consultation during the planning stage of their activity.

The public is not fully informed on its part in adjustment to some of our
modern changes. With good roads, electricity and telephones and desirable
developments in clinics and hospitals there is no more need for a physician
at every crossroad than for a general store. A doctor ten miles away may be
more readily available now than the one who a generation ago was in walking
distance. A well-informed public can also conserve the doctor's time and
save considerable expense by office instead of home visits, day rather than
night calls, and by more prompt but shorter hospitalization. In former gen-
erations the doctor and hospital were used only in extreme emergencies.
Medical costs are less when the physician is consulted early for the "ounce
of prevention" or the "stitch in time".

Perhaps the glamor of the medical specialist and the specialized or cate-
gorical public health worker has been disproportionately emphasized; cer-
tainly too little is associated with the genera.1 practitioner and the generalized
service of the local health department. Medical students fear lack of pres-
tige in general practice and the public and appropriating bodies get exag-
gerated views of individual diseases and other health problems rather than
an enthusiastic appreciation of the value of the best generalized medical and
health services fitted to the needs of each individual and community.

Constructive suggestions for improvement of public health practices are
always welcome from individuals and from the county and state medical
societies. These should be made to local boards, or the state board, of health,
however, and not handled so as to leave the impression that we in medical
and health work are a house divided against ourselves. County medical
societies are urged to furnish leadership and guidance in medical and health
planning. Local health departments are relatively free and should be re-
sponsive to their local medical societies and the people they serve. State
Board of Health rules on policy are general and flexible. Where we fall short
in uniformity we gain in freedom and utmost accomplishment in school
health and other services as we appreciate more fully our local health depart-
ments. Your health officer, local or state, welcomes the kind of relationship
each of you would wish if you were a health officer.

Two misconceptions that I would like to speak against have been encoun-
tered. One is that the use of tax funds inevitably leads to bureaucratic
control and loss of individual freedom. The selective and wise use of tax

104 Thirty-Fourth Biennial Report

money may have the opposite effect. Federal appropriations to our State
Board of Health and state and federal monies used by our local health depart-
ments aid and assist, but have not interfered with, our complete state and
local freedom. The same can be said, so far, with regard to Hill-Burton
funds in the construction period. Hospital maintenance problems are becom-
ing complicated and deserve careful long-range planning.

Another misconception is the idea that North Carolina public health work
infringes upon the field of private practice and leads to increasing govern-
mental controls. Each and every one of you are invited to analyze the work
of your State Board of Health and your local health department with care
and you will convince yourself otherwise. Which of these services would
you as private practitioners eliminate or be able, or wish, to do altogether
by yourselves,— environmental sanitation; control of sewage, water and
food; communicable disease epidemiology; maternal and child health; health
education; vital statistics; diagnostic and central laboratory; oral hygiene;
industrial hygiene; mental health; organizing for cancer case-finding; plan-
ning school health services; making arrangements for crippled children's
work; nutrition education; accident prevention education. Physicians on
our State and local boards of health have a major share in planning and in
guiding policies in this State. North Carolina physicians, dentists, pharma-
cists and other leaders can take real pride and reassurance of continued
freedom from medical regimentation in the excellent public relations created
by these health services.

A matter worthy of mention, even in a brief report, is that some who take
the shorter, easier, cheaper training for the care of the sick are increasing
their insistence that no distinction be made between them and those with
more thorough preparation. In the 1951 Legislature there were introduced
five bills as follows: chiropodist to be defined as the physician and surgeon
of the foot and leg; naturopaths to have a special board; chiropractors to sign
death certificates; drug clerks to become assistant pharmacists; optometrists
not to be distinguished from opthalmologists in referrals by public agencies.
A common thought is seen in all five bills; — "Do less, but demand just as
much recognition as the one who does more. Scream 'discrimination!' when
a distinction on the basis of qualifications is attempted." Does the plan of
salvation operate "without discrimination" when it promises a crown only
to those who bear the cross? Ability to select and being able to make a dis-
tinction— being discriminating — among those who render medical and health
services are basic necessities for progress. Remove this freedom from public
agencies and the loss of individual freedom may soon follow.

Other items of interest from the 1951 General Assembly are: $50,000 for a
cancer hospital for indigent patients in the terminal stage of the disease;
$86,500 for crippled children; a stream sanitation law to be administered by
a committee under the State Board of Health; a rewritten tuberculosis con-
trol law; setting up a board for registration of physical therapists; and slight
amondments to our laws relating to vital statistics; retirement of public
health workers; diphtheria immunization; and sanitary districts. The new
State Health Department Building is to be officially known as the "Cooper
Health Building."

It seems appropriate to close by reference to one whose life was devoted to
increasing joint action by private practitioners and public health workers

North Carolina Board of Health 105

through which everyone has been benefited. After forty-five years in private
practice, local and state health work, Dr. George Marion Cooper was gathered
to his fathers on December 18, 1950. His and succeeding generations rev-
erently give thanks to our Creator and call him blessed. For many, his un-
selfish and devoted service adds years to life and also life to years. His life
is proof that public health and private practice can advance hand in hand
and that the health of each and all is thereby made better. He led us far
along the road we should follow. He proved that as we overcome or divest
ourselves of handicaps that beset us as an individual or as a profession our
hold on those things we would like most to keep is strengthehed.

(For synopsis of departmental reports see The Health Bulletin, issue June,
1951.)

1952 CONJOINT SESSION
LOOKING AHEAD— FOR HEALTH IN NORTH CAROLINA

J. W. R. Norton, M.D., M.P.H., F.A.C.P.*

Pinehurst, North Carolina
May 7, 1952

A detailed report of public health activities is being submitted to the
President of the Medical Society and the State Board of Health. As has
been done the last three years, our time at this Conjoint Session will be used
to discuss matters considered of mutual and timely interest to private medical
practitioners and to health workers as we work and plan to salvage and re-
habilitate those who have become ill or injured and to maintain and promote
ever better medical and health care. The Auxiliary is of increasing impor-
tance in service operations, in long range planning, and particularly in our
public relations.

You, in private practice, deal with individuals primarily. You hear their
complaints, test and examine, diagnose, and minister to their medical needs.
We in public health practice hear the stories of, and serve in a similar man-
ner, the community, county and state. It is important that private practi-
tioners and public health practitioners coordinate efforts since one has con-
stant touch with the individual, and the other with the public, pulse. Each
has developed teams of co-workers in order to operate more competently and
economically. In past generations much of the available time has been used
almost exclusively in meeting urgent emergency situations and a considerable
part in travel or subprofessional work. During the last quarter century
remarkable progress has been made in hospital construction, surgical tech-
niques, therapy by chemical, antibiotic and hormone agents, nutrition, re-
habilitation, economical screening tests for early case-finding and more com-
plicated tests for diagnosis and prognosis, environmental sanitation, immun-
izing agents, and in reducing the catastrophic shock of health loss by public
underwriting for the indigent and by voluntary prepayment plans, complete
for those of lower, and partial for upper, income families. The voluntary
prepayment plan approved here this week should prove beneficial to the
public and to physicians and their interrelationships.

Perhaps we have overpublicized the things we have become able to do and
the progress we have made and even combined this at times with a conde-
scending and hurried manner. If we physicians are looked on as supermen
your individual private patients and the public with whom we physicians
in public health deal have greater difficulty understanding how and why
there should be medical or health deficiencies or difficulties for anyone. After
seeing amazing success in medical accomplishments formerly impossible, the
public tends to lose appreciation for the difficulties overcome in making these
possible and criticize anything short of absolute perfection. Shortcomings

Read before the Conjoint Session of the State Board of Health and the Medical Society of
North Carolina, Plnehurst, May 7, 1952.

•Secretary of the State Board of Health and State Health Officer.

North Carolina Board of Health 107

are magnified and exaggerated. Babe Ruth often got boos when he made
only a double or single. All sense of proportion is lost in appraisal of those
who so regularly accomplish the seemingly impossible and that psychology
is behind some of the present day criticisms of doctors. Unfortunately, many
persons repeat criticisms which tend to snowball with the passing and I
often ask, "What has been your own experience in your family with your
doctors?" And the answer most often is, "He always does everything needed
promptly and really does not charge as much as he should." A helpful trend
is that even with increasingly crowded curricula, the better medical and
dental schools have insisted on better training in sociology, preventive medi-
cine and public relations.

It may be enlightening to contrast the public attitude toward another pro-
fessional group — lawyers. Do you hear any clamor for "socializing" or
regimenting them? Yet our State supports about an equal number of lawyers
and medical doctors and at similar incomes. They undergo few of the per-
sonal sacrifices, take pride in the status quo and follow precedent all the
way back for hundreds of years. Except at high retainer fees they do little
or nothing corresponding to our preventive medicine services. What do they
do comparable to the heavy charitable service load of almost every private
practitioner? They have been given the majority of key posts in all three
branches of our government and enjoy popularity and public acclaim. Even
though the lawyers who run our government enjoy this popularity and the
medical doctors are temporarily under criticism it would seem short-sighted
and extremely uneconomical to place them as costly middlemen between the
patient and his doctor in any tiype of so-called socialization scheme. Inter-
posing a costly and unwieldy bureaucracy as a substitute for the confidential
and direct relationship between patient and doctor would not hasten correction
of the difficulties we are already on our way toward eliminating.

We should discourage the idea that we physicians are supermen and as
quickly as possible recover the public attitude that medical doctors are human
beings — just ordinary citizens of the community with a need for study, sleep
and recreation. Many factors influence health. The standard of living is a
vital factor. The patient and the public have a considerable responsibility
for health progress or lack of it. Most families after moving to a new place
wait for an emergency (often at night) to get acquainted with the doctor.
Every crossroads village feels neglected unless a doctor is induced to settle
there and then everyone takes all except minor complaints and emergencies
to the larger town or city doctor, and except in bad weather and at night.
Families that do not expect to pay are particularly prone to call the doctor to
the home instead of going to his office and at night when a day call could
have been made. One doctor trying to serve a small community, when thus
treated, will soon wear out or move away — with rare exceptions, of course.
With good roads and telephones available there should be two doctors wherever
possible, rather than one serving half that population so that each can live
as a human being in the community. As a human being, I repeat that each
doctor is entitled to study, recreation and even to become sick or get some
sleep and the other will thus be available to serve the community without
interruption and without the necessity of travel over a long distance.

Dr. F. R. Taylor, one of our esteemed colleagues, has urged that in any
difficulty it is well to start with, "It is my fault." I have referred to the

108 Thirty-Fourth Biennial Report

quirk of human psychology evidenced by the present attitude toward med-
ical doctors and towards lawyers. Have we doctors sufficiently reminded
patients and the public that doctors are human beings and that individual
and public understanding, cooperation and active helpful participation are
essential in order that the medical teams, private and public, can be of
greatest service? Taking the public into active partnership in meeting
present needs and in long range planning will prevent those outside the
profession from completely taking over and eventually telling the doctor
what to do and how and when and where.

Physicians have limits of physical endurance. They do their best work
only if families are well informed and carry out their obligations by main-
taining environmental sanitation, coming in for immunizations, and by
consulting the physician early rather than after illness or injury has become
complicated by delay. Medical and health services are not just handed out
on a silver tray by doctors or selfishly withheld by them; in many cases of
failure the individual, the family, the community have added difficulties to,
or made impossible, the effectiveness of the doctor's efforts. Let's admit and
correct the unfortunate situation that in the area of responsibility of the
individual, the family and the community progress has not kept pace with
recent improvements in the training of doctors and in the tools with which
they work. This is one of the many joint responsibilities of physicians in
public health with those in private practice.

This year we celebrate the Diamond Jubilee Anniversary of the founding
of the State Board of Health. It is a time for inventory-taking, for analysis
and appraisal, for discreet long-range planning. Our most urgent needs are
public understanding, reestablishing local responsibility, and honest determ-
ination of each individual in the state to do his utmost toward improvement
of the many factors influencing medical and health care. In addition to the
individual problems referred to, the public fails to provide adequate support
for training schools for medical and assisting personnel, for mental and
tuberculosis hospitals, and for health departments and then there is much
unfair criticism of the doctors in charge of these agencies. Construction and
maintenance of schools, hospitals, nurses' homes and health centers and
better distribution of doctors (and assisting personnel) is proving helpful.
Maintenance, particularly of our new general hospitals, will require careful
immediate and long-range planning for with the impact of this enormous new
financial burden could come overwhelming demands for undue federal sup-
port and control.

The entire program of the State Board of Health and of the local health
departments has been developed under the leadership of the State Medical
Society and through medical representatives on the respective boards. The
health services have been of enormous public relations value to physicians
of this state and could be greater if every physician would identify himself
with them. A few backward doctors, by lack of understanding and destructive
criticism, prevent fuller capitalization on this good will created by health
departments. State funds are appropriated for health work to twenty-odd
other agencies than the State Board of Health (and local health departments)
but in no other board is there similarly adequate representation by medical
doctors.

No other agency, private or public, can render public health services as

North Carolina Board of Health 109

competently and economically as your health departments. Many of these
services would not or could not be performed elsewhere and they help the
private medical practitioner and the public. Examples are: — laboratory serv-
ices; vital statistics records; immunizations; supervision of midwives; pre-
natal and well-baby centers; nutrition; school health; protection of water,
milk and food; safe disposal of human wastes; oral hygiene; crippled chil-
dren's clinics; occupational hygiene; home accident prevention; early case-
finding in tuberculosis, venereal diseases, cancer, diabetes, and mental
disorders; insect and rodent control; and health education. It is through
working and planning together by assuring participation by public rep-
resentatives that private and public medical practitioners can enlist appre-
ciation and support for these and all other medical and health services.

The Public Relations Committee of the State Medical Society has been
helpful. Several weekly newspaper columns, the Health Bulletin, and radio
broadcasts (including that of the State Board of Health over three major
stations) have also been useful in helping to bring public understanding and
cooperation nearer to the high level attained and held for technical medical
and health services.

Certain very active committees in each local medical society are needed,
particularly on public relations, public health and grievances. The public
relations committees at this time have an opportunity and a responsibility,
heretofore largely overlooked, to inform local Assemblymen who will meet
in January, and these committees should also keep our Congressmen informed
at all times on legislative matters affecting individual and public health.

May I urge each local medical society to arrange one annual meeting for
the purpose and to require the local health officer to report on policies and
programs. He should be present at the monthly meetings to report on and
answer questions regarding current health needs. This is being done in a
few counties. Since we have local autonomy and since most of the health
work is done in or through local health departments all private practitioners
will thus keep better informed. An active public health committee in each
local medical society is needed for consultation with the local board of health
and health department, and will assure that our health services are kept in
usetful fields. Some medical societies are promiting excellent public relations
by forming local health councils and making an active partnership with public
representatives in this advisory group.

More publicity is desirable regarding the handling of grievances. Every
effort should be made to change our reputation (sometimes deserved) of pro-
tecting misfeasance whenever perpetrated by a medical doctor. We protected
the public by cleaning house for those in the training period by closing inferior
medical schools. More active grievance prosecutions and corrective action
are needed now on the basis of public protection and we should continue our
good record in this state of avoiding those on the basis of technical medical
politics. It will help and not hurt our public relations when we frankly admit
that one may be able to pass rigid medical examinations without accepting
our even more rigid medical ethics as his way of life. The medical profession
should be itself the first to admit, and assist in bringing about correction of,
its offenders. Being good individually is not enough; failure to eliminate the
rare instances of selfishness, greed, dishonesty or incompetence in our ranks

110 Thirty-Foubth Biennial Repobt

has caused loss of prestige and could do much toward eventually causing loss
of individual freedom in medical and health practice.

In my report a year ago reference was made to efforts by those with limited
training who are continually attempting to remove legal distinctions (so
called discriminations) from those more fully qualified. It is urgent that a
more active interest be developed by all physicians in legislation not only in
continuing efforts against that which is harmful to the public but in con-
structively planning and aiding that which would promote health. Attention
is invited to two examples of the latter. A medical examiner bill (erroneously
called the coroner bill) was introduced late during the last session of the
General Assembly. It would eliminate many of the objections to our present
obsolete system without in any way interfering with the present prestige
and prerogatives of our coroners. With informed medical practitioners back-
ing it and if introduced early in the next session such constructive legisla-
tion should have a better chance of being passed.

In North Carolina, the principal local unit of government is the county.
In our local health departments there is more local autonomy than in any
other state. You know that the local public health nurse is assigned to an
area of population performing all services among them rather than using
the overlapping uneconomical plan of having a specialist nurse for each
activity and with one getting in the other's way all over the county. Some
of the states, even a few of the large areas, are still attempting to operate
local health services (so-called), from the state capital. I urge you to look
into this situation and to request your Congressman and Senator to vote for
generalized instead of specialized appropriations for public health. We have
to keep nine separate sets of books on federal appropriations when one for
general health would be better. Specialized appropriations assure a larger
central overhead with overstating by specialists in the national and state
capitals and get less out to the local health departments where practically
all the health services are performed. Your study, understanding and action
is solicited and if you can get the understanding of our legislators it will do
much to curb the tendency toward centralization and strengthen the local
health units where your influence and guidance toward more useful service
will be felt. In the interest of brevity, I have had to be sketchy here but
please talk with your local health officer about these specialized versus
generalized federal appropriations. There will be an article on this in an
early issue of the Health Bulletin.

As we look ahead to future medicine in North Carolina, I'd like to close
with excerpts from a recent Commonwealth Fund Report (1949) :

"Sometimes the people who are trying to change medicine have a word for
the quality they want to add to it . . . Scientific medicine . . . was to tease
out the physical components of disease and set them in order. It has given
us superb microscopy, masterful biochemistry, precision in diagnosis, and—
in some areas— brilliant therapy. It has led to the flowering of specialization.
. . . Specialization has gained at the expense of something equally valuable—
a sound general view of the patient. The parts have run away with the
whole. . . . There are too many people who are allowed to develop ailments
that medicine, either alone or in partnership . . . could prevent. All this
has become a commonplace criticism of medicine, and many medical educators
and other leaders are trying to change the situation.

North Carolina Board of Health 111

"There is no one good word to describe what medicine ought now to be-
come. Those who believe doctors should be wiser than they are now deny
the exclusive claim of the older medicine to the name scientific: they believe
medicine should become more scientific, in the sense of admitting data now
commonly left out of consideration. Medical progressives use the word
preventive when they think of what medicine could do before pathology
develops; constructive when they set 'positive health' as their goal; compre-
hensive when they ask doctors to deal with people whole instead of in parts;
social when they feel the pressure of the human environment on the individ-
ual and want the doctor to be at least aware of it. All these concepts are
facets of good medicine; taken together they mean something different from
the kind of medicine that now prevails. Specifically, without leaving out
anything that is now essential to good medicine, they add new dimensions to
it: breadth, to include more attention to the patient's environment; depth
to include some comprehension of his inner motivations; and duration, to
relate the patient's present condition to his past and future."

(For synopsis of departmental reports see The Health Bulletin, issue of
June 1952)

BIENNIAL REPORT
CENTRAL ADMINISTRATION

(July 1, 1950— June 30, 1952)

During the biennium, June 30, 1950 — June 30, 1952, the Central Administra-
tion has functioned as during the previous two-year period, during which the
reorganization of the State Board of Health's Central Staff was effected, in
order that the organization might be simplified, without loss of efficiency.
Throughout the two-year period covered in this report, demands made on the
Secretary and State Health Officer were heavy. In addition, there were
many speaking assignments outside of Raleigh, and he also attended Medical
and Health Association meetings, both in and out of North Carolina. He
participated in the activities of those organizations which have a bearing on,
and are affiliated with public health organizations. Out-of-state meetings
attended included annual sessions of the American Public Health Association,
State and Territorial Health Officers' Association meetings, the Southern
Medical Association meeting, and the Southern Branch of the American Public
Health Association. In all of these organizations, he took an active part,
both in committee work and floor discussions.

The Secretary and State Health Officer also is called upon to extend con-
sultatory services to many groups, especially local health departments, and
to organizations dedicated to human betterment. One important activity of
the State Health Officer is participating in the deliberations of the North
Carolina Resource-Use Education Commission, in which the State Board of
Health participated financially to the amount of $3,000. He also worked in
close contact with the Governor, the Superintendent of Public Instruction,
and with the officials whose duties make contact with the State Board of
Health necessary.

During the biennium, the Senior Publicity Specialist made 104 broadcasts
over Station WPTF, and expanded the department's radio activities to in-
clude weekly broadcasts over Stations WSJS, in Winston-Salem, and WWNC,
in Asheville. The Publicity Specialist also provided newspapers with press
releases and answered many communications in which information about
public health organizations in North Carolina was requested. He also attend-
ed meetings of the American Public Health Association and of the Southern
Branch.

