Full text of "The Health bulletin [serial]"

HEALTH SCIENCES LIBRARY

OF THE

UNIVERSITY OF NORTH CAROLINA

This book must' not
be token from the
Library building.

Form No. 471

Publi5\edb4 TAZ>^9RmCAK9LI/^A 5TXrL5?AKDs^Am.Un

Thi5 £iullelir\willbe -serxt free to qatj dtizen of ihe State uporyrequest j

Entered as second-class matter at Postofflce at Raleigh, N. C, under Act of July 16, 1891}.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.

Vol. XXXIV

JULY, 1919

No. 7

A Law of Moses, Judge of Israel;
About 1491 B. C.

"Thou shalt have a place also with-
out the camp, whither thou shalt go
forth abroad:

"And thou shalt have a paddle upon
thy weapon; and it shall be, when
thou wilt ease thyself abroad, thou
shalt dig therewith, and shalt turn
back and cover that which cometh
from thee."— Deut. 23: 12-13.

A Law of the State of North Caro-
lina, Enacted A. D. 1919.

1. "Every residence located within
three hundred yards of another resi-
dence must have an improved privy
of a type approved by the State Board
of Health."

TABLE OF CONTENTS

Page

Introduction 2

The State-wide Privy Law Explained 3

Sanitary Principles of the Construction of Privies 5

Types of Improved Privies 8

Plans and Specifications for Approved Privies 15

Summary of Rules for Maintenance of Different Types of Privies 26

Economics of Privy Construction and Maintenance 31

Machinery and Methods for Enforcing the Law 31

INTRODUCTION

By A. J. AVabben,
Assistant Secretary, State Board of Health

This July issue of the Health Bulletin covers in the most
practical manner the largest single factor that is impeding the
progress of health work in N'orth Carolina and that confronts
her citizens today — the disposal of human excreta.

Kealizing this fact and being willing to meet, like true men
should, their responsibility, the last General Assembly passed
an act requiring every home within three hundred yards of
another home to have an improved type of privy that the State
Board of Health would approve. The questions immediately
arise, "What type will the State Board of Health approve, and
what type shall I install?" This Bulletin answers both ques-
tions. The information set forth in this Bulletin is not influ-
enced by a prejudice against nor preference for any particular
type of privy, but each type is dealt with in detail and both the
advantages and disadvantages, together with the comparative
costs given, as each particular type warrants.

The substance of this Bulletin was not compiled until an ex-
haustive study of the various types of privies in use in the
various sections of the country had been made. Each type
was studied not from its theoretical application alone, but in
actual use as well.

We present this Bulletin as the most complete study that has
yet been made public relative to the practical application of
the various types of privies now in use.

The technical matter in this Bulletin was prepared by H. E.
Miller, C.E., Director of the Bureau of Engineering and Inspec-
tion of the State Board of Health, and past assistant surgeon
K. E. Miller of the United States Public Health Service.

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[£j| | PUBLI5AE.D BY TMEL HPR-TM CAgQUhA 5TATL BQMgP 6>^MEALTM I B

VOL. XXXIV

JULY, 1919

No. 7

THE STATE-WIDE PRIVY LAW EXPLAINED

1. Object

The Governor of the State, in his
message to the last General Assem-
bly, said, "A general law should be
enacted making it compulsory for the
owner of property on which a privy
is located within three hundred yards
of the dwelling house of any other
person, to maintain a sanitary privy
in accordance with plans and specifi-
cations approved by the State Board
of Health."

The State Board of Health drafted
and recommended to the General As-
sembly the passage of such an act,
which is explained in this article.

In advocating such a course, both
the highest executive official of the
State and the State Board of Health
had but one object in view — the pre-
vention of human suffering and dis-
tress from preventable diseases, and
the saving of human lives.

2. Meaning and Scope

When reduced from legal terms to
plain English, the law simply means
that the open back surface privy will
no longer meet the requirements and
demands of modern civilization; and
it must be remodeled and converted
into a sanitary type that the State
Board of Health approves. The
term "privy" as used in the act in-
cludes every type of disposal system,
except sewer connections and septic
tanks of a type approved by the State
Board of Health, that is located with-
in three hundred yards of another
residence.

The danger of any open, insanitary
privy is in proportion to the size of
the population to which it is related
by either the fly or water route. An
open back privy in a town or city
block is within fly range, that is,
three hundred yards, of from sixteen
to twenty homes with a total popula-
tion of from ninety to one hundred
and twenty people. An open back
privy in the average rural district is
in three hundred yards of one home
of from five to seven people. The
open privy in the country districts
usually affects only the owner, who is
responsible for his own surroundings,
whereas the open privy in the city
or town affects other people who are
in no way responsible for it and have
no control over it. The enforcement
of the act will protect these defense-
less homes against typhoid fever, dys-
entery, and other "privy-filth" dis-
eases. In the strictly rural districts
of North Carolina, there is one case
of typhoid fever per thousand per
year, whereas in the unsewered city,
town, village or suburban section
there are from five to six cases of
typhoid per thousand population
yearly.

The responsibility for the sanitary
maintenance of the privy is definitely
fixed as falling upon the head of a
family or household, the proprietor
of a boarding-house, hotel, restaurant,
or store, the principal or superintend-
ent of a school, the agent or station-
master of a railroad station or depot,
or the person in charge of an office

The Health Bulletin

building, establishment, or institution.
Any of the above named parties who
permits a privy other than a sani-
tary privy to be used by his or her
household, guests, customers, pupils,
passengers, occupants, employees,
workers, or other persons, will be
guilty of a misdemeanor and subject
to prosecution.