The Budget Section of Central Administration is responsible for the proper
handling of all receipts and disbursements for the Board. During the period
covered in this report, 3,235 orders and 36,818 vouchers were issued, involving
a State-local budget of $8,594,183.71. Monthly Budget Reports of 77 local
health departments, representing combined annual budgets of more than
$5,000,000 were received and audited by the Budget Section. By direction of
the State Health Officer and Division Directors, the Budget Office is charged
with the responsibility of assembling and preparing both State and Federal
budgets, and preparing monthly State and quarterly Federal reports of re-
ceipts and expenditures.

North Carolina Board of Health 113

The Mailing Room mailed out 2,561,362 pieces of literature. During the
period covered by this report 1,560,000 copies of The Health Bulletin were
mailed. More than 3,000 names were added to the list, and an equal number
taken therefrom. During the biennium, 950 addresses were changed; 70 mor-
bidity reports were mimeographed, also 98 radio talks. The total number of
pages mimeographed was 4,260, while mimeographed copies totaled 1,355,642.

The Multilith Section printed more than 5,000,000 copies of forms on the
multilith machine, 309 new forms, 97 old forms revised, 433 new plates were
made, in addition to the other detailed work carried on in this section.

The work of the Personnel Office in Central Administration has been in-
creased by the gradual expansion of state and local health department staffs
and by the intricacies of solving personnel problems within the framework
of the Merit System and also the State Personnel Department for State em-
ployees. On June 1, 1952, a new classification and compensation plan became
effective for our State personnel as a result of a survey by the State Personnel
Department. Other major events concerning personnel were the moving of
the Merit System Office to Raleigh, the closing of the Western Medical Center
at Charlotte, setting slightly increased local salary ranges each year of the
biennium, administering the salary increment plan for State personnel and
distributing an Employees Handbook prepared by the State Personnel De-
partment. The salary range for Health Officer I was revised to allow an
increase of approximately 15 per cent for members of the American Board
of Preventive Medicine and Public Health. Twenty-two new job specifications
and 31 revisions in existing specifications were prepared and adopted for use
in local health departments and at the State Board of Health during the
biennium.

There were 273 appointments processed, 295 separations, 397 re-classifica-
tions, 23 additional salary increases, 440 salary increments, 350 cost-of-living
increases, and 83 adjustments. As of June 30, 1952, there were 326 employees
of the State Board of Health, and 22 vacant positions. In the local health
departments the following personnel actions were processed: 65S appoint-
ments, 715 separations, 140 re-classifications, and 1,631 salary increases. As
of June 30, there were 1,111 persons employed in local departments and 43
vacant positions.

The Central Filing Section operations continued to expand with the in-
creasing program activities. In this office rests the responsibility for record-
ing, protecting and filing all the official records. During the period covered
by this report, approximately 340,461 pieces of material were received for
filing; and 75,596 individual searches for material and information were
made. Three hundred and twenty-six new medical and public health books
were received; and 60 journals are subscribed for annually, with twenty of
these bound for permanent keeping.

STATE LABORATORY OF HYGIENE, RALEIGH, N. C.
BIENNIAL REPORT

July 1, 1950— June 30, 1952

The past two years have been marked by a large volume of work and some
notable changes in the State Laboratory of Hygiene. There were nearly a
million laboratory examinations— 922,424 to be exact which is about 7,500
greater than was reported during the previous period.

Water examinations continue to increase— 21,734 specimens being received
this biennium. New water supplies are being added every few days. Most
of these are for real estate developments — not accessible to existing municipal
distributing systems. Some are industrial supplies, since industry realizes
the protection which a laboratory examination can give them. Most of the
newer supplies are of a satisfactory type and do not contribute a hazard to
the people using them. Several of the private supplies have been discontinued
— usually because of the extension of municipal systems.

There has been some decrease in the number of blood cultures. The
decrease in the prevalence of typhoid fever is partly responsible, but the
prompt administration of antibiotics has also tended to make blood cultures
somewhat less urgently needed by physicians as an aid to diagnosis.

Urine and feces cultures were also smaller in number but were used more
and more for the release of those patients who did develop typhoid or para-
typhoid and for the continued study of typhoid carriers.

Cultures for the gonococci were markedly decreased. The apparent expla-
nation is the effectiveness of penicillin in the treatment of gonorrhea. This
therapeutic measure reduces the importance of cultures to the point where
it is of academic interest almost exclusively.

Of the agglutination tests there was the expected decrease in typhoid — a
slight increase in undulant fever, a decrease in tularemia, and a decrease in
the Weil-Felix tests for the Rickettsia infections— endemic typhus and Rocky
Mountain Spotted Fever, and an increase in the Heterophile antibody test
which has become more popular as an aid to the diagnosis of infectious
mononucleosis. For those who are interested in exact numbers these can
be found in the statistical tables which follow.

Serological tests for syphilis increased approximately 8,000 over the pre-
vious two year period— the total number of 726,549 being performed during
the current biennium. On January 1, 1951, we adopted as our standard sero-
logical test for syphilis the VDRL developed by the Venereal Disease Research
Laboratory of the United States Public Health Service. On all specimens of
blood which give a positive reaction dilutions of the serum are made and
the test repeated with the dilutions — the highest dilution which gives a
positive reaction is reported. All specimens of spinal fluid are examined by
the VDRL. For those specimens which are sufficient in quantity we do
Total Protein Determinations. We are of the opinion that this change in
our serological procedures for syphilis will give the physicians more data
as well as more accurate information than our previous serological tests. The
VDRL is somewhat more sensitive and somewhat more specific than the older

North Carolina Board of Health 115

serologic tests. However, it is not free from false positive reactions and is
not always positive in patients who have clinical syphilis. It is generally
believed that repeated titered tests on blood will assist in ruling out falsely
positive reactions when the titer decreases without treatment, and will materi-
ally assist in determining clinical relapses on reinfections in treated patients.

We have not been able to develop the complement fixation test for Endemic
Typhus and other Rickettsial or virus infections as rapidly as we expect to
in the future.

For the Group making microscopic examinations — nose and throat cultures
for diphtheria remain almost constant. This reflects rather accurately the
static condition of our fight against diphtheria. While other states are mak-
ing rapid progress — North Carolina is lagging behind to the point where we
now lead the nation in both cases and deaths from diphtheria.

The growing interest in our fight against Tuberculosis is reflected in a
substantial increase in the number of specimens of sputum examined during
the past two years over the previous comparable period. During this period
cultures for tuberculosis have tripled in number.

The number of specimens examined for malaria show a marked reduction
over the previous two year period, however, even with the smaller number of
specimens we did discover in nine — typical malaria parasites. In all whose
histories could be traced we found they were either veterans of the Korean
War or in close association with them and presumably infected by them.

The number of animal brains sent in to be examined for rabies was ap-
proximately 200 less during the current biennium than for the previous one;
however, evidence of rabies was found in 399 of the 1710 specimens examined.

Although our laboratory procedure for the examination of specimens for
Vincent's Angina has proven to be of little value, we still get sizeable numbers
of specimens.

Urethal smears for gonorrhea show a sizeable reduction in number. Of
13,500 specimens nearly 1,700 showed organisms typical in staining and
morphological characteristics. Here again antibiotic treatment is so effective
that clinicians are only moderately interested in laboratory aids to diagnosis.

Fewer and fewer specimens of suspected chancre serum are coming in for
Darkfield examination.

Our Health Officers are retaining their interest in the public health problem
of intestinal parasites — 34,614 specimens were sent in during the current
biennium — more than 4,400 more than in the previous one. Of these speci-
mens 5,801 showed the presence of one or more intestinal parasites. Since
many of these specimens were sent in connection with surveys, this infesta-
tion rate of nearly 14% emphasizes the fact that intestinal parasites are still
a public health problem in North Carolina.

For the biological products distributed by the Laboratory there are marked
reductions in the amount of Alum Precipitated Toxoid and almost identical
amounts of the soluble or Ramon Diphtheria Toxoid, although the number
is small. There is a relatively moderate reduction in the amount of Diphtheria
Toxoid and Pertussis Vaccine. An almost threefold amount of Tetanus
Toxoid was distributed. There was a slight increase in the combined Diph-
theria and Tetanus Toxoid, and a marked increase in the amount of Triple
Antigen. This product containing Diphtheria Toxoid, Tetanus Toxoid and

116 THIRTY-ForBTH BIENNIAL REPOBT

Whooping Cough Vaccine has been increasing in popularity during the past
several years. For the past ten months the trend has been strongly away
from the other immunizing antigens and in favor of the triple antigen.

For several years the amount of smallpox vaccine distributed has been
more than three times the number of live births in the State. If all this
vaccine is properly used, it should give us a well immunized population so
far as smallpox is concerned.

With the decrease in the prevalence of typhoid fever, the intensive immun-
izing campaigns that were so popular some ten to twenty years ago have
largely disappeared. Consequently, the amount of typhoid vaccine distributed
continues to decline. An additional factor is that for those taking the annual
booster dose intradermally only a small quantity of the vaccine is used per
individual.

More than 1500 antirabic treatments were distributed during the present
biennium, a reduction of 110 over the previous one.

The only point of significance in connection with the diphtheria antitoxin
distributed is that our diphtheria incidence is only slightly decreased.

We have dscontinued the 1000 unit packages— only the 10,000 and 20,000
unit packages are now available. It is difficult to explain the increase in the
amount of the 1500 unit package of Tetanus antitoxin. With more and more
of our people being immunized against tetanus by tetanus toxoid it would
seem that the use of tetanus antitoxin would be decreased.

Neoarsphenamine and sulpharsphenamine so widely used twenty years ago
are now discontinued items. The same fact applies to distilled water, since
the laboratory cannot now purchase it at a reasonable price.

We continue to receive Immune Globulin free of charge from the American
Red Cross which product has proved to be popular and effective in the control
of measles. More than 42,750cc were distributed during the current biennium.

Other discontinued biologicals are blood plasma and Rocky Mountain
Spotted Fever Vaccine which are no longer available free from the Red Cross
and the United States Public Health Service respectively.

There are a few items in the Receipts that would seem to need explanation;
for instance, the laboratory does not produce animals for sale. We do, how-
ever, sell those surplus animals, such as horses, sheep, calves, guinea pigs or
even mice. The Laboratory does not engage in the timber business— we did,
however; in the period — July 1, 1948 to June 30, 1950 sell as timber those
trees on the State Laboratory of Hygiene Farm which were designated by
a forester employed by the Conservation and Development Commission as
being marketable. The small amount of Receipts for timber during the cur-
rent biennium was primarily for pulp wood we derived from those trees indi-
cated as diseased or which needed to be cut for thinning purposes recom-
mended by the forester mentioned above. The Laboratory is not a commercial
producer of wool. — Yet for the proper operation of the Laboratory we need
a considerable number of sheep — these sheep need shearing. The wool
sheared from them is sold and the proceeds entered as Receipts.

One of the changes made by the State Laboratory of Hygiene during the
current biennium represents the departure from past practices and may or
may not constitute a precedent. This is the assignment of a Bacteriologist
employed by the State Laboratory of Hygiene to make bacterial examinations

North Carolina Board of Health 117

of shellfish for the Conservation and Development Commission and the
Division of Sanitary Engineering of the State Board of Health. This activity
is frankly an experiment but is intended to aid in the placing of the shellfish
industry on a more safe foundation. Many of the shippers of shellfish products
have been discriminated against by purchasers in the Northern markets
because they could not indicate that their plants and their products had been
adequately studied and certified by officials in their own State of North
Carolina.

During the entire biennium, especially during the latter part, we have
undertaken laboratory assistance in connection with the Stream Sanitation
Program. It is anticipated that this work will increase markedly during the
years to come.

Cancer cytology continues to be a service limited to the patients passing
through our Cancel Clinics and the female inmates of our state institutions.

The State Laboratory of Hygiene has endeavored to keep our laboratory
procedures up to a high standard of performance and to render dependable
service to the physicians of the State, our local health departments, general
hospitals, and our other state institutions. To a considerable measure we
believe we have succeeded. However, we are not satisfied and will continue
to make every effort to render better service to all the people of the State.

118

Thirty-Fourth Biennial Report

STATE LABORATORY OF HYGIENE, RALEIGH, NORTH CAROLINA
REPORT OF EXAMINATIONS MADE

July 1, 1950- June 30, 1952

Water Analyses

Bacterial & Chemical

Blood Culture Typhoid.
General Blood Cultures.
Feces & Urine Cultures
Cultures for Gonococci..

Positive Negative

292

73
95
66

145
68

7,525

5,717
1,814

Unsatis-
factory

247

July 1, 1948
June 30, 1950

Total

21,734
7,817
1,505
6,014
1,860

Total

19,320
8,482
1,833
6,438
3,897

Agglutination Tests

Typhoid & Para Typhoid. .

Undulant Fever

Tularemia

Weil Felix, Typhus & Rocky
Mountain Spotted Fever

Heterophile Antibody

Other Specimens

Serological Test for Syphilis

Total Number of Tests

Spinal Fluid (Wasserman) . 1 ,179

Spinal Fluid VDRL 3 ,535

Spinal Fluid-Total Protein.. 924

Qualitative Blood 670 ,094

Quantitative VDRL Blood.. 50,814
Rickettsial Diseases
Epedemic Typhus

Rat Bloods... __

Human Bloods

Rocky Mountain Spotted Fever

Q Fever

Rickettsial Pox...

Eastern Equine

Encephalomyelitis

Microscopic Examinations

Diphtheria -

Spinal Fluids

Tuberculosis (Sputum) 3 ,571

Malaria (Blood Smears) 9

Rabies (Animal Brains) 399

Vincent's Angina 483

Gonorrhea 1 ,694

Darkfield (Chancre Serum) 2

Feces, Intestinal Parasites... 5,801

Animal Inoculations

Tuberculosis-

Rabies...

Miscellaneous..

TOTAL

6,480 6,553 14,780

10,781 10,876 9,162

7,229 7,295 9,172

8,506
2,319

130

8,651 17,508

2,387 1,538

130

726,549 718,705

233

8 ...

313
9

5
1 ...

9
1

637

6,816

7,464

,6S5

33,187

903

1,265

2,380

11,667

28,557

626
31
46

148

256

37,384

943

1,710

2,863

13,509

34,614

195
147
21.872
922,424 914,938

7,622

30,155

1,900

2,013

6,754

17,355

30,162

130

201

5,909

North Carolina Board of Health

STATE LABORATORY OF HYGIENE, RALEIGH, NORTH
REPORT OF EXAMINATIONS MADE

July 1, 1950-
June 30, 1952
Diphtheria Toxiod (Alum Precipated)

lcc Vials 98

lOcc Vials 7 , 808

Diphtheria Toxiod (Ramon)

lOcc Vials 112

Combined Diphtheria Toxiod & Pertussis Vaccine

lOcc Vials 20 ,028

Tetanus Toxiod

lOcc Vials 2 ,874

Combined Diphtheria-Tetanus Toxiod

lOcc Vials _ 1 ,534

Triple Antigen

2cc Vials

lOcc Vials

Schick Tests for Diphtheria

Tests

Schich Control for Diphtheria

Tests

Smalpox Vaccine

Individual Tubes..._

50 Dose Vials

Typhoid Vaccine

lOcc Vials

50cc Vials

lOOcc Vials..._

Rabies Treatment

Pertussis Vaccine Treatments __

Autogenous Vaccine .__

Diphtheria Antitoxin

1,000 Unit Packages

10,000 Unit Packages 1,633

20,000 Unit Packages 1,969

Tetanus Antitoxin

1,500 Unit Packages 9,324

20,000 Unit Packages 225

Dick Test for Scarlet Fever 550

119

CAROLINA

July 1, 1948-
June 30, 1950

105

12,485

121

28,082

1,069

1,370

13,921

2,362

61,080

98,390

4,680

6,010

248,632

213,621

2,607

6,308

14,584

18,526

6,895

9,566

1,594

2,645

1,520

1,630

14,054

17,949

225

145

179

2,505

2,017

4,998
145

975

120 Thirty-Fourth Bienxial Report

July 1, 1950- July 1, 1948-
June 30, 1952 June 30, 1950

Neoarsphenamine & Sulpharsphenamine

0.6 Gram Ampules __ 2,991 9,123

0.9 Gram Ampules _.. 227

Distilled Water

lOcc Vials 14,753 30,671

Influenza Virus Vaccine

5cc Vials 4

The following are furnished the Laboratory by the

American Red Cross and Distributed Free of Charge

Immune Globulin (For Measles Control)

cc 42,754 45,358

Blood Plasma

250cc 11

500cc 5 p 595

The following are furnished to the Laboratory by the
U. S. P. H. S. and Distributed Free of Charge

Rocky Mountain Spotted Fever Vaccine

cc -

Noeth Carolina Board of Health 121

STATE LABORATORY OF HYGIENE
RECEIPTS

July 1, 1948-
July 1, 1950— June 30, 1952 June 30, 1950

Biologicals and Products

Toxoid $ 46 ,760 .29

Pertussis Vaccine 6,762.41

Autogenous Vaccine 390.00

Silver Nitrate 3 ,847 .12

Antirabic Treatments 6,887.35

Diphtheria Antitoxin 1 ,274 .95

Tetanus Antitoxin 5,245.76

Neoarsphenamine 431 .40

Distilled Aater 793.55

Dick Test .___ . 55.00

Water Tax ._.. 40 , 354 .75 37 , 613 . 50

Specimen Outfits 31,990.40 32,039.51

Special Fees ._ 911 .00 1 ,107 .75

Miscellaneous 203 .52 2 ,369 . 12

Animals 1,566.06 2,294 60

Timber 48.24 5,625 22

Wool - 389 .87

TOTAL . $ 148,001.67 $ 147,082.63

Refunds 128.04 1 ,664.41

NET TOTAL ...$ 147,873.63 $ 145,418.22

FINANCIAL STATEMENT

Total Expenditures $ 440 , 846 .00 $ 409 , 197 . 57

Total Receipts 145,873.63 145,418.22

Appropriation .__ $ 263,972.32 $ 263,779 35

122 Thirty-Fourth Biennial Report

STATE LABORATORY OF HYGIENE
DISBURSEMENTS

July 1, 1950- July 1, 1948-

June 30, 1952 June 30, 1950

Salary— Directory $ 16,980.00 $ 16,375.00

Salaries & Wages— Staff 260 ,963 .65 237 ,024 .61

Supplies & Materiels 90 ,454 .39 85 ,222 .23

Postage, Telephone & Telegraph 16,558 .97 17,371 .77

Travel Expense 2 ,192 .35 1 ,507 .97

Printing & Binding . 4,596.36 3,131.65

Motor Vehicle Operation 2 ,714 .79 2 ,398 .26

Light, Power, Water 7 ,028 . 15 7 ,222 . 12

Repair & Alterations 3 ,224 .76 4 ,782 .21

General Expense ._ 277.91 414.14

Insurance & Bonding 101 .72 123 .79

Equipment 3 , 035 . 70 1 , 580 . 03

Elevator Maintenance ._ 1,222.00 837.50

Debt Service 25,165.00 24,740.00

Water Analysis Special 5,500 .00 5,250 .00

Workman's Compensation 60 .25 101 .45

Motor Purchase 1,114.84

Calcinator Building 770 .00

TOTAL $ 440,846.00 $ 409,197.57

LOCAL HEALTH DIVISION

Throughout the period of the past biennium people of every county in
North Carolina have enjoyed the benefits of some type of full-time public
health service. All the county authorities have made appropriation for the
operation of that type of service. Failure to give all counties more reasonably
adequate services has been due to the inability to obtain a sufficient supply
of well trained personnel to meet the urgent demands. The shortage has
been the greatest in the category of health officers. Constant and vigorous
methods of recruiting have been persisted in throughout the period. Quite a
number of well trained health officers have been secured; however, the need
for this type of personnel still remains acute.

During the first three quarters of the biennium the Director of this
Division endeavored to supervise the work of all local health departments.
On January 1, 1952 Dr. R. E. Coker, Jr., former Health Officer of Alamance
County, was appointed Assistant Director of this Division. This addition
to the staff enables the Division to render a much more efficient medical
consultation service to the local health departments than has been possible
previously.

In August 1951, the Acting Chief of the Mental Health Section, Miss
Frances Johnson, died rather suddenly and unexpectedly. This threw an
additional load on the Director since it has been most difficult to recruit a
competent successor for that important position.

Notwithstanding the shortage of competent, trained personnel, it is felt
that a satisfactory public health program has been executed throughout the
state. Without doubt this has been due largely to the soundness of the
policies established by the State Board of Health in 1949 for this cooperative
public health program. During the past biennium those policies have been
strictly adhered to by the personnel of this Division. The spirit of teamwork
among the public health workers throughout the state has been effectively
sustained during the past biennium. In addition to the supervision of the
cooperaitve health program, the Director of the Division has focused his
attention on the matter of improving working quarters for personnel in the
local health department. As a result of the cooperation between the State
Board of Health, the Medical Care Commission and local authorities, consid-
erable progess has been made in this particular field.

In the following counties modern and well equipped health centers have been
completed and occupied: Caldwell, Rutherford, Caswell, Moore, Robeson,
Sampson, Greene, Beaufort, Tyrrell, Hertford, Halifax and Martin.

Requests for health center construction have been submitted from the fol-
lowing counties: Burke, Wilkes, Rockingham, Catawba, Davidson, Rowan,
Cabarrus, Stanly, Guilford, Person, Warren, Franklin, Nash, Northampton.
Edgecombe, Wilson, Scotland, Harnett and Currituck. Several of this latter
group are almost ready for occupancy.

It is the firm conviction of the Director of this Division that modern, up-to-
date working quarters for local health departments will markedly increase the

124 Thirty-Fourth Biennial Report

prestige of local health service, raise the morale of local health personnel
and aid materially in the recruitment program for local health officers.

The general functions of the local Health Division may be briefly sum-
marized as follows:

1. Administration

a. The Division is expected to formulate in cooperation with the other
divisions of the State Board of Health and representatives of local
health departments, the general policies to be followed routinely in
the operation of this cooperative program.

b. Perfect and execute a plan for equitable distribution of state and
federal funds to the respective local health departments. A general
formula for such allocation has been developed and was strictly
adhered to during the biennium. The results achieved during the
period have been almost universally satisfactory.

c. Assist the local health departments with the preparation of and give
final approval to budgets to be used in utilizing the allotted and local
funds for the operation of the local health department so that the
use of funds allotted to counties will be in accordance with state and
federal laws and regulations.

d. Recruit and supervise training of personnel in various categories for
use in the local health departments.

e. In cooperation with the North Carolina Medical Care Commission,
assist the local authorities in the procurement of better domiciliary
facilities for the health department in the form of modern health
centers.

2. Consultation

It is the responsibility of this Division to supply, with the aid of other
divisions in the State Board of Health, technical consultation on the various
types of activities carried on by the local health department, such as medical
administrative guidance, public health nursing, public health education,
mental health, laboratory technique, maternal and child health, school health,
tuberculosis control, oral hygiene, venereal disease control, epidemiology and
record keeping and clerical work. The cooperation supplied this Division by
the directors of other divisions has been exemplary and a source of keen
appreciation by the personnel in this Division.

As of June 30, 1952 there were full-time health services in all the 100 coun-
ties of North Carolina. At the close of the biennium there were 77 full-time
health departments in North Carolina, 57 of which were county health de-
partments, 17 district health departments and 3 city health departments.
The number of counties in each district is as follows: 2 districts of 4 counties
each; 5 districts of 3 counties each; and 10 districts of 2 counties each. For
administrative and supervisory purposes a number of the smaller counties
were combined in order to meet the requirements of the U. S. Public Health
Service and the number of budgets submitted to the eFderal Security Agency,
Washington, D. C. was 67.

North Carolina Board of Health 125

There were employed in the 100 counties and 3 city health departments a
total of 1,068 full-time workers. Of this number 60 were health officers, 9
assistant health officers and 3 dentists. There were 25 supervising public
health nurses; 422 staff nurses; 206 sanitarians, engineers and veterinarians;
15 public health investigators; and 12 health educators. The remaining per-
sonnel consisted of 316 clerks, bacteriologists, technicians, etc. There were
43 budgeted positions unfilled because of the lack of available persons with
even a minimum of training.

During the biennium the consultant nursing staff remained the sam?,
except that Miss Dorothy Boone was on education leave from October 6, 1950
through April 15, 1952 taking courses in mental health at the University at
Minnesota.

There are attached pertinent data sheets for the two fiscal years of l\\*
biennium (1950-51 (1951-52).

126

Thirty-Fourth Biennial Report

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136 Thirty-Fourth Biennial Report

During the biennium 82 persons were given academic public health training
distributed as follows: Health Officers 9; P. H. Nurses 42, Apprentice P. H.
Nurses 6; Health Educators 16, Apprentice Health Educators 2; Psychiatric
Social Workers 4; Nutritionists 1; and Laboratory Personnel 2 for a total
of 82.

In addition to above trainees who took academic training at Universities,
several hundred public health workers were given other training in the field
of public health, such as orientation, short courses relating to orthopedics,
tuberculosis, cancer control, mental hygiene, heart disease, geriatrics, child
growth and development, v. d. control, insect and rodent control and milk
sanitation. Also, expenses were paid for many public health workers to
attend institutes, workshops and seminars. Expenses were also paid to enable
many physicians and nurses, other than public health personnel, to attend
short courses on subjects which will fit them better to contribute to the public
health effort.

It is felt that the expenditure of these funds for training purposes represent
one of our best investments and that they will be returned many times over
in increased efficiency and better public health service for the people.

The field representatives of the Local Health Division participated in the
accomplishment of three major undertakings in this biennium: (1) devising
a system of simplified medical and nursing records and filing in the Orange
County Health Department; (2) change in local health reporting from the
old statistical type report to a new evaluation type; and (3) initiating a
program of training for clerical workers in local health departments.

The records and filing system in the Orange County Health Department
was in an experimental stage for several months, but as proof of the satis-
factory development, the system has been expanded throughout the district
to the counties of Person, Chatham, and Lee. Other counties in the state
have manifested much interest in this system and are planning to adopt it.

The change from the old type of report to the new involved about two years,
since the proposed form was used by the counties on a trial basis for two
years. However, in the summer of 1951, a committee worked out a more
permanent form which was ready for beginning use in January, 1952. Since
it has been printed, requests for copies have been received from many states,
and the opinion of public health administrators seems to be that a progressive
step has been taken in a field which has formerly been resigned to tradition.

The initiation of a program of training for clerical workers was made pos-
sible— first, because money for this was set up in the training budget and
second, because the Field Training Department in the School of Public Health
of the University of North Carolina employed a record analyst, Miss Alpha
Kenny, whose responsibility is to plan such courses. During the biennium,
46 clerks have taken the two-weeks Public Health Records Short Course.
Although in the beginning these courses necessarily have been of a survey
and background type, it is felt that they have begun to fill a definite need in
our training program.

During this report period, the Film Library and drug service has grown
considerably. The film library assets and services have expanded to the point
where it is second only to that of the New York State Department of Health
in films available for loan and in total film distribution. The demand for the
film library service has grown with the library. More than 200, 16mm sound

North Carolina Board of Health 137

motion picture films were purchased at a total cost of $12,085.11. The film
library has also purchased a total of 44 motion picture projectors at a cost
of more than $11,846. All of this equipment has been loaned to our local
health departments. The library now has more than 100 motion picture
projectors and 1,000 films, filmstrips and recordings. Even with this increased
number of films available the demand for films has been greater than the
library could supply. There have been as many as 28 requests per day which
could not be met.

Two additional storage bins for 1ms have been secured. A new visible
Cardex File has been set up for use in film scheduling which aids greatly in
expediting film requests.

During the two year period, the library distributed 16,373 films in 10,660
individual shipments for a monthly average of approximately 682 films. One
thousand seven hundred and fifty descriptive film catalogs were printed and
distributed to health departments, schools, churches, colleges and other inter-
ested groups and individuals. The library used more than $3,000 in postage
for 4th class mail alone.

During the biennium, as always, the chief concern of the Public Health
Nursing Section has been the improvement of health service to the people of
North Carolina through public health nursing consultation to local health
departments and through recruitment and training of public health nurses.
This service has been limited because of the large district each consultant
has carried on the generalized program, in addition to serving as consultant
in a particular field. These specialties are: (1) maternal and child health,
(2) planned parenthood, (3) industrial hygiene, (4) tuberculosis, and (5)
mental health. The fifth district was uncovered, except for pinch-hitting of
other members of the staff from September, 1950 to April, 1952 while Miss
Dorothy Boone was on educational leave to take the mental health course
at the University of Minnesota.

Miss Mary Louise Free was employed as Consulting Public Health Nurse in
January, 1952. She is working full time in the orthopedic program.

From January, 1951 to June of 1951 Miss Evelyn Johnson on loan from the
U. S. Public Health Service to the Department of Field Training, School of
Public Health at the University of North Carolina, transferred her headquar-
ters to Raleigh. She worked in dual capacity as educational director with
the Department of Field Training and the Nursing Section, State Board of
Health and in addition, had a four-county district. She served as Chairman
of the Editing Committee for the "Guide— Five Weeks Orientation Program
for Registered Nurses in Public Health " This guide was a project of the
local supervising public health nurses and the state consultant staff.

Miss Johnson's transfer to Massachusetts at the end of June was a distinct
loss. She has demonstrated the need for a full-time educational director on
the state staff. This position under the title of Public Health Nurse (Educa-
tion) and three additional publis health nursing classifications (Mental
Health, Crippled Children's Services and Maternal and Child Health) were
set up in the public health nurse series of the new State Personnel classifi-
cation plan for the State Board of Health. It is hoped that funds may become
available to employ an educational director and the additional consultants
needed to provide adequate service to the people of North Carolina.

138 Thirty-Fourth Biennial Report

It is particularly important that the position of educational director be
filled in the near future because of the need for expanding field training
facilities in order to take care of the new school of nursing at the University
of North Carolina. It offers a four-year integrated, collegiate program lead-
ing to a Bachelor's degree. Graduates from this school will be eligible for
the Jr. public health nurse classification. Both the University of North
Carolina and Duke are asking for field experience which will prepare their
graduates for public health nursing positions. This is our opportunity not
only to recruit nurses for public health but also to help provide North Caro-
lina with nurses who have a better understanding of the social and health
concepts.

An educational director would also have responsibilities in connection with
the expanding field training programs for the other disciplines in public
health. She would join in the planning for a better correlation of field expe-
rience for medical and allied health personnel.

During the past biennium a continuous in-service education program has
been offered to nurses including: (1) classes and institutes in care of prema-
ture infants; (2) one-day institutes on child growth and development; (3)
four-day institutes in venereal disease at the Eastern Medical Center; (4)
training in mental health at Duke either for four weekends or ten-day periods;
(5) five-day courses in mental health, cancer, tuberculosis, heart and geri-
atrics at the University of North Carolina during the summer session and
similar courses at North Carolina College in Durham on cancer, tuberculosis,
premature infant care, maternity and child health, child growth and devel-
opment; and (6) a five-day workshop for local supervisors and consultants.

The program of training in mental health in connection with the Duke
Psychosomatic Clinic is being discontinued because of Miss Florence Bur-
nett's resignation in order to continue the research project in Maryland with
Dr. Greenhill which they began at Duke. This is a distinct loss to North
Carolina's mental health program.

One of the most urgent needs of the state is for adequately prepared public
health personnel. The apprenticeship program provided an excellent means
of recruitment of good public health nurses. It was a great disappointment
that it had to be discontinued because of inadequate funds. With the con-
tinued cut in federal funds it is not possible to prepare the number of public
health nurses needed unless additional funds are forthcoming from other
sources.

The Public Health Education Section has continued to extend the public
health education services through the provisions of consultation and guidance
to the 23 public health educators employed locally. In addition, health edu-
cation services have been provided to the local health departments and
community groups upon request. Although the major emphasis has been
placed on providing services to local health departments, considerable time
has been spent in working with the sections and divisions of the State Board
of Health on health education programs, as well as working on joint programs
with allied agencies and organizations.

Miss Elizabeth Lovell has continued as Chief of the Public Health Educa
tion Section. Mrs. Ruth Thompson Jobe, Supervisor of Public Health Educa-
tion, has been transferred from the combined job of Supervisor of Health
Education for eastern Carolina and health educator with the Wake Count'1"

North Carolina Board of Health 139

Health Department to the Western District Office of the State oBard of Health,
where she will give supervisory services to the western thirty-four counties.
Miss Madeleine McCain, who is jointly employed by the State Board of Health
and Appalachian State Teachers College, has continued to work the Teachers
College and the Alleghany-Ashe-Watauga District Health Department. Mr.
Flay Sellers and Mr. Paul Johnson have replaced Mrs. Lula Belle Highsmith
Rich and Mrs. Mildred 0. Page, Public Health Educators, with the mass
X-ray survey team of the Tuberculosis Section. Miss Betty Payne replaced
Mrs. Edith Hinton as secretary-artist in the Health Education Section.

The year-round program of recruitment has been conducted in cooperation
with the local health educators. An attempt has been made to recruit all
types of public health personnel. Due to the fact that training funds were
curtailed, only six public health educators were trained by the State Board
of Health during the biennium, and only one apprentice was trained during
the two-year period. This section was able to recruit public health education
trained personnel from the graduating classes at the University and North
Carolina College, and twenty-one persons were placed in public health edu-
cation positions in the state during the biennium.

In-service and pre-service training activities were extended considerably
during the past two years. Two local health educators were sent to the
Human Relations Workshop in Delaware and several health educators at-
tended the Alcohol Education Course given at Yale University. The Public
Health Education Section has assisted with in-service training courses, in-
cluding the mental health institutes for health officers, the tuberculosis
institutes for nurses, the training courses for clerical workers, short courses
in civil defense, safety, and education for responsible parenthood for the
public health students at the University of North Carolina and North Carolina
College, the growth and development institutes for nurses, the school health
institutes for health officers, a health education workshop for the Halifax
County Public Health Personnel, and two family life training institutes
sponsored for P.T.A. leaders and home demonstration club leaders by the
North Carolina Congress of Parents and Teachers.

The staff has met with the following groups to participate in program plan-
ning or to take part in program activities of the agencies: N. C. Tuberculosis
Association, N. C. Heart Association, N. C. Negro Congress of Parents and
Teachers, the School-Health Advisory Committee, the Y.W.C.A., N. C. Con-
gress of Parents and .Teachers, the State Public Health Committee on Field
Training, the Southern Branch of the A.P.H.A. meeting, the N. C. Family Life
Council Executive Committee, the N. C. Health Council, the Agricultural
Extension Farm and Home Week meeting, the N. C. Public Health Associa-
tion, the Annual State Welfare meeting, and the annual meeting of the N. C.
Family Life Council.

Due to an increasing number of requests for materials, a survey form was
sent to every local health department in the state, asking them to indicate the
health areas where materials are needed and the type of material they would
like to have. As a result of this survey, quantities of materials were selected
and purchased to be used by local departments throughout the state.

Six exhibits were developed during the biennium in cooperation with other
sections of the State Board of Health. Flip charts on venereal disease and
tuberculosis were prepared for use by state and local health personnel. As-

140 Thirty-Fourth Biennial Report

sistance has been given to other sections of the State Board of Health in
editing, design and layout for manuals and pamphlets.

Two special programs were initiated and carried out during the two-year
period. One of these programs was a series of study courses on health sub-
jects for the women at Woman's Prison in Raleigh, North Carolina. The
study courses were conducted for thirteen weeks and proved to be very suc-
cessful. The other special program was a demonstration in health education
activities in civil defense developed in Asheville. As a result of the program
initiated during the demonstration, it has been possible to gain valuable
experience in procedures and techniques which are being applied in other
areas of the state.

The mental health program in North Carolina has been continued on the
lines of public health education and the operation of mental health clinics.
Throughout the period Pierre the Pelican pamphlets have been mailed rou-
tinely to mothers of first born children in North Carolina. Judging from the
letters received in this office this educational program has been eminently
satisfactory. The section has maintained a circulating library of books on
psychiatry and mental health for distribution to mental health and public
health workers throughout the state upon request. The division has 140
mental health films for free distribution to those desiring this type of service
throughout the state. This phase of the educational program has been emi-
nently satisfactory.

During the biennium mental hygiene clinics have been operating at Ashe-
ville, Charlotte, Duke psychosomatic, Duke Child Guidance, Durham Child
Guidance, Raleigh Child Guidance, Bowman Gray at Winston-Salem. During
the period a mental health clinic was incorporated into the local health de-
partment in Guilford County. During the two calendar years of 1950 and 1951,
6,400 cases were handled in these clinics. Of these 4,469 were closed.

Throughout the period the Director of this division has stressed to all
public health workers in the division and in local health departments the
importance of utilizing sound mental health techniques in their routine
activities. An honest effort has been made to sensitize all public health per-
sonnel to the opportunities daily afforded them for practicing sound mental
health technique in the discharge of their routine duties.

Considerable effort has been made to acquaint the public health workers
with some of the basic procedures involved in mental health work by means
of conferences, institutes and short courses. Nurses and health officers have
been afforded an opportunity to attend the psychosomatic clinic at Duke
University. At Bowman Gray, Dr. Lloyd Thompson has given courses to
public health nurses on mental health procedures involved in prenatal clinics.
Mental health courses have been supplied at the University for quite a group
of public health nurses during the summer months. During the biennium
two mental health seminars of four days' duration each have been held at
Wrightsville Beach for the full-time health officers in the state. Both of these
seminars proved to be eminently satisfactory.

Throughout the period, through the agency of the school health service,
constructive effort has been made to improve the teacher-pupil relationship
by acquainting the teachers of the state with some of the basic principled
of sound mental health technique. Very favorable reports have been received
from this particular activity.

North Carolina Board of Health 141

Mental health is considered a problem of major importance and it is sin-
cerely hoped that increasing attention and activity can be devoted towards
its solution.

The North Carolina School Health Coordinating Service is jointly adminis-
tered by the State Department of Public Instruction and the State Board of
Health, and thus officially represented both agencies in the school health
and physical education programs in North Carolina during the period July
1, 1950 to June 30, 1952.

In carrying out this responsibility the staff members worked with school
superintendents, principals, and teachers, with public health department per-
sonnel, and with representatives of other agencies interested in the health
of children, youth and adults.

Staff members from this section are as follows: Mr. Charles E. Spencer,
Director, salary and travel paid by State Department of Public Instruction;
Dr. R. M. Fink, Consultant on Mental Hygiene, salary and travel paid by
State Board of Health; Mrs. Annie Ray Moore, Health Educator, salary and
travel paid by State Department of Public Instruction; Miss Helen Stuart,
Advisor in Physical Education, salary and travel paid by State Department
of Public Instruction; Mrs. Georgia W. Barbee, Health Educator (Negro),
salary and travel paid by State Board of Health; Mrs. Julia P. Harshaw,
Public Health Nurse (Negro), salary and travel paid by State Board of Health;
and Mrs. Lillie Mae Peddy, Secretary, and Miss Mollie O. Liles, Stenographer,
salary paid by the State Department of Public Instruction.

The health and physical education curriculum project started in 1948 was
continued during the biennium 1950-1952. The publication, Physical Educa-
tion in Elementary and Secondary Schools, was completed by October 1951
and was ready for distribution to schools by January 1952. Twenty-eight
regional meetings were held in the state to implement the use of the bulletin.
During the biennium work was continued on the health guide. Most of the
sections have been mimeographed and sent out for trial use. Several sections
have been revised and completed.

The School Health Coordinating Service, during the biennium, continued
in the administration and supervision of the school health program including
planning and administering the expenditure of school health funds in the
amount of $550,000 annually, appropriated by the 1951 General Assembly to
be allocated by the State Board of Education as grants in aid to city and
county school administrative units. The plan for allocating the funds for
the biennium July 1, 1950 to June 30, 1952 was the same as followed the pre-
vious year, namely: (a) Each county and city school administrative unit
was allotted an amount equal to 50tf per pupil based on the average daily
membership for the first seven months of the previous school year, (b) In
addition the sum of $1,000 was allotted to each county regardless of size.
Each school administrative unit within the county receives a portion of the
$1,000 allotment based on its percentage of the total students in the county.

The policies approved by the State Board of Health and the State Board
of Education in 1949, governing the expenditure of these funds, were con-
tinued during the 1950-52 biennium. Also, the State Board of Health con-
tinued the plan of earmarking an amount equal to 40£ per pupil for school
health work. Expenditures of State Board of Education school health funds
for the biennium were as indicated below:

142 Thirty-Fourth Biennial Report

Salaries: Health Educators $ 30,632.97

Nurses 88,043.12

Physicians 5,973.25

Audiometer Technicians & Dentists 9,274.12

Travel: Health Educators 4,312.87

Nurses 14,348.00

Physicians 185.11

Audiometer Technicians & Dentists 1,875.39

Clinic fees for medical examinations 28,592.43

Correction of defects 304,563.17

Supplies .... 22,201.43

Equipment 16,339.41

In-service training 2,316.00

$528,657.27

Expenditures of State Board of Education school health funds for the period
July 1, 1951 to June 30, 1952 were as indicated below:

Salaries: Health Educators $ 36,865.23

Nurses . 82,281.47

Dentists 7,431.10

Technicians _ _ 550.00

Travel: Health Educators 3,255.50

Nurses 16,267.39

Dentists 882.09

Technicians _ 118.15

Fees for medical examinations 22,234.25

Correction of defects 294,134.50

Supplies - -- 31 ,930.30

Equipment 24,091.83

In-service training 946.39

$520,988.29

A State Advisory School Health Commiteet was organized in September
1950 composed of six representatives of the Health Department, six from the
Department of Public Instruction and two from the School Health Coordinat-
ing Service and one representative each from the Welfare Department, the
P.T.A., the Medical Society and the Dental Society. The State Health Officer
and the State Superintendent served as ex-officio members of the committee.
This advisory committee has studied the school health policies and programs
and from time to time has made recommendations.