The North Carolina State Board of
Health, through its officers and in-
spectors, will supervise the construc-
tion and maintenance of all privies
coming under the jurisdiction of this
act. This will be done by dividing
the State into ten sanitary districts of
ten counties each, and a sanitary in-
spector will be placed in charge of
each district. These ten sanitary in-
spectors will be under the direct su-
pervision of an experienced sanitary
engineer, the chief of the Bureau of
Sanitary Engineering and Inspection.
All types of privies built must be ap-
proved by this bureau.

Whenever an inspector of the State
Board of Health shall find a privy lo-
cated within three hundred yards of
the residence of a person other than
that of the owner or tenant thereof,
which is not constructed according to
the specifications of the Bureau of
Sanitary Engineering and Inspection,
he shall fasten on such privy a notice
reading "Insanitary; unlawful to
use," and the use of a privy so pla-
carded will be a misdemeanor. Or if
a privy be constructed according to
specifications, but is not being prop-
erly maintained, it will be placarded
the same as one not properly con-
structed. When a privy is found to
be properly consti'ucted and main-
tained, the inspector will attach there-
on a license tag permitting its use, and
also instructions for the proper main-
tenance of the privy.

At the time of the inspection, the
owner of each privy shall pay to the
officer or inspector a license fee of
forty cents, for which the inspector is
required to issue a receipt. This li-

cense fee is to be used to defray the
expenses incurred by the State in the
enforcement of this act.

Cities that have a population in
excess of twenty thousand will be ex-
empted from the requirements of the
act if the city officially requests the
State Board of Health to exempt it
from its provisions before the first of
October, 1919.

The Necessity for Such An Act

The swallowing of human excre-
ment causes 2,000 deaths and 34,000
cases of sickness in North Carolina
every year, as is shown by the follow-
ing figures:

Deaths from —

Typhoid 502

Dysentery 604

Diarrheal diseases of infants . . 875

Total 1,981

Cases of sickness —

Typhoid 5,020

Dysentery 12,080

Diarrheal diseases of infants.. 17,350

Total 34,450

It is true that all of the above list
of diseases did not have their sole
origin from the open privy. And it is
also true that after the State has
been sanitated there will continue to
be sporadic cases of diseases of fecal
origin. But it is quite certain that
the open back privy is the chief source
of propagation for the fecal-borne dis-
eases in North Carolina. It is also
quite certain that the enforcement of
this sanitary law will greatly reduce
this number of both deaths and cases
of sickness. And it is a singular fact
noted by sanitarians that wherever
the sanitary conditions are so im-
proved as to render the fecal-borne
diseases of minor consequence, the
general health of the community rela-
tive to the other diseases improves
also, and the total death rate is ma-
terially lowered.

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Let us assume that we prevent
only 18 per cent of deaths and sick-
ness now due to fecal-borne diseases
(an extremely conservative estimate)
by enforcing the sanitary privy law.
We would then prevent 365 deaths,
one for each day in the year, and the
occurrence of 63,000 cases of sickness.
If the 365 lives saved are worth $1,-
000 each, we shall have saved $365,-
000 worth of human economic value.
And if the 63,000 cases of sickness

cost in doctors' bills, druggists' bills,
nurses, time lost from labor, etc., $30
apiece, we shall have saved an addi-
tional $189,000; a total saving of
$554,000 for the State. The question
is simply this: Shall you pay to the
State an annual inspection tax of 40c,
or shair the State lose annually in hu-
man economic values $554,000?

A copy of the law will be sent to
any person desiring it, upon request.

(Signed) A. J. W.

SANITARY PRINCIPLES OF THE CONSTRUCTION OF PRIVIES

It is only in recent years that we
have come to a truer and more
thorough understanding of the mean-
ing of sanitation and its life-saving
principles. More recent still is the
application of these principles in a
wholesale manner to the daily life of
the citizens of a community, to pre-
vent the spread of disease.

Typhoid fever, dysentery, diar-
rhea, summer complaint, and certain
other diseases have been proven to
have their origin in human filth. That
is, in plain English, any person who

contracts one of these diseases has
either eaten or drunk the body waste
of some one else who had the disease.
Repulsive as this may seem, it is
nevertheless a daily occurrence in the
majority of our homes, especially
during the warm months, and it must
be so as long as the insanitary privy
remains in any community, as will be
shown below. There is, therefore, no
more simple and far reaching phase
of sanitation than that dealing with
the reduction of disease by means of
sanitary construction and mainte-

FiG. 1. North Carolina's battlefield. A battery of the enemy's automatic rapid-firing guns
Their firing range is at least 300 yards, and they are a particularly deadly weapon tor the
reason that they shoot in all directions with equal effectiveness.

The Health Bulletin

nance of the privy, from which, or the
lack of which, practically all fecal
borne disease has its origin. It was
with a full realization of this fact
that the people of North Carolina,
through their representatives, the
members of the General Assembly,
put themselves on record as desirous
of protecting themselves and their
neighbors from the ravages of fecal
borne diseases, by passing a law in
February, 1919, entitled, "An Act to

and dysentery, when we eat vege-
tables contaminated with human
filth, when our wells and springs are
polluted with it, and when the food
upon our tables is accessible to flies
that were bred and bathed in the hu-
man excreta of our own family or of
diseased neighbors. Therefore, the
open surface privy, which violates
every law of sanitation, is a nefarious
institution in any community, and
must be entirely eliminated.

Fig. 2. A backyard "bum" planted and ready for destruction of the occupants of the
home.' This open surface privy is less than 10 feet from a surface drinking-water supply.
It is perhaps the source of constant pollution of the drinking-water in this case.

Prevent the Spread of Disease from
Insanitary Privies."

What constitutes an insanitary
privy ? It is best exemplified by the
open surface privy, which is very
commonly used in our State. In this
type of privy, which is usually open
in back from the seat to the ground,
the excreta is deposited upon the sur-
face of the ground, where it can be
reached and scattered about by flies,
birds, domestic fowls and animals,
and with every rain may be washed
into the open well or spring, or into
the adjoining garden, where vege-
tables become contaminated with the
human filth. It is little wonder, then,
that we have typhoid fever, diarrhea

On the other hand, a properly con-
structed privy is one in which there
is a vault, pail, or tank which re-
ceives and retains the excreta until
properly disposed of. This receptacle
should be surrounded and protected
by fly-tight walls. Self-closing lids
should always be provided, and kept
closed, in order to keep the flies en-
tirely away from the filth. In addi-
tion, due regard must be paid to the
protection of drinking water supplies
from contamination, either by water-
proof receptacles, or by locating at
such distance from the water supply,
and down slope from the same, so
that the dangers from seepage and
drainage will be done away with.

The Health Bulletin

oo'^/t?-" 3-, -Cause and effect— the open surface privy and near-by cemetery. Disreputable

A discussion of each individual type
of privy will be entered into in the
succeeding articles.

From the foregoing, one is prompt-
ly convinced of the simplicity of the
principles involved in sanitary privy
construction. But, while simple, they
admit of no compromise. In addition,

another factor quite as important as
construction is that of proper main-
tenance, without which no privy will
pass the inspection of the State Board
of Health. Specific directions will be
given along v/ith the discussion of the
various types of privies that may be
used.

fr.I-^S'J',-'^^^- effect of winds, etc., on open surface privy filtli. Soiled toilet paper was
found floating in this tank, having been blown in from the near-by privies.

The Health Bulletin

TYPES OF IMPROVED PRIVIES

Advantages and Disadvantages of
Each

In order to assist the individual in
the choice of the privy which he shall
install, a discussion is here givlen
covering each of the several types of
improved privies. It will be seen
that no one of them has a field of
universal application. Each type has
its limitations, and likewise each type
has features which would especially
recommend it, all depending upon the
conditions existing in each case where
the installation is to be made. But,
by virtue of the several types of im-
proved privies from which one has to
chose, there is no condition that may
arise, so far as we can see, that can-
not be satisfactorily met and disposed
of.

The types of improved privies are
as follows:

1. Earth pit.

2. The box and can,

3. Tank construction employing the
L. R. S, principle,

4. Chemical privies.

5. The double compartment con-
crete vault.

6. Miscellaneous.

The Earth Pit

By all means, the simplest of all
improved privy types is that of the
dry earth pit. Humble as it is, the
principle upon which it is operated
enjoys the distinction of being in-
cluded among the rules laid down by
Moses, the great giver of the law.
The reference is found in Deuter-
onomy, chapter 23, verses 12 and 13,
which is here quoted as follows:

"Thou shalt have a place also with-
out the camp, whither thou shalt go
forth abroad: And thou shalt have a
paddle upon thy weapon; and it shall
be, when thou wilt ease thyself
abroad, thou shalt dig therewith, and
shalt turn back and cover that which
Cometh from thee."

The principle here involved is the
immediate burial of the waste mat-
ter from the human body, which is in
effect what is accomplished in a prop-
erly constructed and properly oper-
ated earth pit privy.

Advantages

1. It is the cheapest of all types.
When the task in hand is merely one
of reconstruction of an existing in-
sanitary privy to make it correspond
to the specifications for an approved
pit privy, the expense for materials is
small.

2. It possesses many of the quali-
ties of a fool-proof privy. It cannot
be too often reiterated that the con-
struction of a privy is no more than
half the task to be performed. The
other half is maintenance. Certain
types require very intelligent super-
vision, and lots of it, and without this
their purpose may not only be de-
feated, but they may become public
nuisances. This is particularly true
of the box and can privy. When once
properly located and constructed, the
earth pit requires little attention be-
yond occasional removals to new pits,
and it will give effective service even
among ignorant and careless classes.

3. It may be quickly installed, and
is frequently used in cases of emer-
gency, or during the interim while
higher types of waste disposal sys-
tems are under contemplation or un-
der construction. In fact, this is the
chief purpose for which they can
properly be considered in towns and
villages.

Disadvantages
1. The earth pit privy is the only
type particularly influenced by geolo-
gical conditions. In most places in
the State of North Carolina the pit
may be used with safety, but there
are some places where it may be
used only with caution or not at all.
(a) In limestone regions where the
stratified rock comes as close as ten
feet from the surface. The danger
is particularly great in cases where

The Health Bulletin

the rock strata are tilted. Due to
this fact, one is often deceived, and
in locating the privy down slope from
his well it sometimes happens that
an arrangement is effected by which
the privy filth may reach the well
directly by traveling along sheets of
rock that are tilted opposite to the
slope of the surface earth. It is,
therefore, essential to notice not only
the surface slope, but the slope of the
sub-surface rock strata as well, (b)
Another type of earth in which pit
privies may not be suitable is very
low, swampy lands where the ground
water level is very high. The danger
here is that of overflowing at certain
seasons of the year, due to an excess
of ground water. Bear in mind, how-
ever, that water in a pit is no great
disadvantage, so long as there is no
danger of overflowing. But, due to
the presence of water, there is fre-
quently copious mosquito breeding in
the earth pit. This may be the source
of considerable annoyance, but is of
no danger to health, as the malaria-
bearing mosquito rarely, if ever,
breeds in such a place. The difficulty
is easily remedied by pouring in a
half cupful of kerosene once each
week during the months from April
to October.

2. Judgment must be exercised in
the location of the earth pit with re-
spect to any well or spring. In no in-
stance is it permissible except when
located down slope from the water
supply. Although the limit of safety
will differ in different soils, the State
Board of Health will not approve any
earth pit privy that does not conform
to certain requirements as to loca-
tion. (See specifications.)