In December 1951, upon recommendation of the Health Officer and the State
Superintendent, the State Medical Society appointed a Medical Society School
Health Committee to: (1 ) advise with the School Health Coordinating Service
in regard to policies, procedures and programs involving the members of
the medical profession; (2) interpret the school health program to the med-
ical profession and to the public; and (3) to advise with the State Health

North Carolina Board of Health 143

Officer and the State Superintendent regarding school health policies. The
Advisory Committee approved the policies already in effect with some slight
modifications.

The School Health Coordinating Service has served in a coordinating and
cooperating capacity with other divisions of the State Board of Health and
the Department of Public Instruction in the development of: (1) a cumulative
observation and screening card, (2) recommendations regarding pre-school
clinics, (3) school sanitary score sheet, and (4) basic nutrition material for
teachers.

The staff of the School Health Coordinating Service with the cooperation
of other divisions of the State Department of Public Instruction and the State
Board of Health, the Welfare Department, the Parent-Teacher Association and
the State Medical and Dental Societies conducted ten Regional School Health
Conferences, to promote and assist with planning for better school health
programs on the local level. Many planning conferences in individual counties
were held after the regional meetings upon request of local health officers
and school superintendents.

Health Education Workshops were sponsored by this section and the Uni-
versity of North Carolina at Chapel Hill for six weeks periods during the
summers of 1951 and 1952. The purposes of the workshops were to provide
opportunities for teachers, school administrators and health workers (1) to
study the major health problems of children and adults, (2) to assist them
in planning functional programs to meet the needs of their own particular
school-community situations and (3) to gain basic information and a mastery
of skills and techniques essential to the best implementation of such programs.

Six semester hours of graduate or undergraduate credit were given by the
University to those who completed the workk.

Local tuberculosis associations and cancer societies provided scholarships
to individual participants from their respective counties and cities.

During the summer of 1951 the School Health Coordinating Service assisted
in a two weeks Health Education Workshop at Catawba College.

During the summer of 1952 this section has assisted with health education
workshops at Catawba College and East Carolina College and will during the
rest of the summer help with health education workshops at Appalachian
State Teachers College and Western Carolina Teachers College.

The Negro Health Educator also assisted with the six weeks workshop at
North Carolina College at Durham.

Other services rendered by the School Health Section were:

State planning and promotional work and services were rendered to school
and health department personnel through consultative services, field visits,
planning and carrying on in-service education, production of materials, re-
viewing and recommending use of materials, locating and recommending the
use of local, state and national resources, evaluative procedures, joint state
conferences and committees, state and national organizations.

Beginning in October 1951 the School Health Coordinating Service has been
preparing a quarterly bulletin, "Timely Tips for Supervisors," which was
intended to give suggestions and materials to supervisors and superintendents
regarding school health and physical education.

144 Thirty-Fourth Biennial Report

a. Health services — This involved working with school and health depart-
ment personnel in teaching screening and observation of children with obvious
deviations from normal. Audiometer testing, physical and psychological
examinations were done and follow-up work with parents carried on to get
needed corrections of defects. Consultant and promotional and advisory
services were also given to promote better records and reports, and to promote
activities directed towards making educational experiences out of health
services.

b. Health instruction — This involved working with teachers and adminis-
trators in identifying and solving child health needs through experiences
directed towards improvement of habits, attitudes and knowledges. It in-
volved directing work with teachers in preparation of materials of instruc-
tion and evaluation in such areas as mental hygiene, community health, fam-
ily life education, communicable disease control and sanitation, safety and
personal health problems, such as nutrition, dental hygiene, rest and sleep,
and care of the eye, ear, nose and throat, and education with reference to
harmful effects of alcohol and narcotics.

c. Healthful school living (the environmental aspects of health) — This in-
volved assisting administrators in selecting and improving environmental
facilities and in the care and use of such facilities. It also involved work with
administrators in the organization of the total school health program to pre-
vent over-crowding, over-work, or an unbalanced program.

d. Physical education — This involved giving assistance to administrators
in organization, scheduling, selecting and care of facilities and equipment,
personnel and the program of physical education, including the required
credit, instruction, recreational activities, intramural activities and varsity
athletics. Twelve regional meetings and many local meetings and demon-
strations were held.

3. Mental hygiene — The Consultant for Mental Hygiene worked with school
and health department to make mental hygiene an integral part of the entire
school health program. Mental hygiene was emphasized from the positive
approach as: (1) an area in health instruction as shown above and (2) a
healthful way of living for teachers, pupils and parents in whatever activity
they are engaged.

During the past biennium 22 extended programs have been conducted on a
city-wide or county-wide basis for teachers and administrators. These pro-
grams have been jointly sponsored by school and health departments. In
many instances the public health nurses have joined teachers for the planning
and study sessions.

In addition 71 short institutes have been held for teachers, nurses, parents
or a combination of these.

A series of bulletins have been prepared and distributed to all school sys-
tems in the state. These bulletins attempted to offer suggestions for adminis-
trators for the application of principles of mental hygiene to school practice.

In one county a four-year program has been started in an effort to measure
the results of teacher education regarding mental hygiene as reflected by
changes in the general emotional stability of pupils. This study will be
completed in 1954.

North Carolina Board of Health 145

In carrying on the above listed activities the School Health Coordinating
Service was particularly aware of its responsibilities to: (a) cooperate with
other divisions of the State Health and Education Departments and with
other agencies and organizations in worthwhile school health projects, and
(b) work towards coordination of all school health activities to avoid duplica-
tion and omission of services.

The Negro staff members worked extensively in Negro schools in the fol-
lowing counties and cities: Hoke, Randolph, Moore, Granville, Anson, Onslow,
Union, Lee, and Columbus Counties and the Cities of Asheville and Wilming-
ton.

DIVISION OF EPIDEMIOLOGY
BIENNIAL REPORT

July 1, 1950— June 30, 1952

For the biennium ending June 30, 1952 the various Sections of the Division
of Epidemiology have the following activities to report:

Public Health Statistics Section

During this period the Public Health Statistics Section has performed the
bulk of the statistical services for the divisions of the State Board of Health.
This was in conformity with the 1950 reorganization plan to centralize, in
so far as possible, all statistical activities for the most efficient method of
collecting, compiling and presenting statistical information.

The Public Health Statistics Section includes the following units: Admin-
istrative, Tabulating, Nosology and Statistics, Certification, Registration
of Births and Deaths, Registration Promotion, and Morbidity Reporting.

The statistical services rendered for each program were as follows:

General Vital Statistics:

Registration of births and deaths; promotion of better registration
Certification of births and deaths; recording of adoptions and legitima-
tions.
Coding, tabulation, and publishing routine reports

Acute Communicable Diseases:
Morbidity reporting
Statistical analysis

Tuberculosis Control:
Morbidity reporting
Tabulation of mass x-ray survey reports

Maternal and Child Health Services:
Prematurity care program
Crippled children service tabulations
Preparation of maternal death transcripts

Venereal Diseases:
Morbidity reporting
Contact investigation reports

Local Health Service:

Health department activity tabulations

Cancer:

Morbidity reporting

Mobile x-ray unit reports

Diagnostic management and detection center reports

Special mortality tabulations

Mental Hygiene:
Addressing and mailing mental health pamphlets for all first-born chil-
dren

North Carolina Board of Health 147

Heart Disease:

Special mortality tabulations

Accident Prevention:
Motor vehicle reports
Home accidents survey reports
Special mortality tabulations

Special Services:

Miscellaneous reports and tabulations provided on request
Statistical consultations to state and local health personnel and related
agencies.

In the past few years, one of the biggest needs of the Section has been the
improvement of registration of births and deaths and a great deal of progress
has resulted. In 1940, the Census Bureau conducted a birth registration test
in all the states and found that only 86% of the infants born in this state
during the test period had a birth certificate on file in the Bureau of Vital
Statistics. In 1950, a similar test revealed that 96% had certificates on file.
Visits by our full-time field agent to people and agencies responsible for filing
certificates have aided greatly in improving registration. Registration pro-
motion in newspapers and over radio, supplemented by printed matter, corre-
spondence, and lectures has also contributed to the progress made.

At the close of the biennium there were 611 local registrars serving the
state. It is hoped that this number can eventually be reduced to 100, one for
each county. At one time we had approximately 1,500 local registrars, but
by consolidating counties with the health officer serving as registrar for the
entire county instead of having a registrar for every incorporated town and
township, the reduction has been effectied. Four more counties have been
consolidated since the last biennium. Forty-four counties are now served by
the local health officer. Fewer registrars mean more efficient and economical
registration. Statutory authorization provides for the State Board of Health
to consolidate counties as rapidly as possible.

During the biennium 66,000 certified copies of birth and death certificates
were issued from this office; 15,000 free verifications of births and deaths
were made during the same time. Parents have continued to receive a
photocopy of all birth certificates filed in the state office during the biennium.
This has aided greatly in getting an accurate certificate placed on file shortly
after birth of the child. The parents are learning that if a photocopy is not
received by them that a birth certicate has not been filed.

In this biennium, approximately 225,000 regular certificates of live birth,
30,000 delayed birth certificates, 5,200 stillbirth certificates and 64,000 death
certificates were filed in the state office. The recording of these vital events
involved editing for promptness, completeness and accuracy, numbering, cod-
ing, microfilming for the National Office of Vital Statistics, key-punching,
verifying, tabulating, photographing, binding, indexing, and the many other
operations necessary to process such a volume of certificates and to preserve
them for their many future uses.

We certify to the proper county official the number of certificates for which
the local registrar is to be paid.

The crude birth rate in 1951 was 27.4 per 1000 population and the crude
death rate was 7.7. The relatively high birth rate and low death rate is
primarily due to the comparatively young population in this stale. North

148 Thirty-Fourth Biennial Report

Carolina for the last several years has had around three and one-half times
as many births as deaths. This is one of the highest birth-death ratios in the
nation.

The reduction in infant and maternal mortality continued during the bien-
nium; however, this state still has a higher infant mortality rate than 38
other states and a higher maternal rate than 36 states. There were 32.9 infant
deaths and 1.1 maternal deaths per 1000 live births in 1951.

The ten leading causes of death, with provisional crude death rates per
100,000 population, were as follows:

Cause Number Rate

Diseases of the heart 10,341 250.8

Vascular lesions affecting central nervous system , 4,039 98.0

Malignant neoplasms, including lymphatic and

hemotopoietic tissues __. — 3,283 79.6

Influenza and pneumonia _ - — 1,290 31.3

All accidents (except motor vehicle) 1,253 30.4

Motor vehicle accidents 1,143 27.7

Immaturity __ 913 22.1

Nephritis and nephrosis - 704 17.1

Tuberculosis, all forms _ - _ 630 15.3

Diseases of arteries - 567 13.8

The Section processed (edited, coded, pupnched, tabulated) approximately
75,000 morbidity reports during the biennium. Approximately 49,000 of this
number were venereal disease reports, 6,000 tuberculosis repohts, and 20,000
other communicable disease reports. Over one-half million x-ray report cards,
61,000 venereal suspect report forms, 19,000 medical charts prepared by the
cancer detection and diagnostic management clinics, 8,000 cancer morbidity
reports, 4,600 cancer x-ray reports, and 16,000 crippled children reports were
processed in like manner. Over 300,000 certificates received during the bien-
nium had to be processed along with 500,000 old certificates.

Parents of first-born children received over 500,000 pamphlets pertaining
to the rearing of the child during the first year of life. These were addressed
and mailed by the Tabulating Unit. This project was conducted in coopera-
tion with the Mental Health Section.

Each local health department was furnished with lists of all resident
deaths that occurred in its jurisdiction in 1950 and 1951. These lists provided
information on the deceased, such as residence, place of death, cause of death,
age, sex, race, attendant, and institution of death, which enabled the local
health officers to compile promptly more detailed mortality statistics for
their own area than is available in state and national reports. Each local
health department was furnished with a full-sized photocopy of certificates of
all resident births and deaths that occurred outside its jurisdiction. Approx-
imately 46,000 such copies were mailed to the appropriate health officers
during the period. This, too, has enabled the health departments to provide
more completely the health services needed by their people.

The Central Tabulating Unit prepared over 1,200 monthly, quarterly, semi-
annual, and annual reports during the biennium. Over 300 of these tabulated
reports were compiled as a result of special requests from people and agencies
interested in health statistics. In addition, requests for other statistical
information were filled from reports already tabulated in over 500 instances.

North Carolina Board of Health 149

A new statistical program was initiated as of January 1952. This program
was in cooperation with the Maternal and Child Health Section and deals with
a statistical analysis of our premature infants born to residents of this state
in 1952 and subsequent years. Efforts will be made to learn more about the
causes of prematurity as they relate to age, race, and parity of the mother.
The mortality data of the same nature, plus the weight of the baby at birth,
the legitimacy status and other factors that might influence the baby's chances
of dying or surviving the first year of life will also be analyzed. Of the
prematures that die, 81 % die within forty-eight hours after birth. Prematur-
ity has long been a leading cause of death. Much research is needed to learn
ways of reducing the number of babies born prematurely, and of saving their
lives if they are born prematurely. From seven to nine per cent of our babies
are born prematurely each year and 25% of all infants dying during the first
year of life die because of prematurity.

For the first time since before World War II the Section has been able to
furnish prompt service in issuing certified copies of certificates requested
by the general public. This is due to improved indexing of our certificates
(over 4,000.000 at the present time) and to smaller personnel turnover in the
searching unit.

The administrative problems encountered during the period were less acute
than in the previous biennium. A smaller number of personnel resigned and
it was possible to obtain competent replacements more promptly. During the
period thirty-four employees resigned. As of June 1952 there were 70 bud-
geted positions in the Section.

During the fiscal year 1951-52 a total of $209,705 was expended by the Sec-
tion for salaries, machine rental, printing, travel, supplies and equipment.
Of this total, $100,315 was expended from state funds and $109,390 from
federal funds. There follows a breakdown of expenditures for the fiscal year
1951-52:

Item State Federal Total

Salaries _ -$ 93,520 $ 68,883 $162,403

Machine rental _ _ _ 250 16,032 16,282

Printing _ _ 14,623 14,623

Travel - 1,000 1,262 2,262

Supplies and Equipment 5,545 8,590 14,135

Total. $100,315 $109,390 $209,705

Legislation enacted during the last General Assembly resulted in providing
more protection to illegitimate and adopted children to the extent that vital
facts regarding the child were made more confidential. Four sections of the
General Statutes were amended for clarification in order to assign, more
satisfactorily, legal responsibility to concerned persons. Unfortunately, a
legislative bill that would have improved death certificates by establishing a
medical examiner program in which only licensed physicians could serve as
county coroners was not enacted into law.

Tuberculosis Control Section

The Tuberculosis Control Section of the State Board of Health emphasizes
case-finding and follow-up and is one of the principal agencies of our state
government which has to do with tuberculosis control as a whole. Other

150 Thirty-Fourth Biennial Report

agencies that are concerned with tuberculosis control in the State Board of
Health are:

Division of Local Health Administration

Public Health Statistics Section of Division of Epidemiology

State Laboratory of Hygiene.

Additional state agencies which are included in the general tuberculosis
program and which are not under the control of the State Board of Health
are:

State Sanatoria for the Treatment of Tuberculosis

State Department of Public Instruction (supervising the Division of

Vocational Rehabilitation)
State Department of Public Welfare.

The 1951-1952 budget of this Section was $204,665. Of this amount, $176,700
was grant-in-aid funds from the Federal Government, and $27,965 state funds.
$45,232 from the budget was allocated to counties. The 1952-1953 budget is
$182,496. $153,400 of this amount is grant-in-aid funds from the Federal Gov-
ernment and $29,096 state funds. $40,323 from the budget is allocated to
counties.

This Section owns ten x-ray units. One unit is a portable 60 M.A. West-
inghouse machine, and nine are photoroentgen units. One photorentgen
unit is on loan at the Duke University Medical School Hospital and one on
loan at the Baptist Hospital in Winston-Salem. There is also equipment
other than x-ray machines on loan at the Wake County, Mecklenburg County,
and Forsyth County Health Departments. Additional equipment consists of
eight tractor trucks, one Chevrolet carryall, one generator and spare x-ray
parts.

Personnel consists of twenty persons on full-time duty and one person on
part-time duty. On full-time duty there are two doctors, ten x-ray technicians,
one darkroom technician, five clerks, two health educators, and one consultant
nurse on part-time duty.

Community-wide surveys were conducted in 24 counties and surveys of
special groups, using one to two x-ray units, were conducted in 69 localities.

Some schools, colleges, and state institutions were survey by special
request. Others were routinely surveyed if requested by local authorities
during community-wide surveys of the county where schools, colleges or state
institutions were located. State institutions which were surveyed included
the State Hospitals in Goldsboro, Raleigh, Butler and Morganton; the Caswell
Training School, Kinston, Central and Woman's Prison, Raleigh; State Col-
lege, Raleigh; and the University of North Carolina, Chapel Hill. The survey
of menta. institutions is being emphasized and it is intended to survey these
institutions at least once every eighteen months.

Emphasis is being placed on follow-up activities. A technician is required
to remain in the area after a community-wide survey has been completed
for the purpose of conducting the follow-up clinics. We do not have sufficient
personnel to conduct follow-up clinics in the case of special surveys. It is
our policy to have this technician conduct these clinics as long as required
by the local health officer, and the period varies from three weeks to approxi-
mately one month.

Surveys of special groups, using one to two x-ray units, are also being
emphasized. Special groups include food handlers, industrial workers, stu-

North Carolina Board of Health

151

dents, and fcaulty in colleges and schools, school teachers, and also the
general population as desired by the local health officer.

Community-icicle ex-ray surveys have been scheduled for the remainder of
1952 and eight counties have been scheduled for 1953. Special surveys have
been scheduled for the remainder of 1952 and thirteen counties have requested
this type of survey for 1953. A total of 83 counties have now had community-
wide surveys and six of these counties have had communty-wide surveys
twice.

For the period July 1, 1950— June 30, 1952, 467,723 70-mm. films were made
in 24 counties and 69 localities by our mobile units. The percentage of 14 x
17 films taken to confirm the diagnosis varies from 3.5 to about 4%, and
therefore during this period there were between 18,000 and 20,000 14 x 17
plates made in addition to the 70-mm. films. A total of 34,547 were made by
our unit on loan at the Duke University School; 1,706 were made by the unit
at the N. C. Baptist Hospital.

The number of persons examined and the rate per thousand who showed
reinfection tuberculosis, suspicious and other tuberculosis, and other pathology
is tabulated in the case of community-wide surveys, as the follow-up activities
only in these surveys are adequate for definite conclusions. The findings
noted are the final x-ray diagnoses from the 14 x 17 plates which were inter-
preted at the Central Sanatorium at McCain. This tabulation follows:

Mass or Community-Wide Surveys

LOCATION

Total
70mm
Taken

Findings From 14 x 17 Film

Reinfection

Tuberculosis

Other

Tuberculosis

Minimal

And

Moderately

Suspected

Advanced

Tuberculosis

Far Advanced

No.

Per 100

No.

Per 100

Non-Tuberculosis
Pathology

No.

Per 100

Columbus County

Bladen County

Brunswick County

Nash County

Franklin County

Wilson County

Halifax County

Edgecombe County

Richmond County

Forsyth County

Alleghany-Ashe- Watauga .

Avery-Yancy-Mitchell

Greene County

Granville County

Sampson County

Martin County

Bertie County

Totals.

19,995
11,149

6,380
14,380
11,704
26,511
24,368
14,168
17,670
48,485
14,778
11,885

5,446

8,857
14,605
10,944

7,291

68
29
11
62
29
74
88
29
36
120
26
44
9
15
50
17
17

3.4
2.7
1.7
4.3
2.4
2.7
3.6
1.9
2.0
2.4
1.8
3.7
1.6
1.6
3.4
1.5
2.3

268,616

724

2.7

642

2.9

2.8
4.8
1.8
1.2
1.4
1.8
1.4
1.7
1.8
3.4
4.7
3.4
2.8
2.3
4.1
3.7

114

126

154

121

165

453

158

113

141

100

2172

4.4
6.7

13.5
7.9
6.9
4.7
6.3
8.1
9.3
9.3

11.0
9.5
8.4
8.7
9.7
9.1

10.8

8.1

(Total Number Examined. 267,119)

152 Thirty-Foukth Biennial Report

Special Surveys

Total Persons X-rayed

Mental Institutions... 13,518

Schools and Colleges 21,828

Penal Institutions - 1 , 238

Other Surveys 198,326

Total Locations Included 69

Venereal Disease Control Section

The beneficial results of the intensive venereal disease control program of
the past few years were apparent in this biennium. There was a marked
decline in the total number of cases of syphilis reported and especially of
early infectious syphilis. The ideal aim of a venereal disease control program
is the eradication of the venereal diseases, but it is becoming more difficult to
secure financial support to maintain a large scale program in the face of declin-
ing prevalence of these diseases. The local health departments have been
assisted to take over the venereal disease program in their jurisdiction as a
more efficient way of handling the problem that still exists. Some of the
methods that have been used to prepare the local health departments to assume
the venereal disease program will be outlined in this report. The morbidity
figures show:

Total Cases Reported for Fiscal Years 1951 and 1952

Percentage
1951 1952 Difference

Primary, Secondary Syphilis . _ 923 555 — 39.9

Congenital Syphilis - _ 369 460 +24.7

All Cases of Syhpilis _____ 4,668 3,959 —15.2

Gonorrhea 14,848 15,713 + 5.8

Chanchroid 238 294 +23.5

Lymphogranuloma Venereum 87 83 — 4.6

Granuloma Inguinale 70 52 — 25.7

While there has been a gratifying decrease in early infectious syphilis, the
same cannot be said for congenital syphilis. It is apparent trom these figures
that there is an increase of reported cases of this stage. This does not imply
that there are more children born with the disease. Actually, the increase
of reported cases reflects better case-finding since many of the cases reported
are over one eyar of age. The increase of congenital cases reported reflects
a more diligent search for those cases that have been overlooked in the past.
Actually, the number of cases that are born with the disease has declined in
the past three years. The number of syphilitic infants born and diagnosed
within a period of one year of birth has decreased from 50 in the calendar
year 1950, 32 in 1951, to 15 in the first six months of 1952.

The cases of gonorrhea show a slight increase. The number of cases of
gonorrhea reported has remained constant for the past five years. This lack
of decline is a convincing answer that adequate treatment alone is not suffi-
cient to control a venereal disease. We do have a simple treatment that is
effective in almost every case of true gonorrhea. In spite of this, the number
of cases reported remains the same. The reason for this is that the reinfec-
tion rate in this disease is very high. Obviously, improved contact investiga-

North Carolina Board of Health

153

tion is necessary if a decline in this disease is to be effected. An intensive
contact investigation program has been started in New Hanover County.
Although this program has been in effect for only the last six months of this
year, a satisfactory decline in the reported cases of gonorrhea has been dem-
onstrated. In the coming period increased emphasis on this type of work will
be made in the rest of the state. The other minor venereal diseases show a
slight decrease in prevalence.

The newer derivatives of penicillin, which provide effective blood levels
of many days' duration, have placed the treatment of syphilis on an ambula-
tory basis. It has, therefore, become increasingly difficult to justify the use
of in-patient care for the treatment of this disease. In addition, many patients
are being treated locally for the same reason. In view of this, the necessity for
the rapid treatment centers has declined. Accordingly, the Western Medical
Center at Charlotte was closed in December, 1950. The Eastern Medical
Center at Durham is scheduled for closing in the fall of 1952. To take up the
slack and aid in the transition to completely local care, several diagnostic
and prevention and treatment centers plan to begin operation before the
Eastern Medical Center is closed. These smaller centers will be associated
with existing local health departments. They will be operated on an out-
patient ambulatory basis and be so located that they will provide adequate
service to the whole state.

Cases Admitted to the Rapid Treatment Centers

Fiscal Year
1951

Fiscal Year
1952

Total Admissions Since
Opening in 1943

2,764
649*

2,672

31 755

25,708
57,463

Total

•Closed December 30, 1950

During this biennium, the Eastern Medical Center has functioned as a
teaching center for health personnel to aid them in taking over the venereal
disease problem. Short intensive courses were given which covered the
clinical facts of the venereal diseases, especially syphilis, demonstration and
practice of interviewing for contact investigation, and a discussion of venereal
disease problems. These courses were also offered to Negro physicians and
several attended. The following personnel have attended these courses:

Fiscal year 1951

Fiscal Year 1952

Health Officers....

22
33
137

174
30

Private Physicians...

Public Health Nurses

Nurses in Training.

V. D. Investigators

154 Thirty-Fourth Biennial Report

Efforts were made by this section to assist local health departments to
evaluate and close out their old venereal disease records. A simplified sched-
ule of evaluating previously treated cases was made and distributed to the
local health departments. The evaluation program is proving a fruitful
source of cases of venereal disease. Many cases of syphilis were inadequately
treated in the past and are now being returned for adequate treatmnt. One
small county that evaluated its old records found 1,300 cases that required
some service. These cases required a blood test, a spinal fluid examination,
re-treatment, or a combination of these. The Eastern Medical Center was
utilized for performing spinal fluid examinations for these cases. The prob-
lem of venereal disease inl migratory workers was taken up in this biennium.
These migratory workers are Negroes recruited in deep South who spend
the spring and early summer in this state harvesting crops. Most of these
workers move from camp to camp; however, they stay in one location for only
a short period of time. In the summer of 1951, mass blood testing of these
workers was done in the Currituck and Henderson areas. The percentage of
positive bloods obtained in these surveys varied from 20% to 30%. From
figures obtained from the Farm Labor Office it is expected that there will
be 10,000 migratory workers in this state. In view of these facts, the survey
will be repeated in 1952.

A special project operated in cooperation with the U. S. Public Health
Service, which was started in 1949, was continued in this biennium. From
15 to 20 college graduates were given special training and assigned as venereal
disease investigators to counties in military areas and in areas of high
venereal disease incidence. In October 1951, a group of these investigators
was organized as a survey team and mass serologic testing was begun in
counties selected because of their high syphilis incidence. An intensive
educational program preceded the serologic surveys. The following shows
survey results:

County Number of Specimens Percentage of Postives

Robeson County 6,000 7.3<?

Onslow County. _ 1,900 9.5%

Pender County

Northampton County 4,000 6.0%

Halifax County

The investigators of this special project are detached from time to time to
aid in the migratory worker program.

In 1951 the Section was able to provide patient interviewing service for
the prison system, including the Central State Prison at Raleigh. In addition,
a female interviewer was provided for the Women's Prison in Raleigh during
the year 1952.

Some of the other services offered by this Section during the biennium
were: Medical consultation services to local health departments and private
physicians, close contact with the medical officers at Fort Bragg and Camp
Lejeune to assist in the civilian part of venereal disease control as it affects
these military areas. Two medical officers were assigned by the Public
Health Service in neighboring county health departments and one venereal
disease investigator was stationed at each post.

North Carolina Board of Health 155

While the actual mechanics of venereal disease control are in the process
of being transferred from a central to a local health department operation,
it is felt that there will be no diminution in the progress to control the
venereal diseases.

For this period, the following financial data are submitted for this Section:
The 1951-52 venereal disease budget was $506,386 in Federal funds. Of this
amount, $101,000 was grant-in-aid, $50,000 to employ out-patient service in
defense counties, $97,180 for operation of the special case-finding project, and
$20,188 was provided for the operation of the special syphilis study program
at Chapel Hill, North Carolina. A total of $238,018 was budgeted for in-patient
care at the Eastern Medical Center in Durham; approximately $21,000 of
this lapsed. The State appropriated $43,504 for drugs and medical supplies.

Industrial Hygiene Section

Medical. Medical activities of this Section have been confined primarily to
services rendered the dusty trades in cooperation wit hthe North Carolina
Industrial Commission, North Carolina Department of Labor, and North
Carolina Compensation Rating and Inspection Bureau. Employees of several
non-dusty industries were x-rayed upon request from management and in
cooperation with the Tuberculosis Control Section. The following services
were rendered:

Physical examinations and x-rays (dusty trades of silica and asbestos ) ...8959

X-rays taken in non-dusty trades 9289

Employees issued work cards (1-year employment only) 8751

Employees recommended to be removed from dusty trades _.__ 20S

Employees recommended for further sanatorium studies 16

Employees with silicosis 101

49 first stage silicosis (early)

43 second stage silicosis (moderate)
9 third stage silicosis (advanced)

Employees with asbestosis ___ 10

3 first stage asbestosis (early)

4 second stage asbestosis (moderate)
3 third stage asbestosis (advanced)

Other pathology ._ __ __ _ __ 81

7 active tuberculosis 4 cystic disease

1 active tuberculosis with cavitation 2 tumor
26 questionable tuberculosis 1 spontaneous pneumothorax

1 silico-tuberculosis 30 lung pathology, undetermin-

9 admissions to sanatoriums ed

Plants visited for x-rays 257

241 silica plants
10 asbestos plants
6 non-dusty plants

Pre-employment x-rays studied.. __ 1739

Medical case histories submitted to Industrial Commission 101

Supplementary medical case histories submitted to Industrial Commission 69
Special physical examinations and x-rays requested by the Industrial

Commission _ _ 126

Court hearings attended _ 135

Testimony given in court hearings _ 64

Conferences (general) 104

156 Thirty-Fourth Biennial Report

Conferences held with Advisory Medical Committee on controverted med-
ical questions 2

Conventions attended - 2

Autopsies witnessed 1

New personnel 6

An important development occurred in 1951 with respect to the activities
of the industrial hygiene program. A compensation insurance carrier, feeling
there had been an excessive number of occupational disease claims filed
against it in recent months, discontinued operations in North Carolina. The
Compensation Rating and Inspection Bureau requested the N. C. Department
of Labor to furnish a "Certificate of Compliance" for each industry affected
by the carrier's withdrawal so that each might be assigned to another car-
rier. The Department of Labor, in turn, requested the assistance of this
Section in making medical surveys and in evaluating the dust hazard in the
industries concerned. This proved to be an enormous task, requiring several
months of intensive work by the medical and engineering staff. Joint efforts
of the Department of Labor, Plant Management and this Section made possible
the completion of improvements necessary to make a majority of the indus-
tries in the State eligible for "Certificates" by the close of the year. At that
time, most of the remaining industries were striving to complete improve-
ments which would make them eligible.

Routine medical surveys and dust studies were carried out in industries
not affected by the incident mentioned above, but were fewer in number than
in previous years.

Engineering. Following a plant to decentralize engineering activities in
order to serve industry of North Carolina better, two engineers moved their
headquarters from Raleigh, North Carolina, to Charlotte, North Carolina, in
September 1950. One engineer was left at the Raleigh office to serve industry
of Eastern North Carolina. On January 1, 1951 the engineer of the Raleigh
office was called into military service. This position was never filled as his
return to duty is expected in October 1952. In October 1951 the two engineers
located at Charlotte moved their headquarters to the Union County Health
Center, Monroe, North Carolina, in order to secure more adequate office and
laboratory space for the Unit.

The statistical report which follows hardly does justice to the various
activities engaged in by this Unit during this report period. In addition to
the usual attention given the dusty trades, the Engineering Unit conducted
special studies of health hazards in such industries as insecticide re-mixing
plants, garages, dry cleaning establishments, and tourist places where open
flame-type gas heaters are used for heating. At present there is in progress
a study of x-radiation hazards associated with the use of x-ray equipment being
used at local health units, in the offices of private physicians and hospitals
of North Carolina. This study should be completed late in 1952.

In cooperation with the N. C. Department of Labor and the Compensation
Rating and Inspection Bureau in establishing eligibility of industrial plants
for securing compensation insurance under the State's Assigned Risk Pro-
gram, more duties and greater responsibilities have been placed on this unit.
This particular phase of the program has grown to such proportions that a
large amount of time is spent in conducting investigations as requested by
the agencies named above. This activity is justified by the safer environ-

North Carolina Board of Health 157

mental working conditions being brought about by the requirements of the
agencies.

During the past two years North Carolina has experienced an industrial
expansion probably unparalleled during any other similar period of time.
This has brought about greater demands for Industrial Hygiene services,
thereby presenting a challenge for all those engaged in industrial health
work.

Engineering Activities for July 1950 — June 1952

I. Field

A. Plant Visits 581

1. For routine inspection 211

2. For special Industrial Hygiene surveys 370

a. Samples atmospheric contaminants collected 181

( 1 ) Dust 160

( 2 ) Other 21

3. Number workers involved 24,276

4. Field determinations 541

II. Laboratory

A. Analyses 236

1. Dust 202

a. Particle count 190

b. X-ray diffraction 12

c. Petrographic 10

2. Other contaminants 24

III. Miscellaneous

A. Reports 367

1. Routine inspections 151

2. Special Industrial Hygiene surveys 116

3. Monthly 24

4. Annual 2

B. Conferences and Meetings 31

C. Papers presented 18

Budgetary. For the fiscal year ending June 30, 1952, there was $26,819
available from state funds and $13,856 from federal funds. The budget of
the previous year was slightly larger.

Veterinary Public Health Section

The Veterinary Public Health Section was established by the North Carolina
State Board of Health on July 1, 1951. On July 25, 1951, the Section Chief
assumed the duties of this newly created section within the Division of
Epidemiology.

This Section has the responsibility of planning, supervising, and coordi-
nating activities designed to eradicate or control animal diseases which are
communicable to man, either by contact or indirectly through food products
or insect vectors. The duties of the Public Health Veterinarian may be
divided into two phases:

General.

1. Participation in developing general improvement in public health.

2. Assistance in administering the general health program.

158 Thirty-Fourth Biennial Report

Special.

1. Promotion of veterinary public health activities to eradicate animal
diseases transmissible to man.

2. Advice and constultation to other divisions of the State Board of Health

regarding veterinary public health problems.

3. Enlisting the cooperation and soliciting the support of private veterinary
practitioners in public health problems.

4. Providing professional consultation and liaison with voluntary and offi-
cial agencies.

5. Administrative duties

A. Regulatory. Establishment of quarantines and review of existing
regulations that are subject to revision.

B. Miscellaneous. Preparation of literature, spot maps, graphs, reports
and handling of correspondence.

The following will reveal briefly the accomplishments during the past year
in this Section. Since rabies is a serious public health problem in North
Carolina, the largest amount of time has been spent in developing a uniform
state-wide rabies control program with operational phases carried out by the
local health departments. The assistance from this Section to the local health
departments concerning rabies control is summarized as follows:

1. Consultation with the health officer and his staff in 38 local health de-
partments.

2. Conference with boards of county commissioners in 18 counties to ex-
plain the State Board of Health plans for assistance to local health
departments and to appeal to the boards for assistance of a dog warden
for the control of stray dogs.

3. Solicitation of support from 135 practicing veterinarians in vaccination
clinics and support of other veterinary public health functions.

4. Attendance at various public meetings throughout the state called by
numerous county officials regarding rabies control in order to explain
the operation of an adequate program.

5. Preparation and distribution of several bulletins, pamphlets, maps, news
releases, and posters regarding rabies and its control.

6. Assistance in three radio programs on rabies control and preparation of
an article on rabies for Wildlife Magazine.

7. Organization of a conference on rabies held in Raleigh on March 4, 1952.
The conference stressed the laboratory diagnosis of rabies and practical
control programs. In attendance were 66 health workers.

8. Placed an educational exhibit on rabies at the North Carolina Public
Health Association meeting in Winston-Salem, North Carolina.

In addition to the activities on rabies control listed above, this Section
Chief participated in several seminars and lectures at the School of Public
Health at Chapel Hill and the Bowman Gray School of Medicine in Winston-
Salem. Also, when requested, advice and consultation were given to other
divisions of the Staet Board of Health on public health matters relating to
this field. The Section Chief delivered talks to various civic clubs and
regional state veterinary associations on the activities of the Section.

Conferences attended by the Section Chief during the past year are as
follows:

North Carolina Public Health Association, Winston-Salem, N. C.

U. S. Livestock Sanitary Association, Kansas City, Mo.

North Carolina Board of Health 159

Middle Atlantic Rabies Conference, Washington, D. C.
N. C. Veterinary Medical Association, Morehead City, N. C.
American Veterinary Medical Association, Atlantic City, N. J.
Western N. C. Public Health Association, Blowing Rock, N. C.

Acute Communicable Disease Control Section

On January 1, 1952, at the request of the U. S. Public Health Service, the
State Board of Health increased the number of diseases that are reportable
by law in North Carolina so that this group would conform to the list recom-
mended by the U. S. Public Health Service for adoption by all of the states.
The basic idea underlying this request was to include in the new list all of
those diseases the infectious agents of which might be used in biological
warfare. If we are to have effective civil defense measures, we must be con-
stantly on the alert for any unusual increase in the prevalence of infectious
diseases in any part of the free world.

The physicians of North Carolina are showing an increasing willingness
to notify health workers of reportable diseases coming to their attention.
They have a sympathetic understanding of the purposes and objectives of
morbidity reporting and realize that satisfactory control measures can be
effective only when the public health agency has accurate information.

A table comparing the list of reportable diseases prior to January 1, 1952
with the list, including seven additions, which was made effective on that
date is shown below. Also shown on this table are the reported cases of each
disease on the list during 1950, 1951, and for the six-months period January
through June 1952.

160 Thirty-Fourth Biennial Report

Reportable Disease Table — Acute Communicable Disease Control

Diseases Reportable
Prior to 1-1-52

Diseases Reportable
Effective 1-1-52

Reported

Cases

During

1950

Reported

Cases

During

1951

Reported

Cases

During

Jan-June 1952

'Anthrax

Chancroid .

'Cholera ..

Dengue Fever

•Diphtheria

* Dysentery, Amebic

• Dy sen tery , Bacillary -

Encephalitis

Glanders -

•Gonorrhea

Granuloma Inguinale

Leprosy .

Lymphogranuloma Venereum
*Malaria._ ..

Measles .

•Meningococcus Meningitis...
•Paratyphoid Fever

Plague

Poliomyelitis

Psittacosis

•Rabies

•Docky Mtn. Spotted Fever. .

Scarlet Fever

SeptisSore Throat

Smallpox

•Syphilis

Trachoma...

•Tuberculosis (All Forms)

•Tularemia

•Typhoid Fever

•Typhus Fever, Endemic

'Typhus Fever, Europ

•Undulant Fever.. —

Whooping Cough

Yellow Fever

Anthrax

Botulism

Chancroid

Cholera

Dengue Fever

Diphtheria

Dysentery, Amebic

Dysentery, Bacillary

Encephalitis

Glanders

Gonorrhea

Granuloma Inguinale.

Hepatitis

Leprosy

'Leptospirosis

Lymphogranuloma Venereum..

Malaria

Measles -

'Mengococcus Infection

Paratyphoid Fever

Plague

Poliomyelitis

Psittacosis

'Q Fever --

Rabies

Rocky Mtn. Spotted Fever

Scarlet Fever —

Septic Sore Throat

Smallpox

Staphylococcus Food Poisoning-
Syphilis

Tetanus

Trachoma

Trichinosis

Tuberculosis (All Forms)

Tularemia —

Typhoid Fever

Typhus Fever, Endemic

Typhus Fever, Europ

Undulant Fever

Whooping Cough..

Yellow Fever

265

499

132

14,930

,964

116

756

1,885

5,146

3,653

3,352

253

373

15,779

,3)5

151

314

2,236

4,080

3,106
17
44
19
0
28
1,961
0

163

7,552

262

117

4,197

123

1,383

2,092

1,284

347

•Diagnostic laboratory service is available for these diseases from the State Laboratory of Hygiene.
(Source of statistical data: Annual and Monthly Morbidity Reports, PHS Section)

Of the reportable diseases, diphtheria is the first on the list which, under
present conditions, constitutes a public health problem of major importance.
The reported cases for 1951 showed a marked reduction over those recorded
for the calendar year 1950. It is sincerely hoped that this is the beginning
of a downward trend in the prevalence of diphtheria in North Carolina. In
1950 this state occupied the unenviable position of having the highest diph-
theria case rate in the United States. Presumably this is due to a breakdown

North Carolina Board of Health 161

in our mechanism for immunizing children. We have a long record of com-
placency and indifference in regard to diphtheria. Since we rely almost
exclusively on immunization to control the disease, we must be constantly
alert in our efforts to keep our younger population immunized.

Amebic dysentery also showed an encouraging decrease during 1951.

The reported cases of gonorrhea are remaining practically constant. Were
it not for this fact, we might be encouraged, on the basis of our syphilis
reports, to feel that the morality of our people is improving. Fortunately,
the penicillin treatment for gonorrhea renders it non-infectious so promptly
that we should be able to make some progress in the epidemiological study and
contact investigation of reported cases.