3. There is no provision for dis-
posal of filth except burial on the
spot where the building is located.
When the pit fills to its capacity, a
new pit must be dug and the building
moved and placed over it. The inter-
vals when this must be done vary in
such wide limits that no reliable

statement can be made on this point,
but it is safe to say that this is of-
tener than desirable.

In towns and villages there are
considerable disadvantages connected
with the use of the earth pit. (a)
There is great difficulty usually in
finding sufficient space to permit of
the location of the pit the required
distance from a water supply, (b)
It is more than possible that the con-
gestion of a great number of privies
into a small area will result in a su-
persaturation of the soil to a point
where the whole water table will be
endangered.

4. Although the pit privy is the
most primitive method of waste dis-
posal, it is likewise the crudest of all
allowable types. It is the first step
toward safe disposal of human waste
matter, but is not held up as the ulti-
mate and unqualified solution of the
problem.

The Box and Can Privy

The box and can privy collects all
the privy filth in a water-tight recep-
tacle which is inclosed inside a fly-
tight compartment. Thus it admir-
ably satisfies the two principles of
sanitary privy construction. But in
its practical operation it is found,
like all other types, to have its ad-
vantages and disadvantages.

Advantages.

Certain of these are similar to
those of the pit privy.

1. Next to the pit privy, it is the
cheapest to install, and as regards
rapidity of installation it excels all
others. When the boxes are supplied
ready for installation a carpenter can
install from 8 to 12 in a day.

2. This type is especially suitable
to towns and villages having as many
as 300 homes to serve. A community
of this kind can be quickly and cheap-
ly supplied with sanitary privies by
handling the job on a wholesale plan.
Some one takes the contract to build

The Health Bulletin

the required number of boxes at a
minimum figure. A carpenter is then
employed by the job or piece to do the
installations. In this way, uniform
work is accomplished throughout, and
the cost to the individual is reduced
to the lowest terms. (Illustration,
Quantity Production of Boxes.)

3. As with the pit privy, any build-
ing in good repair that will afford
adequate shelter from storms and
rain may be utilized in which to in-
stall it.

4. The box and can may be used in
all places without regard to geologi-

week. In practice, it is found that
where this duty is to be performed
by the user of the privy it is almost
al.,ays neglected, resulting in over-
flowing of the can and consequently
highly insanitary conditions. In gen-
eral, it may be said that a well organ-
ized and operated scavenger service is
absolutely essential to the success of
the box and can privy. For this rea-
son, the State Board of Health will
consider the box and can plus a satis-
factory scavenger service as an insep-
arable sanitary unit. The failure of
either portion of the unit will bring

Fig. 5. Quantity production of boxes for box and can privies

cal conditions or nearness to water
supplies, though, of course, one v/ould
naturally avoid any unnecessary near-
ness to the source of drinking water.

Disadvantages

1. Its capacity is very limited. The
can holds only about nine gallons, and
is therefore sufncient to serve the
average family only about one week.
On this account the box and can privy
is not advisable for general adoption,
since the average man does not like to
go to the trouble of removing the can
and burying the contents once each

condemnation upon the whole unit.
Those contemplating such installa-
tions, therefore, should do so with
great caution, as they will be under
the constant liability of having to
adopt some other more satisfactory
system. The box-and-can-scavenger
system, at best, is only a makeshift.

Such a scavenger service as men-
tioned above can hardly be expected
in a community of less than 300
homes. In order to be effective, the
scavenger service must visit each
px'ivy regularly once each week.

The Health Bulletin

Practice has shown that the only sat-
isfactory way to operate such a ser-
vice is by means of cans belonging,
not to the individual, but to the town
or village, as otherwise a hopeless
confusion would result from mis-
placing of cans. The scavenger man
starts out on his rounds with a load
of clean cans, which he exchanges as
he goes for those containing privy
filth. Having completed the exchange,
he hauls the load of filled cans to a
proper disposal station, where they
are emptied, washed, and treated
with a disinfectant solution, rendering
them ready for use again.

2. It will be seen from the above
description of the scavenger service
necessary to operate a box and can
system that it is a matter involving
a continuous expense. This item
varies greatly in different localities,
from $1.25 a quarter up to $3.00 a
quarter for each privy. At the pres-
ent cost of labor and equipment it is
very unlikely that the work could be
undertaken for less than $1.75 to
$2.00 a quarter in any locality in the
State.

3. The privy contents are more ac-
cessible to flies than in any other type
of privy. The scavenger men are
usually a careless class, and common-
ly leave the tops of the boxes improp-
erly adjusted after the weekly visits
for removal of the privy cans. Again,
the privy contents, being located in a
box having a fair amount of light in
it, are much more likely to attract
flies through small cracks, or seats in-
advertently left open, than similar
contents in the bottom of a deep, dark
pit or vault.

4. During the hot summer months
the privy filth in the cans is frequent-
ly subjected to considerable heat in
privies exposed to the sun, giving
rise to a high degree of putrefactive
fermentation, which will create very
foul odors unless great care is taken
to insure effective ventilation. Furth-
ermore, in mid-winter the privy ma-

terial sometimes freezes. This freez-
ing is not such as to burst the cans,
but adds to the difficulty of the scav-
enger in emptying them.

Tank Construction Employing the
L. R. S. Principle

The so-called L. R. S.* principle in
privy construction is based upon the
liquefying action of certain bacteria
in surroundings suitable for their
growth and activity. When fecal mat-
ter is deposited into water in certain
proportions and provision made for
suitable length of storage therein,
there is developed a growth of lique-
fying bacteria which convert the
major portion of the privy solids to
a liquid state. This principle is made
use of in various privy vault designs,
several of which are supplied to the
market by commercial concerns. As
good as any of the designs employing
this principle is . the North Carolina
privy, which is illustrated on page
23. Special mention is made of this
design for the reason that it is one
that can be duplicated by any one ex-
perienced with concrete construction,
at an expense somewhat less than re-
quired for the purchase of the com-
mercial products. The individual
should be warned, however, against
assuming that this is a trivial under-
taking. Until one is certain that he
can carry through all the details of
the work without making any mis-
takes it should best not be attempted.

The prime virtue arising from the
use of the L. R. S. or septic privies is
liquefaction of privy solids, thereby
rendering the ultimate disposal of the
privy contents much easier. All such
privy designs must provide for some
adequate drainage system to carry
the liquefied material away from the
privy and dispose of it in such a man-
ner that it will not become a nuisance

♦The term "L. R. S.", as here used, is
derived from the names of three U. S. Public
Health Service officers, Lumsden. Rucker,
and Stiles, who were the originators of this
type of privy construction.

The Health Bulletin

or in any way endanger public health
through contamination of food or
drinking water supplies. Privy filth
so treated is not purified to such an
extent that careful provisions for safe
disposal of the effluent can be over-
looked. The public should be guarded
against the arguments of ignorant or
unscrupulous salesmen who would
lead them to believe in the extreme
purifying power of privies of this
type.

The usual provisions for drainage
from septic privies consist of sub-
surface tiling with uncemented joints
to admit of underground distribution
and absorption of the liquefied mate-
rial. In soils where the absorption
is poor it may be necessary to pro-
vide a filter trench.

There is room for considerable
confusion as to the difference be-
tween a septic tank and a septic
privy. Indeed, the contention may
be raised by exponents of the septic
privy that the terms are identi-
cal. While the action is similar in
both cases, the practical operation of
them is essentially different. In the
meaning of the State Board of Health
any sewage liquefaction tank utiliz-
ing for this purpose bacterial action
and receiving its human waste mat-
ter by means of a water carriage sys-
tem will be considered a septic tank.
Such a liquefaction tank receiving
its human waste matter direct will be
considered a septic privy. It is obvi-
ous from this definition that the most
essential difference lies in the fact
that the septic tank receives an
abundance of water automatically
through flushing, while the septic
privy receives none except that which
is added at such intervals and in such
amounts as the user sees fit. Since
we have seen that certain propor-
tions of water to privy filth are neces-
sary to maintain this process in effec-
tive operation, it is plain that the
maintenance liabilities of the septic
privy are very great as compared to

the septic tank. It is for this rea-
son that this sharp distinction must
be drawn, so as to make clear the
reasons why it is imperative to in-
clude the septic privy within the pro-
visions of the state-wide privy law.

Advantages

1. All but a small portion of the
privy solids are reduced to a liquid
state, which admits of ultimate dis-
posal without handling in any way.
This is a great point in favor of this
type of construction, since no one
relishes the task of handling privy
filth. It must be remembered, how-
ever, that not all the privy solids are
eliminated. A certain small residue
remains, which settles to the bottom
and is called sludge. This gradually
collects to the point where the ef-
fectiveness of the privy is destroyed
unless the sludge be removed. Ordi-
narily this will have to be attended
to once in every three to five years.

2. The cost of maintenance is very
small, involving only the cost of toilet
paper, which is an essential, and the
cost of cleaning at long intervals.

3. It is a type of privy that can be
used in practically any soil or loca-
tion, though the location of the dis-
posal bed is governed by certain limi-
tations. (See specifications.)

4. It has the advantage of perma-
nence. It grows better with age,
rather than deteriorating.

5. In towns and villages where sew-
erage is not an economic possibility in
the near future the superiority of the
septic privy over other types can
hardly be questioned. Nowhere is
this more true than in industrial vil-
lages.

Disadvantages.

1. The first cost is comparatively
large.

2. Intelligent care is required, (a)
Water must be added regularly in or-
der to maintain an approximately
constant water level. This will re-
quire from three to five bucketfuls

The Health Bulletin

of water each week, (b) Only toilet
paper may be used in the septic privy,
as other materials will clog it up.
Special care must be taken to prevent
children and irresponsible persons
from throwing rags, sticks, cotton
waste, etc., into the tank, (c) Should
a heavy mat of privy filth form on the
surface, this must be broken up and
allowed to settle.

3. For the reasons just stated, the
septic privy is not, as a rule, suitable
for use in public places, except where
constant and strict supervision is
maintained.

Chemical Privies

All types of chemical privies on the
market are patented commercial
products, none being home-made af-
fairs. Like the septic privies, their
object is liquefaction of fecal matter
so that it may be the more easily dis-
posed of. This object is accomplished,
however, through chemical instead of
bacterial action. Generally a special
iron tank of sufficient size to allow
for storage over a considerable length
of time, six months to a year, is pro-
vided. The tank is then charged with
a certain stated amount of caustic
substance which has the power of li-
quefying fecal matter. When the
tank is filled to its capacity the
liquefied matter is removed either by
pumping out into a tank wagon or by
underground drainage into a filter
bed or cesspool.

Advantages.

1. Like the septic privy, it has the
advantage of adaptability to any loca-
tion.

2. Like the septic privy, also, it
makes ultimate disposal easy by
means of liquefaction. In this con-
nection, it has an added virtue by rea-
son of the fact that its liquefying
powers are greater than those of the
septic privy.

3. In addition to liquefaction, there
is a high degree of purification accom-
plished through the destruction of

bacteria and the eggs of intestinal
parasites.

4. A virtue possessed by this type
of privy in greater extent than in any
other type is that of deodorization.

5. The fly nuisance is reduced to a
minimum in this type of privy.

6. It seems to be particularly
adapted for use in schools, churches,
and other public places.

7. It is better suited to inside in-
stallation than any other type of
privy.

Disadvantages.