It is rather disconcerting that in 1950 we had only 36 reported cases of
malaria and in 1951 we had 82. Although these numbers are much smaller
than we experienced some 15 or 20 years ago, any increase in prevalence of
a disease which has been our common enemy for years and which we have
almost eradicated is disconcerting. Follow-up of a considerable number of
the patients reported as having malaria indicates that the infection was
contracted in Korea or in other far flung areas occupied by our military forces.
Unquestionably, a considerable number of cases of malaria are not based on
accurate laboratory findings. Since we have staged such an extensive cam-
paign against malaria, it is desirable that all patients suspected of having ma-
laria have an accurate diagnosis. Unfortunately, some of our local laboratory
technicians seem to have difficulty in determining the difference between a
platelet that is superimposed on a red cell and a malaria parasite. We there-
fore urge all physicians to secure suitable blood films from all patients sus
pected of having malaria and that either unstained or stained blood films be
sent to the State Laboratory of Hygiene in Raleigh or to the Communicable
Disease Center in Chamblee, Georgia, for confirmation.

Since measles can be attenuated or temporarily prevented with immune
globulin, it no longer presents the worrisome problem that it did in former
years. We urge that immune globulin be used in producing attenuated
measles since the protection afforded by attenuated measles seems to be as
sound as when the patient has a full blown attack of the disease.

Meningococcus infection is another condition which is so readily controlled
and adequately treated by the sulfa drugs or by the antibiotics that it also
has been largely removed from the list of public health problems.

Poliomyelitis, which produced the largest epidemic in the history of this
disease in North Carolina during 1948, showed some sign of strength in 1950.
The number of reported cases in 1951, however, was less than half of that of
the previous year.

Scarlet fever, formerly one of our most dreaded infectious diseases and one
that in times past called for our most elaborate quarantine and fumigation
regulations, yields so readily to penicillin that it has almost become a
nuisance instead of a menace.

Smallpox, which once terrified our people, has been nonexistent in the State
during the biennium for which this report is made.

The number of cases of syphilis reported has diminished markedly. This
applies particularly to primary and early syphilis. The reduction seems
almost too good to be true. If it were not for the fact that gonorrhea reports

162 Thirty-Foueth Biennial Report

have been almost constant, we would suspect that something was wrong with
our morbidity reports for syphilis. Syphilologists are inclined to credit the
decline in syphilis not only to more effective treatment but also to our effi-
cient methods of case-finding and treatment of infected contacts.

Tuberculosis reports show the effect of our efforts to combat this disease
which was once called the "Great White Plague". In spite of our mass x-ray
surveys and strenuous efforts to uncover new infections, our reported cases
have declined from year to year.

Typhoid fever is an excellent example of the effects of a strenuous publis
health program extending through the years. Only a few years ago nearly
every county in the state would report more typhoid fever than is now re-
ported for the entire state. In fact, typhoid fever has become so rare that
many of our health departments have discontinued the typhoid vaccination
campaigns which were so popular only a few years ago. It is felt that the
efforts of our health officers and nurses could be used to a better advantage
in combatting other public health problems. We now have a register of
typhoid carriers containing 76 names. Each health officer has been informed
concerning the typhoid carriers residing in his health jurisdiction. Each
health officer sees that these carriers are instructed not to serve as food
handlers and that they are thoroughly informed as to the possible danger to
their associates and their neighbors. They are also carefully instructed in
matters of personal hygiene. When a carrier moves from one geographical
area to another, the health officer at the first location notifies the State
Board of Health and the health officer having jurisdiction over the carrier
in his new location. It is hoped that the efforts being made to find and guide
typhoid carriers will result in a still further reduction in typhoid fever in
the state.

Immunization against whooping cough seems to be reducing the prevalence
of this disease, which formerly killed many of our infants under six months
of age.

Botulism, hepatitis, leptospirosis, Q fever, staphylococcus food poisoning,
tetanus, and trichinosis were the new additions made to our list of reportable
diseases on January 1, 1952. Of these, hepatitis is the only one which has
constituted a real worry, 262 cases having been reported during the period
January through June 1952. These cases have been distributed through
more than thirty counties of the state, the greatest prevalence occurring in
our western counties and in the metropolitan area around Charlotte although
a considerable number have been reported in Cumberland, Orange, Durham,
and Craven counties.

It would seem that North Carolina urgently needs the services of a field
epidemiologist. The investigation of hepatitis is but one of the problems
which should be studied in the field.

Histoplasmosis is more prevalent in the state than most of us realize. The
magnitude of the problem that it presents has not been determined. A field
epidemiologist could materially assist in evaluating the size of this problem
and perhaps exert some helpful influence in determining its solution. A field
epidemiologist also could evaluate the effectiveness of our immunization
programs and encourage the more efficient use of immunizing agents. For
efficient control of the infectious diseases we need, first of all, accurate in-
formation. Then we need efficient application of suitable control measures.

North Carolina Board of Health 163

Summary

In summarizing the activities of the various sections of the Division of
Epidemiology, it would seem that a short appraisal is essentially as follows:

1. Public Health Statistics Section. During the biennium the efforts of
this Section have been devoted largely to the improvement of our reporting
system of births and deaths, the mechanical processing of these certificates
so that certified copies can be readily supplied and that the conventional
statistical tables can be published in the annual reports. Very gratifying
progress has been made in this field of endeavor. In fact, it would seem that
it would be possible to devote more thought and effort in using the statistical
material available to us for use in endeavoring to diagnosis our public health
problems and evaluate our public health procedures.

2. Tuberculosis Control Section. Our mass x-ray studies have been pro-
moted in an energetic manner and have not practically covered the state.
There is still considerable demand for this type of study, mass surveys having
been scheduled through the entire year 1953. A number of our county health
departments have installed x-ray or fluoroscopic equipment or have such
equipment available to them locally. It would seem that in the near future
there would not be sufficient demand for mass x-rays to keep our present
equipment in use at all times. The intriguing suggestion has been made that
when the demand ceases to exist for mass x-ray surveys that we schedule the
sending of x-ray equipment into each county of the state at least once each
year. This would enable us to have our heavy equipment in the mountains
during the summer and in the eastern part of the state during the winter,
and in the central part of the state during the spring and fall. It would
enable health officers to make epidemiological studies of their tuberculosis
problems and to send their contacts, their suspected cases as well as the
tuberculosis patient residing in the homes, to the trucks housing our x-ray
equipment.

3. Industrial Hygiene Section. Our Industrial Hygiene program has been
weaker than it should be due, to a considerable extent, to illness of staff
members.

Much effort in this field has been devoted to the study of the dusty trades,
particularly those dealing with asbestosis. It is hoped that in the near future
we shall be able to strengthen this activity and render greater service to
an expanding industry.

4. Venereal Disease Control Section. As the biennium ends, all doubt has
been removed that the Eastern Medical Center at Durham will be closed and
that the responsibility for treating patients with venereal disease will be
vested in the health officers of the various counties of the state. Plans are
underway for the development of regional clinics where health officers may
send their patients for examination, diagnosis, and suggested treatment by
physicians who have been especially trained in venereal disease control.

5. Veternary Public Health Section. In July 1951 the State Board of
Health employed a veterinarian trained in public health procedures and
established a Veterinary Public Health Section in the Division of Epidemi-
ology. Within the period of one year the Chief of this Section has organized
a number of counties for effective campaigns against rabies. Notable prog-

164 Thirty-Fourth Biennial Report

ress has been made in connection with the development of programs against
other diseases that are primarily of animals and secondarily of man. In the
future, it would seem that this Section will be of considerable assistance in
our fight against the communicable diseases.

6. Acute Communicable Disease Control Section. In the field of communi-
cable disease control we have continued our efforts to secure the better re-
porting of reportable diseases and have endeavored to process those report
cards we receive so that current information is available on the problems of
reportable diseases throughout the state. Conventional tables of morbidity
statistics are prepared and published.

In the future, we hope to have the services of a field epidemiologist who can
study those conditions which present unusual problems and encourage the
development of more effective procedures in combatting communicable dis-
eases.

General Comment. It seems that the Division of Epidemiology and each of
its sections has rendered useful service to the State of North Carolina during
the biennium and that each section has the laudable ambition to render better
service to the State during the year that are to come.

REPORT OF THE SANITARY ENGINEERING DIVISION
July 1, 1950— June 30, 1952

The Sanitary Engineering Division is responsible for the development,
promotion, and technical supervision of the State Board of Health's program
of environmental sanitation, and for the coordination of this program with
those of local health departments. It is also responsible for the enforcement
of State health laws and regulations relating to sanitation and sanitary
engineering. The activities governed by State laws and regulations include
the following:

1. The general superivision and inspection of public water supplies.

2. The review and approval of plans for the construction of water purifica-
tion and sewage treatment plants.

3. The sanitation of public lodging and eating places, including tourist
camps, tourist homes, and summer camps for children.

4. The sanitation of public and private hospitals and institutions.

5. The control of malaria and other insect-borne diseases.

6. The sanitation of meat markets, abattoirs, poultry processing plants,
and frozen food locker plants.

7. The enforcement of the State Bedding Law.

In addition to the above legal activities, the Division engages in the pro-
motion of safe milk supplies through the adoption by local communities of
the Standard Milk Ordinance, assists with the training of local sanitarians,
develops standard inspectional procedures, prepares and distributes technical
and informative bulletins regarding sanitation, assists in the development
of local ordinances relating to sanitation, and acts as consultant to local health
departments and other State agencies on problems relating to all phases of
sanitary engineering.

ADMINISTRATION

Some changes have taken place in the administrative organization of the
Division during the period covered by this report. Malaria control and
typhus control have been combined, and now operates as the Insect and
Rodent Control Section; industrial waste studies and stream sanitation
activities have been more closely coordinated with the State Stream Sanita-
tion Committee, which was authorized by the 1951 General Assembly as a
separate unit within the State Board of Health. The Division, therefore,
now consists of three main sections: Engineering, Sanitation, and Insect and
Rodent Control. There have been a number of personnel changes during the
two-year period, caused mainly by dissatisfaction over the salary schedules,
and the delay on the part of the State Personnel Department in reclassifying
positions and establishing equitable compensation schedules. One of our
Senior Engineers was recalled to military duty, and two of our Section Chiefs
changed positions, one entering private business, the other accepted a position
as Executive Secretary with the State Stream Sanitation Committee. Three
of our Junior Engineers resigned to accept employment in private industry

166 Thirty-Fourth Biennial Report

at considerable increases in salary. There has also been a considerable turn-
over in our stenographic positions. The loss of experienced personnel, to-
gether with the loss of time in training new personnel has had its effect upon
the volume of work done, and the results accomplished. As of June 30,
there were 34 persons employed in the Division, including three persons paid
directly by the CDC Unit of the U. S. Public Health Service at Atlanta. The
34 persons employed as of June 30, and grouped according to the major
activities in which they are engaged, are as follows:

1. The Engineering Section, which is primarily concerned with water,
sewerage, and industrial wastes, has eight engineers and two secre-
taries.

2. The Sanitation Section, which is concerned with milk, foodhandling,
shellfish, bedding, and the enforcement of State Laws relating to sani-
tation, has two engineers, thirteen sanitarians, two secretaries and one
clerk.

3. The Insect and Rodent Control Section, which is made up primarily of
employees paid by the U. S. Public Health Service, consists of one engi-
neer, one typhus control aide, one secretary, and one entomologist.

The above does not include the Director and his secretary.

LEGISLATION

After several years of work on the part of this Division and others con-
cerned, and after many failures in our attempt to secure legislation regarding
stream sanitation, the 1951 General Assembly enacted into law a bill creating
the State Stream Sanitation Committee, and placed this Committee within
the framework of the State Board of Health. This Act should prove to be one
of the most far-reaching pieces of legislation adopted by the 1951 General
Assembly, and as years go by should have a most beneficial effect upon the
health and economy of our State in further protection and conservation of
our water resources. Legislation was also enacted improving or clarifying
the Sanitary District Law, and we also sponsored and secured legislation
reducing the price of Bedding Stamps.

ACTIVITIES

The primary activities carried on by the Division during the period 1950-52
are enumerated according to the sections mentioned above, and are as
follows:

Engineering

One of the most significant things in the Engineering Section has been the
increasing amount of assistance given to consulting engineers, municipal and
State officials, and industrial officials. The assistance provided has been
mainly in connection with water, sewage, and industrial waste problems.
Plans have been reviewed and approved for all new constructions or major
renovations, a number of well sites have been approved, as well as hospital
sites for the Medical Care Commission. Assistance has been rendered a great
many of our operators of municipal water and sewage treatment plants, with
respect to operational problems. Furthermore, since very few of our local
health departments have engineering service available through their own

North Carolina Board of Health 167

personnel, a large percentage of the time of our engineers is given over to
helping the local Health Officers and their sanitation staffs with sanitary
engineering problems. During the past two years, 178 sets of plans for water
and sewerage projects were reviewed and approved by this office, or an
increase of approximately 40% over the approvals given during the previous
two years. The types of projects considered and approved were as follows:

New water systems or extensions — public 43

New water systems or extensions — industrial.. _ 5

New sewer systems or extensions — public 37

Municipal water plant improvements.. 22

Sewage treatment plant improvements — public 16

industrial or institutional 9

School sewage disposal plans approved ..28

Swimming pool plans approved 5

State parks water systems approved 6

State parks sewerage systems approved 7

During the biennium contracts were let for 54 major water system im-
provements, and 37 sewage works improvements, totaling $11,836,000 for water
and $4,812,000 for sewerage. We now have a total of 371 public water sup-
plies and 277 sewerage systems in the State.

The industrial waste studies which were begun in 1949, when Federal funds
became available for these studies, have progressed rapidly. A number of
detailed surveys have been made of special industrial waste problems, in
connection with the work of the State Stream Sanitation Committee. One
of the greatest benefits derived from this program, however, has been the
assistance which we have been able to give to new industries considering the
location of plant sites in North Carolina. Special surveys and investigations
have been made at the request of the State Department of Conservation and
Development, the State Treasurer, other officials, and from industry. Our
ability to provide this assistance has, or will go a long way in the development
of better working relationships with these industries, once they locate within
the State. It also enables us to get first-hand information as to what might
be expected in connection with, pollution problems, before the plants are
built. The work of the Industrial Waste Unit, which has been an activity
of the Engineering Section during the past two years, is being transferred
to the State Stream Sanitation Committee, effective July 1, since funds for
continuing this work were not appropriated by Congress.

Accurate cost estimates on all improvements to water and sewage are not
available; however, this office conservatively estimates that at least $17,000,-
000 were expended by municipalities and industry for water and sewage
treatment and expansion during the biennium. Tins office also supplied plans
for school sewage treatment plants to architects and engineers in connection
with the school building program. During the biennium, 145 sets of plans
for sewage treatment plants for consolidated schools were issued by this
office. Investigations were made of the location of each of the plants and
follow-up visits and assistance were rendered the local health departments
and the architects in connection with these projects. Stock plans were also
issued for other installations at camps, for swimming pools, industrial plants,
motor courts, etc.

168 Thirty-Fourth Biennial Report

Serious water shortages occurred during the biennium at Asheville, Raleigh,
Burlington, Henderson, Roxboro, Sanford, and some of our smaller towns
throughout the State. Emergency water supplies were approved and assist-
ance given these municipalities with regard to emergency chlorination, the
selection of auxiliary supplies, etc. The usual surveys and inspections were
made of all interstate carrier watering points and water supplies, in coopera-
tion with the Public Health Service.

Fluoridation of public water supplies also received a lot of attention. Con-
siderable interest is being shown by our medical and dental professions and
municipal officials in the fluoridation of public water supplies. During the
biennium, 17 projects were approved and one (1) town (Winston-Salem )
began fluoridating its water supply.

Another of our most important activities has been the cooperation with the
University of North Carolina, Duke University, and North Carolina State
College, the American Water Works Association and the Federation of
Sewage Works Association in conducting training courses for water works
and sewage works operators. Certificates are awarded those completing the
courses, and who pass an examination given on a voluntary basis by an
examining board of the Water Works Operators' Association. Since this pro-
gram began in 1939, 397 certificates have been issued.

Also, during this biennium the first Industrial Waste Conference to be held
in this State, or in the South, was held at State College. Top level adminis-
trative and technical men from industry and municipalities took part in the
conference and we believe that it will contribute materially to improvement
in our stream sanitation program in the future.

Sanitation Section

The activities of the Sanitation Section were for the most part of a
routine nature concerning the enforcement of State laws and regulations,
although a number of significant activities in the field of promotion of better
environmental health were engaged in by the Staff. Of particular interest
has been the further development of courses of field training for local sani-
tarians. The personnel of this Division assisted with this program, which
is carried on at the School of Public Health, University of North Carolina,
through its department of Field Training. During the biennium, 7 courses
were given to 110 local sanitarians. These training courses consisted of 12
weeks' field training for sanitarians, together with topical short courses on
the protection of private water supplies, food control, insect and rodent
control, and special short courses in milk plant operation and sanitation,
which were given at State College, in cooperation with the Dairy Division
of the college.

Special attention was also given to the development of Civil Defense sani-
tation measures, and discussions were held with sanitarians throughout the
State regarding emergency senitation programs.

Milk sanitation continued to receive attention from the personnel of this
office. Surveys, which are made of all milk supplies in the State at least
once every two years, show that the over-all sanitation of our milk supply
in this State is gradually improving. At the present time, 91 counties are
covered by county or district ordinances, and 6 municipal ordinances are
also in effect in the State. During the biennium, plans for 40 new milk

North Carolina Board of Health 169

plants were reviewed. Efforts are continuing to bring about more uniform
inspection and certification of milk supplies from one county to another
within the State. During the past two years, 80 surveys were made of the
milk sheds in this State by two men assigned to this activity.

A program of assisting operators of foodhandling places, institutions, and
hospitals has continued as in the past, and is proving most valuable. During
the past two years, 54 foodhandler training courses were given, and were
attended by approximately 13,500 persons.

During the biennium, closer cooperation was developed between the State
Department of Public Instruction, in connection with the approval of plans
for new school house construction. Although, we have been operating jointly
on this program for a number of years, considerable progress was noted dur-
ing the past two years in the reviewing of plans and the securing of better
lunchroom facilities in the new schools. In cooperation with the School
Health Coordinating Unit, a school sanitation inspection sheet was developed
and put in operation by the county health units. This also is proving very
helpful.

During this period, conferences were held with officials of the N. C. Fairs
Association at which time regulations governing itinerant restaurants, or
foodhandling practices at fairs, were developed. The itinerant operator of
foodhandling places carried on in conjunction with fairs and carnivals has
been a source of concern for a number of years. We believe that under the
present swstem of cooperation with the fair officials, that progress is being
made in connection with this work.

The laboratory established at Morehead City in connection with the shellfish
sanitation program is gradually improving, and is functioning at the present
time better than at any time since it was established.

One engineer has devoted practically his entire time during the past two
years assisting owners of abattoirs and poultry processing plants in develop-
ing plans for these two types of operations. There has been a great increase
in the poultry production and processing in this State, and this office has
contributed materially to the development of that program.

We have continued our assistance to local health departments in connection
with rural sanitation. One man has devoted his entire time to privy building,
septic tank construction, and private water supplies in areas where com-
munity sewerage systems are not available. A revised water bulletin is
being written this year and should be available soon.

A new program consisting of the sanitation of roadside parking areas has
been carried on jointly with Highway and Public Works Commission. At their
request, we are now assisting in the location of these parking areas, and in
the approval of water supply and sewage disposal facilities at these parking
areas. We also have worked very closely with the Division of Local Health
Administration and the Medical Care Commission in connection with the
approval of sites and review and approval of plans for new health centers.

Insect and Rodent Control

Since March 1, 1950, when the Malaria Control Section was transferred to
the Sanitary Engineering Division, it has taken on the additional responsi-
bility of rodent control and the control of all insects affecting man.

During the biennium. this Section has lost five of its staff through reduction
of personnel and transfer.

170 Thirty-Fourth Biennial Report

There were five deaths from malaria reported during the biennium, one
from Harnett County in 1950. Onslow, Pamlico, and Sampson counties each
reported one in 1951, and one was reported from Wake County in 1952. No
deaths were reported from typhus fever, but, 13 deaths resulted from Rocky
Mountain Spotted Fever.

Although malaria control is still given emphasis in the residual spraying
program, fly control is also given a place.

Reports are regularly received in this office from approximately 18 coun-
ties in which insect and rodent control is being conducted, and figures have
been compiled from these. It is known, however, that many more programs
are being conducted throughout the State. A total of 76,495 premises were
treated with residual spray in areas which were previously regarded as
malarious, and where mosquitoes and flies are a problem. The use of fogging
machines in several of our large cities is also adding to the mass protection
of the population from flies and mosquitoes.