1. It is a commercial product which
cannot be home-made. This is nat-
urally a factor in increasing the first
cost.

2. In their present state, the life of
the chemical privy tanks is certainly
not' permanent.

3. The cost of maintenance is
greater than that of the septic privy,
but the trouble attached thereto is
considerably less, provided the con-
tents of the tank be carried off by
drainage.

The Double Compartment Concrete
Vault

A recent development in privy con-
struction is the double compartment
concrete vault. The principle herein
involved contemplates the action that
takes place in privy filth in the pres-
ence of some drying substance such as
dry earth or lime, when allowed to
stand for a period of three to six
months. When such drying substance
is used regularly and in sufficient
quantity, the product, after standing
for several months, is similar to well
rotted manure, and offers little or no
offensiveness in handling it. A vault
of suitable size is built (see specifica-
tions) with a partition wall dividing
it equally from front to back. Only
one compartment at a time is used,
the other being closed completely.
When one compartment becomes
filled it is closed up and the other
opened for use. The collection in the

The Health Bulletin

first is allowed to stand untouched
during the period that is consumed in
filling the second compartment. This
takes from three to six months, aver-
aging nearer three than six.

This type of construction has been
extensively employed in extra-canton-
ment zones, and while still in the ex-
•perimental stage to a certain extent,
some very good results are reported
from its use wherever it is properly
attended to. At the present time
there are studies in progress upon the

Disadvantages

These, likewise, are similar to those
of the septic privy. The first cost is
about the same as for the home-made
septic privy, but the cost of mainte-
nance is greater unless the cleaning is
done by the user, as it requires atten-
tion at rather frequent intervals. The
care to be exercised in its use must be
constant, as the object of the privy is
defeated unless a sufficient amount of
dry earth or lime be used to take up

Fig. 6. Excellent seats, but faulty seat covers. Always be on guard for warping such
as seen in this picture. This furnishes ample opportunity for flies to reach the privy
contents.

use of caustic soda in these vaults in-
stead of dry earth, the object being to
effect both liquefaction and steriliza-
tion of the contents. Inasmuch as
these experiments are unfinished, we
cannot give further information upon
them.

Advantages
The advantages in the use of this
type of privy are similar to those of
the septic privy. It is a permanent
construction; if properly cared for
will render the contents inoffensive to
handle; the privy can be used in any
location; and can be home-made.

the excess of moisture from the con-
tents.

Miscellaneous

1. Chemical Commodes. These are
nothing more nor less than box and
can privies. A chemical substance is
used which generally gives them the
advantage of liquefaction, deodoriza-
tion and sterilization. These proper-
ties are relied upon to make the
chemical commode adaptable to use
inside the house. As compared to the
ordinary box and can privy, however,
they are much more expensive to in-
stall, and more expensive to maintain,

The Health Bulletin

the chemical alone costing about $7.00
a year for the average family. An-
other decided disadvantage connected
with them is that they are not capable
of being cared for by a systematized
scavenger service, as is the ordinary
box and can. The reason for this is
the fact that they are generally in-
door installations, and it would not be
at all practicable for a scavenger man
to have to go inside a house to re-
move privy cans. Thus, the chief ad-
vantage claimed for this type of privy
becomes at once its chief disadvan-
tage. However, an exception is made
with reference to the chemical com-
mode v.'hich will permit it to be used
without being served by a scavenger
system, as required for other box-and-
ean privies.

It is not the intention of the State
Board of Health to place an unquali-
fied disapproval upon this type of
privy, but it is the purpose of the
board to discourage the use of the
chemical commode, for the reason
that v.e know of but few instances
where some other type of privy would
not be more suitable.

2. Cesspools. A cesspool is a drain-
age basin, not having water-tight
walls, for the reception and disposal
of the effluent from a flush closet or
chemical privy. The cesspool is com-
monly made by digging a hole 8 to
10 feet deep in the earth, which is
usually walled up with stone or brick
to prevent caving. Its essential ob-
ject is to get rid of the fluid portion
of such effluents, in order to avoid
creation of a nuisance. In doing this,
the effluent is taken up by the deep
layers of the soil, thus subjecting the
water-bearing strata to great danger
of pollution.

The use of cesspools for disposal of
human filth is prohibited, except for
effluents from approved chemical
privy vaults.

3. Sewerage Systems. A discussion
of sewerage systems does not rightly
belong in this Bulletin, which is de-

voted to privies, except to stress the
fact that privies should be regarded
only as stepping stones to sewer sys-
tems as an ultimate goal. In all
to\\-ns v.here a sewer system is an
economic possibility, serious consid-
eration should be given to its instal-
lation, or to extension of the system
where one exists. This is also true
for isolated homes, but the case here
is net so urgent as it is in towns or
cities.

This matter will be taken up in
some detail in a succeeding bulletin.

PLANS AND SPECIFICATIONS
FOR APPROVED PRIVIES

In order that the work of remodel-
ing and construction of privies, to
meet with the requirements of the
new privy law, may proceed without
delay, plans and specifications, such
as will be approved by the State
Board of Health, are herein set forth.
I. General for All Types of Privies

1. Privy Building. (a) General.
While the specifications for building

Fig. 7. A good iirivy building which is
capable of reconstruction to meet the re-
quirements for improved privies.

The Health Bulletin

must of necessity be rather elastic in
order to provide for utilizing as many
as possible of the old buildings, it
must be borne in mind that no type of
privy can be maintained and operated
in a satisfactory manner unless it is
housed in a well constructed and
maintained building of sufficient size
and capacity. The building shall be
so constructed as to afford privacy to
the user in the acts of urination and
defecation and protection from in-
clement weather conditions. It must
be provided with a hinged door which
can be closed and fastened on the in-
side.