Two projects, alone, report 1,347 miles of new and old ditches being dug
and maintained, and that 21,418 gallons of larvacide were used for the con-
trol of mosquitoes. During the biennium, pond construction has nearly dou-
bled over the previous two years, with 2,108 applications for permits being
received by the State Board of Health, and 1,512 impounding permits being
issued.

The John H. Kerr (Buggs Island) Dam and reservoir has been completed
by the U. S. Army Engineers, and the gates were closed on June 30, 1952.
Filling is expected to require between eight and ten months. The mosquito
control team working on the reservoir is progressing well with the control of
the malaria mosquito.

Only one malaria bloodslide survey was conducted in the past two years.
This was made in the schools in Roanoke Rapids, and the results were all
negative. In September 1950, the laboratory technician attached to this
staff was transferred to the laboratory staff.

The entomologist for this unit examined 50,225 rat ectoparasites and 1,880
mosquitoes, flies, ticks, and other arthropods collected on surveys, or sent in
for determination by the various health departments. Numerous insect and
rodent surveys were made, and consultation service was given to the various
counties by members of the staff and U. S. Public Health Service consultants.

Two members of the rodent control staff were lost on May 30, 1952, due to
reduction of personnel, thus curtailing the rat survey work which was an
assistance in the promotion of rat control in the State. The rat-proofiing
program has been greatly reduced in the past two years, a total of 3,103
establishments having been rat-proofed or repaired. Approximately 17,000
premises were treated with 22,000 pounds of 10% DDT dust for the control
of rat ectoparasites. With the introduction of Warfarin as a rat poison, new
emphasis has been placed on rat poisoning. There were 105,581 premises
treated with 83,963 pounds of rat poison during the biennium.

Technical assistance is given to local health departments in organizing
and operating fly control programs, and large quantities of DDT, Chlordane,
and Lindane have been purchased by local health departments from the State
Board of Health, which maintains a supply of these insecticides on hand for
resale at cost.

North Carolina Board of Health 171

Numerical Summary of Activities of Sanitary Engineering Section
July 1, 1950 — June 30, 1952

Engineering

Public water supply inspections 574

Well sites examined and approved 165

Water samples collected and examined 218

Special investigations conducted (water supplies).. 159

Sewerage system inspections 922

Stream pollution problems investigated 73

Plant sites investigated 317

Special investigations (sewerage systems) _ 105

Sand analyses 90

Water supply plans approved SI

Sewage works plans approved 121

Swimming pool plans approved 10

Outdoor batbing places investigated 14

Sewage plant plans furnished 220

Swimming pool plans furnished 8

Sources of water supply examined for interstate carirers 24

Watering points examined _ 137

FHA developments investigated 65

FHA cases processed .... 1,904

Special conferences with engineers, city and county officials. 1,346

Sanitation

Milk plant inspections — 417

Dairy farm inspections 1,934

Milk surveys completed 83

Milk plant plans reviewed 42

Special investigations (Milk) 35

Milk samples collected 343

Conferences regarding milk 717

Foodhandling establishments inspected ._ 3,414

School lunchroom inspections 542

Abattoir and meat processing plant inspections 61S

Meat market inspections 879

Frozen food locker plant inspections 125

Poultry plant inspections 31S

Plans reviewed for foodhandling establishments 1,373

Foodhandler schools held 59

Private water supply inspections 3,997

Private sewage disposal inspections 1,178

Privy inspections _ S.2S4

Summer camp inspections 52

Institutions inspected 54S

Hospital plans reviewed 202

Hospital plans approved 40

Public school inspections ... _. 496

Swimming pool inspections ._ 26

Hotel and tourist camp inspections 369

172 Thirty-Fourth Biennial Report

Complaints general sanitation 258

Special investigations 140

Special meetings 665

Shellfish packing plants inspected 1,660

Retail seafood markets inspected _ 286

Patrol inspections of restricted waters _ 124

Plans distributed 281

Number of court cases _ 23

Insect and Rodent Control

Ratproofing projects in operation 8

Estimated ratproofed ._ 3,103

Estimated dusted (DDT) 17,000

Pounds DDT used — 22,000

Poisoning programs operating 23

Premises treated 105,581

Local campaigns supervised (Rat Poisoning) 47

Residential spraying projects 26

Drainage projects — 6

Impounded water permits granted 1,512

Bedding

Retail places inspected 3,086

Manufacturing plants inspected 8,449

Pieces of bedding condemned 4,433

THE BIENNIAL REPORT
THE DIVISION OF ORAL HYGIENE

July 1, 1950— June 30, 1952

Average number school dentists on staff.. 10

Number of counties served - - 72

Number of elementary schools visited _ 1,017

Number of children — mouths inspected 161,098

Number of underprivileged children receiving dental corrections.. 61,814

Total number of operations ..262,260

Amount and Class of Treatment Itemized as Follows

Number amalgam fillings 25,346*

Number cement fillings 7,539

Number silver nitrate treatments 87,904

Number teeth extracted 55,025**

Number children — teeth cleaned _ 54,087

Number miscellaneous treatments — 7,322

Number sodium fluoride applications 25,037

Total 262,260

* Number teeth filled that were six year molars. _ 20,423

**Number teeth extracted that were six year molars 7,955

Number classroom lectures on Mouth Health by dentists 4,375

Total attendance at lectures 161,068

(average of 450 each school day)
Number children referred to local dentists... _ - 99,254

There is more to this brief statistical report of two years' work than ap-
pears at a casual perusal or than is indicated by the mere figures. It should
be superimposed, mentally, upon a map of our State — a map showing one
hundred counties — each county dotted with school buildings — school buildings
bursting at the seams with children — children needing dental attention. Here
and there, inside a few of the schools, may be found school dentists teaching
in classrooms or making dental corrections for the underprivileged children.
With such a mental backdrop, the figures take on real significance.

The average number of dentists, ten, during the two year period is a matter
for great concern. As a study of subsequent figures will show, this number
is not adequate. But what the dentists do is more important. To appreciate
and evaluate their work in the schools it is necessary to understand certain
basic principles of the program. They are as follows:

1. Public health is primarily interested in the prevention of disease and
must not be associated in our own minds cr in the minds of the public
with curative medicine.

2. Dental diseases are, to a large extent, preventable.

3. Prevention of dental diseases depends largely upon individual initiative
and knowledge which, in turn, must be gained through education.

174 Thirty-Fourth Biennial Report

4. Many dental diseases and many systemic diseases of dental origin may
be prevented by the early detection and correction of dental defects.
Therefore, the practice of making regular visits to a dentist, beginning
early in life, is the most effective preventive measure known today.

5 IT IS TO THE END THAT ALL CHILDREN IN THE ELEMENTARY
SCHOOLS MAY HAVE EXPERIENCES THAT WILL FAVORABLY
INFLUENCE THEIR DENTAL HEALTH KNOWLEDGE, ATTITUDES,
AND PRACTICES AND WILL RESULT IN THEIR ACCEPTING
THEIR PERSONAL RESPONSIBILITY FOR THEIR OWN DENTAL
HEALTH THAT THE PROGRAM IS DIRECTED.

In line with these principles the school dentists teach Mouth Health
didactically and through demonstration. The dentist goes into the class-
room as a specialist and introduces the subject. It is done in the presence
of the classroom teacher with the hope and expectation that it will stimulate
the teacher's, as well as the pupils', interest in Mouth Health and that she
will continue the teaching and incorporate it in her classroom program and
activities throughout the year. That this goal is being accomplished is
borne out by the numerous requests from teachers for dental health teaching
aids and by the accounts of dental health units and studies being carried
on in the schools.

Another, and a very valid purpose of the dentist's appearance in the class-
room is to meet the children and to have them meet him under circumstances
which will be conducive to a friendly relationship. In other words, it is to
give the children experiences that will favorably influence their attitudes
toward the dentist and give them an appreciation for and desire to have
clean, healthy mouths. It will be noted that the dentists on the staff visited
4,375 classrooms in 1,017 schools. They taught more than 160,000 children
or approximately 450 children each school day. This seems to be a large
number until compared with the average daily membership of about 700,000
children.

Following the classroom instruction the dentists inspect the mouths of
all the children. They make the necessary dental corrections for as many
underprivileged children as time in the school will permit. During the
biennium, 61,814 children received this service. It must be remembered
that these are children who, otherwise, would not have had dental attention.
The figures show an average of four and a half operations per child. Of
especial significance is the number of six year molars filled. These 20,423
six year molars may be looked upon as that many permanent teeth saved.
The 7,955 six year molars extracted tell another story.

An important group represented in the report is that of the referred chil-
dren, almost 100,000. These are the children whose parents are financially
able to take care of their dental needs. Postal cards, signed by the school
dentist, are mailed to the parents. The cards suggest to the parents thar their
children should be taken to their family dentists. Even the privileged need
reminders. These are the children who can and should be led to accept per-
sonal responsibility for their own dental health.

The fact should be emphasized that all of the children receive the benefits
of the educational program. This program includes additional activities.

A major service of the Division of Oral Hygiene is the preparation and
distribution of dental health literature. This consists of a handbook for
teachers, graded dental health material for classroom use, posters, and dental

North Carolina Board of Health 175

health news releases for school papers. The dentists distribute this to the
teachers in the school they visit. It is also available to any teacher upon
request to the Division of Oral Hygiene. Two new publications were re-
leased during the biennium: a booklet for third and fourth grades based on
a school experience of one of the staff dentists and a booklet, MY FRIEND
THE DENTIST, which is furnished the dentists in private practice for dis-
tribution to their child patients. Approximately a million pieces of dental
health literature were distributed each of the two years. It is noteworthy
that this material is dispensed only in response to specific requests.

The puppet show, a visual education project starring Little Jack, has been
found to be a very effective means of providing experiences that will favor-
ably influence the dental bealth knowledge, attitudes, and practices of the
children. The show is presented in three elementary schools on each school
day. During the biennium, Little Jack visited 806 schools. The show was
seen by 269,683 children. Little Jack invites the members of his audiences to
write to him and to tell him the four rules for taking care of the teeth. He
receives and answers hundreds of letters from the children each week.

The educational program has not been confined to educating the individual
as to the things he, himself, can do to have good teeth. It has also been
engaged in efforts to educate the individual and the public concerning
fluoridation as a public health preventive measure. We would say that dur-
ing the past two years fluoridation has been the major preoccupation in the
field of dental public health.

Following the endorsement of fluoridation by the American Dental Asso-
ciation and the American Medical Association, the Division of Oral Hygiene
has been increasingly active in promoting it. We look on fluoridation as a
measure which restores to the water a nutritionally essential element which,
in the proper proportions, reduces the incidence of dental caries. The director
of the Division has met with local dental societies, city councils, parent-
teacher associations, and other interested groups in many communities
throughout the State. Fluoridation literature, secured from the U. S. Public
Health Service, has been widely distributed. Reprints of an excellent news-
paper article advocating fluoridation by Dr. Norton, the State Health Officer,
were furnished dental offices and health departments throughout the State
for distribution.

We expect to see a decided reduction in the incidence of tooth decay in
North Carolina in a few years when fluoridation has been more widely adopted
by the municipalities. In the meantime, the dental health conditions of our
children constitute a major health problem, and the Division of Oral Hygiene
is in great need of more dentists on its staff.

PERSONAL HEALTH DIVISION
July 1, 1950— June 30, 1952

Near the end of the 1948-50 biennium, reorganization added nutrition, cancer
control and heart disease control to the original Division of Preventive Medi-
cine— maternal and child health, and crippled children. Nutrition has had
an able section chief the whole time. Chief of CC and MCH sections was
employed February 1, 1952.

A report of each of the sections follows:

Maternal and Child Health Section

Several additional M&I clinics were established during the biennium. The
participating clinician's fees were changed from a verying flat rate per clinic
to a system of paying $10.00 per hour for the first hour or part thereof, and
$5.00 for each additional hour.

An experienced public health nurse was given a year's postgraduate train-
ing (extending into this biennium) primarily in pediatric nursing, and
secondarily in the field of obstetrics and prenatal care.

The rest of the program has followed the same pattern as in the past. A
brief statistical report for the M&I clinics follows:

Total clinics conducted — - — - 10,285

Attendance — Maternity patients — 55,269

Infant and preschool __ .102,906

Publications sent out from the mailing room:

Prenatal Care — 28,871

Prenatal Letters 14,517

So You're Expecting a Baby 4,506

Infant Care - 42,298

Baby's Daily Schedules 51,200

Breast Feeding 6,918

Infantile Diarrhea 6,226

Height and Weight Charts ----- 4,894

Your Child from One to Six - 16,208

Your Child from Six to Twelve - 27,944

Guiding the Adolescent 14,036

Children are our Teachers.—. 441

The Premature Infant Care Program is an important part of the Maternal
and Child Health Section. The objective is to lower the infant mortality in
North Carolina by special attention to the premature infant which accounts
for one-third of our infant deaths and eight percent of our live births. There
were 8,953 premature infants born in North Carolina in 1951. The Program
consists of case finding, care, follow-up. and education. The 1949 Legislature
passed a bill requiring the reporting of all premature infants (under 5*4 lbs.)
born in this state within 24 hours.

Six large hospitals have major premature centers with a total capacity of
85 beds. They are:

North Carolina Board of Health 177

Duke Hospital Durham _ -20 beds

Watts Hospital Durham 12

Rex Hospital Raleigh 14

Victoria Hospital .Asheville _ _ -15

Baptist Hospital Winston-Salem 12

James Walker Hospital ...Wilmington 12

July 1, 1950 thru June 30, 1952
In Major Centers

Cases authorized 1301

Cases closed 1342

Average cost per case — — $ 406.40

Hospital payments 489,909.00

Doctor payments — - 55,483.00

$545,392.00

Due to increased hospital costs the State Program sponsors 42 of the 85
beds. The major centers are unable to take care of all the requests for
premature care. Other hospitals in the state are encouraged to become sec-
ondary centers. These are hospitals that have set aside a nursery for prema-
ture babies, have a pediatrician on the staff, and a nurse that has special
training in premature care. The Program lends these centers two or more
incubators and consults with them in the set-up of the nursery. The following
are listed as secondary centers:

Albemarle Hospital.. Elizabeth City

Park View Hospital ..Rocky Mount

Pitt Memorial Hospital Greenville

Wayne Memorial Hospital.— _ _. Goldsboro

Cabarrus County Hospital ..Concord

Rutherford Hospital Rutherfordton

Grace Hospital Morganton

The Program does not pay for care in secondary centers.

Aluminum carriers equipped with oxygen and hot water bottles are placed
in most of the county health departments and the public health nurses
transport the infants to the nearest center. A program of home visit and
following up by the public health nurse is also inaugurated. A teaching
center at Duke Hospital has been established and in July, 1951 Miss Eileen
Kiernan from the New York Hospital was employed to give her full time
to teaching nurses and doctors premature infant care. Three courses of
four weeks each were given in 1951-52 nad a total of 17 public health and
hospital nurses were trained. In addition, lour 2-3 day nurses conferences
on prematurity were held at Wilmington, Charlotte. Asheville, and Elizabeth
City. Some pediatricians and obstetricians participated in these conferences
and a total of 99 hospital and public health nurses attended. Numerous
talks on the problems of prematurity were given by Miss Kiernan and the
Pediatric Consultant to district nurses, meetings, midwife meetings and to
the Southern Pediatric Seminar at Saluda. Two papers on prematurity were
presented at the State Medical Society at Pinehurst by the Pediatric Consult-
ant as follows: -'North Carolina Premature Infant Care Program" and
"Evaluation of the North Carolina Premature Infant Care Program".

178 Thirty-Fourth Biennial Report

Crippled Children's Section

One additional physical therapist was added to the Crippled Children's clinic
program. Three new clinics were organized. Post-clinic conferences were
emphasized. Nurses, physical therapists, nutritionists, and one medical social
consultant participated in these conferences, working out problems and plan-
ning services to the children involved. In the field of education, conferences
were held in hospitals and in health departments on a district and local basis.
Emphasis on the total child was stressed. An operating manual was com-
pleted and is in use. A 3-weeks camp for forty-odd children was operated in
'51. A most attractive booklet with many pictures of camp activities was
made. A pamphlet giving the history of the Crippled Children's Program
and information on services rendered was prepared and dedicated to the late
Dr. G. M. Cooper, who developed and operated the program.

For the first time in the history of the crippled children's program, the
State Legislature made a direct appropriation to the crippled children's pro-
gram in the sum of $86,500 per year for the biennium. In the past, appropria-
tions made to the State Orthopedic Hospital had to be used as matching funds
in securing federal appropriations for the crippled children's program. The
directors (state and federal) of the crippled children's program are extremely
grateful for the state's appropriation specifically for crippled children.

During the past biennium the program added surgery for operable con-
genital heart or blood vessel abnormalities. We also added one specially
trained nurse whose duties will be largely those of nursing education and
in-service training in the field of crippled children, growth and development,
etc.

Table 1

Case Statistics of Major Services

1. General hospital admission authorizations outstanding as of

July 1, 1950 ___ - 197

2. General hospital admissions authorized during biennium 3,914

3. General hospital extension authorizations issued during biennium . 865

4. Crippled children under general hospital care July 1, 1950— 146

5. Crippled children admitted to general hospitals during biennium ._ 2,754

6. Crippled children discharged from general hospitals during
biennium 2,718

7. General hospital admission authorizations outstanding July 1, 1952 226

8. Total number of days provided in general hospitals 41,905

9. Children provided convalescent or foster home care during

biennium — 154

10. Number of appliances purchased during biennium... 1,158

11. Number of applications received state office and deferred as of
June 30, 1952 75

Table 2
State clinics

1. Number of clinics held (33 clinics reporting) 997

2. New patients registered for whom clinic Form 13 is made out 5,752

3. Patients attending clinic for first time during calendar year 12,780

4. Return admissions (those attending 2nd, 3rd or more times in same
calendar year 11,459

5. Total attendance at clinics 24,239

6. Number of cast procedures __ — 1,037

7. Number of brace procedures 1,137

8. Number of dressings applied - 157

North Carolina Board of Health 179

9. Number of bandage procedures (proprietary ).__.. 229

10. Corrective shoes advised 3,929

11. Number of corrective exercises 2,373

12. Number of dietetic treatments 1,312

Table 3

1. Office

a. Number State Staff conferences 89

b. Number conferences with surgeons 1,117

c. Number of conferences with health officials 2,033

d. Number of conferences with welfare officials.- 896

e. Number of conferences with official groups 61

f. Number of conferences with non-official groups 109

g. Number other conferences . 2,198

h. Number talks . 69

1. Number in attendance •. ... 2,107

i. Number In-service Institutes: Conducted 5

Attended __ 8

1. Number in attendance 165

j. Professional meetings 32

2. Clinic

a. Number State Orthopedic clinics attended 958

b. Number patients interviewed 16,621

c. Number applications for hospitalizations _ 731

d. Number applications for appliances 394

e. Number patients treated by physical therapist 1,164

3. Field

a. Number home visits 522

b. Number cases referred to clinic or surgeon 1,503

c. Number not home visits _ 85

d. Number cases referred to Vocational Rehabilitation 563

e. Number physical therapy treatment clinics 26

f. Number patients treated by physical therapist.. 295

Heart Disease Control Section

The salary of an EKG technician at Duke Medical School and Hospital has
been continued. Three-day refresher courses in cardiovascular diseases for
thirty rural general practitioners were given in September, 1951, and March,
1952. A three-day course in the Fundamentals of Electrocardiography was
given to thirty general practitioners at Duke in June, 1952. It is planned for
the above courses to be continued on a semi-annual and an annual basis,
respectively, as long as funds are available and physician participation justi-
fies the procedure. Subscriptions to the Heart Bulletin have been paid for
for all white general practitioners, internists, cardiologists and members of
the State Medical Society's Committee on Chronic Illnesses. This bulletin
is also sent to each Negro physician in the state. Short courses in heart
are being paid for for public health nurses at Chapel Hill. The heart section
provides appropriate leaflets for free distribution and sound films for use by
lay and professional groups. Heart funds pay most of the salary of a health
educator in the service of the North Carolina Heart Association. We work
closely with the American Heart Association officials. Work is being done
on heart abnormalities disclosed by tuberculosis screening X-ray programs.
Form letters are being sent to each individual advising him to see the indi-
vidual doctor named as his family physician and stating that the findings of
his X-ray have b:en sent to his doctor. Another form letters goes to the

180 Thirty-Fourth Biennial Report

named doctor giving the interpretation of the firm so far as heart abnormal-
ities are concerned. A return card is enclosed for the doctor to show when
patient reported to him, or that patient did not report, after sixty days had
elapsed.

Cancer Section

The Cancer Section operates as a part of the Division of Personal Health
Services, and, having been without the services of a Medical Chief for almost
three years, comes under the immediate supervision of the Director of that
Division. The Cancer program is financed by both State and Federal ap-
propriations, and all of its activities are directed by the State Board of
Health in collaboration with the Cancer Committee of the North Carolina
State Medical Society.