Location. Location of the privy
within convenient reach of the house
is a matter of great hygienic impor-
tance.

(1) A properly operated privy does
not have to be located in a remote
corner. Get it as near the residence
as is consistent with esthetic and
sanitary principles.

(2) "Provide a walk- way from back
door to privy, so that the privy may
be visited in bad weather or at night
with ease. Such a walk covered with
vines or lattice work is strongly
recommended.

Disregard of these suggestions in-
terferes with one's privy-going habit,
thereby giving rise to habitual consti-
pation, or aggravating it in those al-
ready affected in this way. It should
be emphasized that constipation is
perhaps the cause for more calls upon
the physician than any other physical
ailment.

(b) Utilization of Old Buildings.
In a great many instances the old
building may be repaired and used
to house a new or improved privy. In
Figure 7 there is shown an open sur-
face privy, with building well con-
structed and in a fair state of repair.
Such a privy, although the building
is in good condition, is insanitary and
dangerous to health, and would not be
approved by the State Board of
Health. Figure 8, however, shows

the same building repaired and placed
over a septic privy. With very little
expense this privy, originally a
menace to the community, was so im-
proved that it may be used without
danger of spreading disease, and will
therefore pass inspection and be ap-
proved by the State Board of Health,
(c) Old Buildings Condemned. In
Figure 9 there is shown a privy build-
ing v/hich is poorly constructed and in
such a deplorable state of repair as to

mMr'^..-idijSll^iiiliSS£iS

Fa.. S. '1 he same building as shown in
Fig. 7, after reconstruction, placed over
a North Carolina septic privy.

render it past redemption for use
with any type of privy. Such a build-
ing will in no case be approved by the
State Board of Health.

(d) Construction of New Buildings.
In case it is necessary to construct a
new privy building, such a building
as that shown in Figure 10 will be
found inexpensive and easy to con-
struct.

Material required to construct
building shown in Figure 10, 4 feet
square, rear wall 6 feet high, front
wall 7% feet high, is tabulated in
Table 1.

The Health Bulletin

TABLE 1.
Similar to Fig.

Frame

2"x 4"xl4'

Frame

2"x 4"xl2'

Walls

l"x 6"xl2'

114

Roof

l"x 8"xl2'

Floor

l"x 4"xl2'

Seat

I"xl0"xl6'

256

$10.00

Nails

.15

Two

pairs

hinges

.60

Total $10.75

Add for 4 yds. roofing material.

The minimum allowable dimen-
sions of privy buildings shall be as
shown in Table 2.

For each additional seat thereafter
the length shall be increased 2 feet.

(e) Frame. The frame should be
constructed of pieces at least 2" x 4"
in cross section.

(f ) Walls. The walls should be cov-
ered with lap weather boarding,
tongued and grooved, or other closely
fitting boards.

(g) Roof. The roof should be con-
structed of one inch boards, covered
with shingles, tar paper, or other
roofing material.

(h) Floor. The floor should be con-
structed of concrete, or of planks
tongued and grooved or otherwise
closely fitting.

(i) Housing Excreta. All cracks or

TABLE 2.

Height Projection of

Roof

Width

Length Front Back Front Rear

Sides

For one seat

4' 7' 51/2' 6" 10"

For two seats

4' V 51/2' 6" 10"
Dimensions of box seat.

Overall width,

Length

Width Riser to front Back of hole Back of hole

Length

front to back

hole

hole of hole to rear wall to hinge of lid

of lid

24"

12"

9" 3" 9" 6"

20"

Fig. 9.
incapable
a new bu
instance.

The type of building which is
of reconstruction. Nothing but
ilding can be considered in this

holes in that part of the building
which surrounds and houses the ex-
creta shall be so covered and screened
as to exclude flies from the filth.

(j) Box Seat.

(k) Green or unseasoned lumber
should not be used for any part of the
privy building. This is especially
true of the box seat and other portions
housing the excreta, because green
lumber will shrink and produce cracks
between boards, which is especially
undesirable in this portion of the
building.

2. Ventilation. The pit, can, tank,
vault, or other receptacle for excreta
shall be ventilated by means of a
metal or wooden pipe, with a mini-
mum cross-sectional dimension of 3"
for one hole, 4" for 2 holes, and one
additional ventilator, as above pro-
vided, for each additional hole or two
holes, respectively, or the equivalent
thereof. The pipe shall extend from

The Health Bulletin

5" space between roof and
weafher boarding all around
for lighf and venfilafion.

'---Venfilafor pipe jiof /ess than
4" in diameter to extend at
least 2 feet above roof

Excavated earth drains '
water away from pit.---'

''5fnp prevents lid from
remaimtng open v^hen
not in use.

Former ground level

Sides of excavated pit
inclined to prevent caving.

''~/iii^^.'^'^hlly^-'^'Stable manure promotes de-
'^.^A^^^^ri^^tt^Jycomposition and prevents odor.

PIT PRIVY DESIGN

FOR USE IN
RURAL DISTRICTS

NORTH CAROLINA STATE BOARD OF HEALTH

Fig. 10

The Health Bulletin

a point below the seat to a point at
least 2 feet above the roof, as sho\vn
in Fig. 10. The cross-sectional open-
ing shall be screened to exclude flies,
and covered with a vent hood.

3. Seat Covers. All lids shall be
self closing, that is, so constructed
that the lid will automatically fall and
remain closed at all times when the
seat is not occupied.

4. Surface Drainage. The ground
surface adjacent to the privy walls
shall be graded up to an elevation at
least 6 inches higher than any point
within six feet in any direction there-
from. Excavated earth may be used
for this purpose, as in Fig. 10.

The following specifications are of
necessity highly technical, and there-
fore of special interest only to those
contemplating the installation of one
of the types of privies set forth
therein.