The chief objective of this Section is the diagnosis of early cancer while
there is still hope for cure or arrest of the disease. The initial steps in the
effort to control cancer were the establishment of clinics, or Cancer Centers,
throughout the state. The clinics are staffed by members of the Medical
Society in the localities where the Centers are operated. These Centers are
divided into two parts known as Detection Centers and Diagnostic-Manage-
ment Centers. The Detection Centers are open, free of charge, to any citizen
of the state without regard to race, color, creed, or economic status. The
only limitation for admission to the Centers is the age limit (35 years of age
or older for women and 40 years of age or older for men). (A person of any
age is accepted at a physicians' request — or if one of the seven danger signals
is present.) Due to the relatively few physicians in the state, compared to
the total population, some limitation was necessary; and it was agreed to
limit the clinics to the age group where cancer most frequently occurs.

The detection examination is limited to the five areas of the body where
cancer most commonly develops and is more easily detected at an early stage:
the skin, mouth, breast, genitalia, and rectum. It is believed that this
limited examination will probably reveal 90 per cent of the cancers that are
detectable in an early stage, and will reveal more cancers per clinician than
a complete physical examination and at a much lower cost to the State.

No treatment is carried out in the Cancer Centers. All examinees in the
Detection Centers, who are found to have a benign condition, are referred
directly to their personal physicians. All suspicious lesions are refrred to
the Diagnostic-Management Center (when one is immediately available) for
consultation by the six specialists (a pathologist, radiologist, internist, sur-
geon, gynecologist, and dermatologist) who staff the clinic. These examinees
are then referred to their physicians with a report of the findings of this
group and their recommendations for treatment and management. Where
a Detection Center, only, is held, the examinees are given their choice of going
to the nearest Diagnostic-Management Center for further examination or
directly to their family physician.

The staffs of the Diagnostic-Management Centers see only patients referred
from the Detection Centers with potentially malignant lesions, or patients of
any age who have one of the seven danger signals, or who have been referred
by a physician.

Biopsies are made of all superficial lesions when, in the opinion of the staff,
they are indicated and when the biopsy does not result in total extirpation of

North Carolina Board of Health 181

the lesion. Patients, who require dilatation and curettage for biopsy, or biopsy
of a breast tumor, etc., are referred to their personal physicians, or to a hos-
pital service, if they are indigent.

All furniture, equipment, instruments, and supplies necessary for the
operation of the Cancer Centers are supplied by the State Board of Health.
An honorarium is sent at quarterly intervals to each physician serving on
the Center Staffs ($50.00 per month to the Medical Director of a Detection
& Diagnostic Center, $25.00 per month to the Medical Director of a Detection
Center, only; $2.00 per examinee to the D-C examiners, and $5.00 per session
to the Diagnostic-Management staffs). Diagnostic x-rays and laboratory
work are paid for in accordance with a fee schedule approved by the Cancer
Committee of the State Medical Society. Center clerks and supervising nurses
are compensated for their services in keeping with salaries paid in the locality
of the clinic. Volunteer receptionists and nurses' aides are furnished by local
women's organizations and the American Cancer Society.

A total of thirteen such clinics have been established in this state since
the Cancer Section was organized in March, 1948. However, two Centers
suspended operations during the biennium; and at present the following
eleven clinics are in operation:

Detection & Diagnostic-Management Centers

Buncombe County Cancer Center Guilford County Cancer Center

Asheville Greensboro

Durham-Orange Counties Cancer Cen- New Hanover County Cancer Center
ter, Durham Wilmington

Edgecombe-Nash Counties Cancer Wayne County Cancer Center

Center, Rocky Mount Goldsboro

Detection Centers Only

Alamance-Caswell Counties Cancer Northeastern Carolina Cancer Center
Center, Burlington Elizabeth City

Halifax County Cancer Center Wilkes-Alleghany Counties Cancer

Halifax Center, Wilkesboro

Jackson-Swain Counties Cancer Cen-
ter, Sylva

Five of the Cancer Centers are located in hospitals, and the remaining six
are in Health Departments.

A representative of the American College of Surgeons inspected the Cancer
Centers during 1951 and certified each for approval by that Board.

In addition to the routine detection examination, Papanicolaou smears are
taken routinely on all female examinees seen in the Centers at Rocky Mount,
Wilmington, Goldsboro, Durham, Halifax, Greensboro, and Burlington. This
service will be expanded to include the other four Centers whenever the
Laboratory of Hygiene is able to obtain more personnel trained in this pro-
cedure. During this biennium a total of 9,931 smears were studied. Of this
number 131 were reported as positive and 214 were suspicious.

During the two-year period covered in this report, a total of 19,217 detection
examinations were made. Of this number 4,959 were referred to the Diag-
nostic-Management Centers and ultimately to their physicians for treatment,

182 Thirty-Fourth Biennial Report

and 9,209 were referred directly from the Detection Centers to their physi-
cians. 2,066 biopsies were taken in the Centers and 145 diagnostic x-rays
were made. Recommendations to practicing physicians included suggestions
that 454 biopsies be made, 260 D & C's be performed, 2,475 other operative
procedures be done, that 162 cases receive x-ray therapy, and that 260 diag-
nostic x-rays be done.

The Gastric Cancer Detection Mobile which is equipped with a Schmidt-
Helm camera designed for making 70 mm. films of the stomach and esophagus
in an effort to detect early stomach cancer has been in operation constantly
during the past two years. This service is available to citizens 35 years of
age or older and to those of any age upon referral by their personal physicians.
The unit is moved over the state at the request of local Medical Societies and
was located in Durham, Wilmington, Halifax, and Raleigh during the bien-
nium. A total of 7,614 individuals received this service during that period.
The total number of persons x-rayed on this unit since it began operation in
March, 1950, is now nearing the 10,000 mark. "When this number has been
reached, a study of the findings will be made by the radiologists participating
in this phase of the program in an effort to evaluate this experiment in mass
screening.

Early in 1950 a program for the care of Indigent Cancer Patients was inau-
gurated. The State Legislature in 1949 made this program possible by
appropriating $50,000 for each year of the biennium for this purpose. (No
part of the Federal appropriation can be used for the treatment of cancer. )
The 1951 Legislature continued this appropriation. Due to the time neces-
sary for working out the details of such a program and placing it in operation,
$21,668.08 of the initial appropriation for the fiscal year 1949-50 had not been
used by July 1, 1950. However, this money was made available by the Budget
Bureau for use in the year 1950-51. Also, during the fiscal year 1951-52 an
additional sum of $40,000 was reallocated from the regular State Cancer
appropriation to this treatment program.

Due to the relatively small amount of money available for this program,
the plan has been limited to cases offering a hope for cure or arrest of the
disease, and does not cover terminal cases. Hospitalization for any one person
is limited to thirty days in any one year. The participating hospitals are
paid on the basis of Cost Analysis Statements submitted to and approved by
the State Board of Health. Surgery and x-ray and radium therapy are paid
for in accordance with a fee schedule prepared by a Sub-Committee of the
Cancer Committee of the North Carolina State Medical Society.

At present more than 50 hospitals in the state are participating in the
program for the care of these medically indigent cancer cases. During the
period from July 1, 1950, through June 30, 1952, 864 persons were cared for
under this program. $154,393.87 was paid to hospitals and physicians tor this
service.

On July 1, 1951, Federal funds were made available for hospitalization (not
to exceed a period of three days) for diagnosis of possible cancer in the med-
ically indigent. Applicants for this service also must be Welfare certified,
and, in the opinion of tne attending physician, have a condition strongly
suspicious of malignancy. Hospitalization of these cases is also paid on the
basis of a Cost Analysis Statement, and no payments are made to physicians.

North Carolina Board of Health 183

153 cases were authorized for this service during the year at a cost of
$4,037.95.

Short courses in cancer are being paid for for public health nurses at
Chapel Hill.

Nutrition Section

The Section has been gratified by the increasing demands for nutrition
consultant service from all sections of the state during the past two years.
Demands have come from a greater number of agencies and organizations
than at any time since the service came into existence in 1943. The types of
assistance requested have been more varied and there has been more success
in incorporating nutrition into the generalized public health program. The
change in this state followed the national trend since there is a growing rec-
ognition among health authorities of the increasing importance of nutrition
on the degree of health to be attained and maintained by human beings.
There is evidence of an awareness of the "subtle effects of nutrition upon the
resistance to infectious diseases'1 and its important role in the chronic and
degenerative diseases. The reduction of the incidence of infectious diseases,
and the disabling effects of chronic and degenerative diseases may be expected
to benefit the total economy and well-being of the nation. In this, nutrition
is playing and will continue to play an important part.

Nutrition services rendered by the Nutrition Section of the State Board
of Health are unique. The emphasis in public health nutrition is toward
assistance to mothers and infants, children, adults, and persons in the older
age groups through helping all of these people to develop food practices
which will improve health and decrease or prevent illness. An especial
effort has been made to reach groups which would not be reached by any
other agency or organization. There is no duplication with the extension
work of State College, with the Department of Agriculture, with the School
Lunch Program, or with any other state or private agency carrying on nutri-
tion activities. The service was planned, from the beginning, to complement
the work of other services within the state.

The Nutrition Section continues to function on the basis of requests for
service from the local health departments. During the biennium, nutrition
services have been offered in 64 counties and in the 3 city Health Departments
of the State. It continues to be impossible to meet the demands of the local
departments with the amount of staff available. The major criticism of the
service has been its inability to work with all of the local health departments
requesting service; to work with them at the time they wish the assistance;
and to work with them for as long a period of time as needed. The division
of a consultant's time in a twelve to thirteen county district has not been
satisfactory to any one of the counties. The small number of consultants
available to work with the health departments, therefore, has limited the
extent to which local health departments have been able to develop this part
of their program which is recognized as being basic to all public health
practices.

The objectives set up by the Section are indicative of the broad service and
long-range plan which is being developed:

^American Journal of Public Health, 1952, 42 :860)

184 Thirty-Fourth Biennial Report

1. Joint planning, consultation and participation with other members of
the staff of the State Board of Health for the nutrition component of
each program, such as premature, crippled children, maternal and child
health, tuberculosis, mental health, heart, health education, cancer, in-
dustrial hygiene, sanitation and others in which nutrition is an integral
part.

2. Provision of consultation service to such agencies as local health de-
partments, welfare departments, institutions and other official agencies
desirous of raising the quality of nutrition services.

3. Provision of Training:

a. To assist other professional workers in raising the quality of educa-
tion in nutrition and its application throughout the State.

b. For the inclusion of nutrition in the staff education program pro-
moted by the State Board of Health and for the formal training of
nutritionists.

4. Cooperation with other officials and voluntary agencies in order to co-
ordinate and promote the nutritional aspects of all health and welfare
services.

5. Studies: To initiate, promote, and participate in studies of nutrition
and subjects related to nutrition which will improve the nutritional
well-being of the people of the state.

General

The amount and kind of nutrition service requested are numerous and are
frequently of an insistent nature. The explanation for this increased demand
of services may be due — in part, to the growing recognition of the role nutri-
tion plays in preventing some of the low-grade health conditions which are
so prevalent in the United States. There is far less concern about severe
deficiency diseases as a result of starvation and more concern about the part
nutrition plays in such diseases as tuberculosis; diabetes; obesity; heart
diseases and others. A genuine aprpeciation of the importance of the quality
and quantity of the nutrients in relation to maintaining the human body
in a state of good health is of greater concern than ever before. A better
application of the known principles of nutrition is greatly needed. There is
much more knowledge about this science and its effect upon health than there
is evidence that this knowledge is being used properly.

Activities

The plan of work during the biennium has followed, generally, the pattern
described in preceding reports. The Section operates on a partially decen-
tralized basis, the State being divided into eight districts, with a full-time
field consultant in seven of the districts from October, 1951, to the 30th of
June, 1952. The headquarters of the nutrition field consultants are located
in a local health office in each district. The consultants' activities included
consultation services, demonstrations, participation in in-service training-
programs, clinic services and cooperation with other agencies on joint pro-
grams and projects affecting health,

A generalized consultation service was provided and specialized programs
such as those for crippled children and others were also included. The scope
of the services depended upon the needs of the local health departments.

North Carolina Board of Health 185

Consultation service to the dietary departments of the state and county
hospitals and institutions which has been available since 1948 has been ex-
tnded to the hospitals operating under the Medical Care Commission. The
dietitians assisted in the establishment of specifications for food service
equipment for state institutions; in evaluating food purchasing practices;
in providing menu guides; in giving consultation service to administrators,
diettitians and food service managers on kitchen management, adequacy of
diets, use of kitchen equipment; and in cooperating in food handlers' courses.

Stipends were provided to two well qualified candidates, and on the comple-
tion of their studies they have been employed as members of the field staff.

The usual consultation services have included continuation of the follow-
ing:

1. Nurses No. Group

Conferences Attendance

(a) Staff education conferences 220 3,054

(b) Conferences with individual nurses about spe- 597
cial problems were held as requested when the
nutritionists made their periodic visits to the
health departments.

2. Clinics

(a) Groups instructed 947 21,756

(b) Individuals referred by physician or nurse 3,822

3. Studies — Dietary Surveys

(a) Surveys in schools 94 2,819

The fundamental information regarding the
food habits of people, secured by this means
was used by health officers and the nurses in
their work and by teachers for planning the
nutrition instruction which is needed in the
classroom.

4. School Health

(a) In-service training for teachers. _ 236 17,431

(b) Individual conferences for teachers 465

One of the most frequent requests made of
nutritionists, both by the health departments

and schools, was assistance in the School Health
Program. This is probably due to the increased
emphasis which has been placed on the school
health work by the local health departments.
Many health departments have realized that
improvement in the child's nutritional status
would affect his general health and help prevent
some of the defects which develop during school
years that may be either directly or indirectly
traced to under-nutrition. The in-service train-
ing program has been the only possible means
of giving assistance to a large number of teach-

186 Thirty-Fourth Biennial Report

ers with so small a staff of trained nutritionists.
Many teachers in the upper grades requested
help in animal feeding experiments, since this
work needs the assistance of a person trained
in experimental animal work.

5. Hospitals and Institutions

(a) Consultation service 88

(b) Review of construction plans 129

(d) Food Handler's courses 20

Special Services:

Through joint planning with consultants within the division and with
Supervisors and Consultants in other divisions and agencies the following
types of services were given upon request:

(1) Attendance and participation of nutritionists in monthly orthopedic
clinics.

(2) Planning for and supervising food service at the Crippled Children's
camps. Instruction to the children attending camp about food as it is
related to health.

(3) Participation of the nutritionist as a consultant in the Premature In-
stitutes being conducted periodically at Duke University and in the
Institutes held throughout the state.

(4) Participation each week in the Well-Child conferences held in Chapel
Hill as a part of the special demonstration program conducted coopera-
tively by the MCH training program of the School of Public Health and
the District Health Department and the State Board of Health.

(5) Participation in Food Handling Courses conducted by the local health
departments and the Division of Sanitary Engineering of the State
Board of Health.

(6) Participation in the school lunch workshops for lunchroom managers
and workers conducted by the School Lunch Program of the Department
of Public Instruction.

(7) Participation in the training program for Prison Wardens conducted by
the Institute of Government.

(8) Assistance to local health departments conducting special projects such
as nutrition instruction for patients in tuberculosis sanatorium; study
programs for special adult and P. T. A. groups; training for midwives.
for workers in a Blind Industry, for residents of a Salvation Army Home
and Crittenden Home.

(9) Consultation service to welfare departments.

(10) Consultants and instructors to Health Education and Resource Use
Workshops for teachers held during the summers at the (a) University
of North Carolina, (b) North Carolina College, (c) Catawba College,
(d) Western State Teachers College, (e) East Carolina College, (f)
and for the Prenatal and Premature Institutes for Nurses.

North Carolina Board of Health 187

(11) Consultants to the state-wide Workshop for Vocational Home Economics
teachers conducted at Chapel Hill.

(12) Participation in a training program for the mothers of blind children
who were entering the State School for the Blind in Raleigh.

(13) Participation in the training of student Tuberculosis Technicians.

(14) Participation in the work of the Food and Nutrition Advisory Commit-
tee of the State Civil Defense Program, and in the preparation of the
state manuals for Mass Feeding and the manuals for the Training of
Workers for Emergency Mass Feeding Operations.

Training Program •

Provision has been made by the Nutrition Section for the services of a
nutritionist to be assigned to the special MCH training program at Chapel
Hill. A nutritionist was employed in this position until June, 1951. Until
this vacancy can be filled a district field consultant is providing part-time
service for this program.

Supervised field experience tor graduate students in public health nutrition
has been provided for students from the following educational institutions:
two from the School of Public Health, University of North Carolina; one
from the School of Public Health, University of Michigan; and one from Sim-
mons College, and the Harvard School of Public Health.

Assistance is given to other Divisions and Sections in the field training of
nurses, health educators, sanitarians and physicians.

Conclusion :

Nutrition is one of the more recent additions to the Public Health services
fo rthe maintenance of good health of populations groups and the prevention
of disease and suboptimal health. Food is an important factor in the sup-
port of all living things, and of no less importance is its effect upon the health
of all of the tissues, fluids and structures of the human body. Unfortunately,
human beings are so influenced by many environmental factors that they
cannot instinctively secure the kind of food which will promote good health
without guidance and assistance.

The amount of scientific information about the effect of diet upon health
is voluminous. The application of sound information is extremely limited.
The potentialities of the people of North Carolina and the contribution they
can make to the state can never be realized until the most important asset,
health, is available to every individual. The daily application of good nutri-
tion practices by every man, woman and child is basic to good health and one
of the simplest and least expensive means of attaining it. Good nutrition
practices should be possible in a state capable of producing an abundance of
food for its people.

The greatest handicap to be overcome is the widespread lack of understand-
ing of the role of nutrition in health. A beginning has been made in breaking
down some of the prejudices and malpractices which have been common for
many years. The extent to which these can be overcome and the length of
time necessary to achieve a good nutritional status for North Carolinians is

188 Thirty-Fourth Biennial Report

dependent upon the interest of the state in supplying the means to bring
this about. At the present time, the stringent limitations imposed by the
state budget upon the nutrition improvement programs of the Health Depart-
ment is reflected in the small amount of assistance which can be provided to
help improve the health of the citizens of the state. This improvement will
be realized only when more people of the state are able to secure the nutrition
services offered by the State Health Department.

BIENNIAL REPORT HEALTH PUBLICATIONS INSTITUTE
(July 1, 1950— June 30, 1952)

Although an indpendent, non-piofit corporation, Health Publications Insti-
tute, formerly known as Venereal Disease Education Institute, is closely
affiliated with the State Board of Health. The State of North Carolina makes
no appropriation whatsoever to the budget of the Institute except to provide
quarters in the Old Armory Building. In exchange for these quarters, the
Institute makes available a minimum of $5,000 worth of its educational mate-
rials and staff services to the State Board of Health without charge.

The capital funds of the Institute have been provided by grants from the
Z. Smith Reynolds Foundation. Current operating expenses are derived from
the sales of its education materials and services. The State Health Officer
is a member of its board of directors and its executive committee.

What the Institute Does

1. The Institute develops, produces, publishes and distributes visual aids
which are required by people engaged in every aspect of health work, such
as books, leaflets, pamphlets, posters, displays, motion pictures, filmstrips.
and advertising materials.

2. A professional creative service such as writing, artwork, layout, and
consultation is available for the use of health departments and related
health agencies requiring such services.

3. Research and evaluation projects in all aspects of health education mate-
rials are carried on, not only to the end that its own materials may be
adequately tested but independently for other health departments and
agencies.

Although charged for to an extent that will make them financially self-
supporting, these services are made available on a non-profit basis.

Accomplishments During the Biennium

Outstanding accomplishments during the biennium include the following:

1. During this period the Institute continued to operate on a financially
self-sustaining basis without the aid of any financial subsidy of any kind.
Prior to June 30, 1949, the Institute had obtained financial subsidies from
the Public Health Service and the Z. Smith Reynolds Foundation.

2. During the biennium the Institute produced more than 50 new health
publications, its total number of titles now numbering 300.

3. Health agencies everywhere use Institute materials more extensively
than ever before, as indicated by the fact that more than 5,000,000 copies
were purchased by more than 13,000 purchasers in every state and 22 for-
eign countries.

4. Increasingly the Institute is becoming a publisher of the proceedings of
health and medical meetings. Notable examples: The Midcentury White
House Conference on Children and Youth, the National Conference on
Chronic Illness, The National Conference on Aging, and The National
Conference of Social Work.

This item circulates for a 4-week period and is
due on the last date stamped below. It may be
renewed for one additional 4-week period. The
fine for late return is 50C day.

7-304 Rev. 6/94

H0011

217

WA
1

N862b

1950

-52

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