III. The Earth Pit Privy— Class 1
1. Location

(a) The earth pit privy shall be located
at least 100 feet if possible, but never less
than fifty feet, from any well, spring, or
other source of domestic water supply, and
upon ground sloping therefrom. Distances
less than 100 feet may be maintained only
with the approval of the State Board of
Health.

(b) The earth pit privy shall never be lo-
cated upon swampy ground. Exceptions to

Fig. 11. Two models of galvanized iron boxes for box-and-can privy.

II. Miscellaneous

1. Cesspools. Cesspools will in no
case be approved for the disposal of
human wastes, except in connection
with chemical privies.

2. Chemical Commodes, (a) Chemi-
cal commodes shall correspond to spe-
cifications of section IV, for box-and-
can privies.

(b) Chemical commodes will be ap-
proved only on condition that dry
caustic chemical substance, of a phe-
nol coeflTiciency of at least 15, be used.

this rule may be permitted, at the discretion
of the State Board of Health.

(c) The earth pit privy shall never be lo-
cated where formations of solid or fissured
rock lie closer than 10 feet below the ground
surface. Distances less than 10 feet may
be maintained only with the approval of the
State Board of Health.

2. The Pit

(a) Sfiripe. The pit shall be dug with sides
sloped, as shown in Fig. 10, to prevent
caving.

(b) Dimensions. The dimensions of the pit
shall conform to the following table :

The Health Bulletin

TABLE 3.

Depth

Min. Width

No.
Seats

Max. Min.

Bottom Top

Min.
Length

5' 4'

1' 18"

5' 4'

1' 18"

an 2 seats

Increase 2'
additional

for each
seat.

(1) The pit shall be provided with a box
curbing at least 18" in depth, fitted closely
to the sides of the pit as shown in Fig. 10.

(2) In loose sandy soils the pit shall be
curbed or sheeted from top to bottom.

(d) Boards shall be placed over the
ground surface on the rear side of the build-
ing, as shown in Fig. 10, to prevent caving
caused by rain water running off from roof.

tice, not only the individual box-and-can in-
stallation, but also the system under which
such installations are operated. Upon such
disapproval by the State Board of Health, the
said box-and-can installation or system shall
be replaced by some other filth disposal
facilities, as are approved by the said Board.

4. Can

The can shall be of 24 to 26 gauge galva-
nized iron, 15 inches in diameter and 15
inches deep. It shall be provided with bail
or handles to facilitate removal.

5. Box

(a) Dimensions. The can shall be housed
in a substantially constructed fly-tight box,
as shown in Figs. 11 and 12, of approxi-
mately the following dimensions, inside
measurements :

Fig. 12. A home-made double seat box-and-can privy.

IV. The Box-and-Can Privy— Class 2.

1. Installation

The box-and-can privy, except the chemi-
cal commode, may be installed and main-
tained only when an adequate scavenger sys-
tem is maintained.

2. Location

The box-and-can privy may be located
without reference to soil conditions or dis-
tance from source of water supply. Only
chemically operated or commode can-privies
may be located within a residence, school, or
public building.

3. Removal

The State Board of Health reserves the
right to disapprove at any time, with due no-

TABLE 4.

Shape

Depth

Min. Diameter

Circular

18"

Rectangular

18"

Min. Width

Min. Length

Circular

Rectangular

20"

If it is desired to use two cans in the same
privy, two boxes of the above dimensions, or
one box twice the length, may be used.

(b) Cover. The top of the box shall be
hinged or removable, as shown in Fig. 11, to
facilitate removal of can.

V. L. R. S. Or Septic Privy— Class 3
1. Location

The L. "R. S. or septic privy shall be so
located that no portion of the drainage sys-

The Health Bulletin

tern shall be less than 25 feet, if possible,
from any well, spring, or other source of
domestic water supply.

2. Tank

(a) Form. The tank shall be of two or
more chambers, connected by baffled weir,
overflow pipe, or orifice properly located, as
shown in Figs. 14, 15 and 16, or two or more
tanks may be connected together in series by
means of overflow elbows and pipe, as shown
in Fig. 17.

IL All cement tanks with walls under 4"
in thickness shall be thoroughly water-
proofed inside and out, or constructed of
cement mixed with a standard waterproof-
ing element.

Warning : Beware, in making contracts
with commercial producers of concrete tanks,
to make sure that they include the following
specifications :

a. The richness of the concrete mixture.

The purchaser should be on guard against
inferior qualities of concrete construction, as

F0F?M5 IN RLACE: IN PIT
COhfCRtTL BOTTOM AND SIDDNALLS POUREC

Fig. 13

(b) Construction.

(1) The tank shall be so constructed as to
render it impervious to water and resistant
to oxidation and decay.

(2) Waterproofing Concrete or Cement
Tanks.

1. All concrete tanks with walls 4" and
over in thickness shall be thoroughly water-
proofed on the inside or constructfd of ce-
ment mixed with a standard waterproofing
element.

concrete constructions are by no means of
equal value. The best mixture is one to
one — that is, one part of cement to one of
clean, .=harp sand. Others used are one to
two and one to three. Each grade may be
used satisfactorily, but there is greater
danger of leakage and breakage in tanks
with the leaner mixtures.

b. All tanks should be guaranteed not to
leak when laid down at the point of installa-
tion.

The Health Bulletin

c. Leakage may be determined by filling
tank with water before being placed in
ground. All leaky tanks should be replaced
or repaired before being accepted.

(c) Capacity. The minimum volumes and
dimensions shall conform to Table 5, which
is based upon the assumption that the aver-
age family consists of five persons.

3. Drainage System

(a) Methods. The effluent from the septic
privy may be discharged into a system of
tile or cement drains, laid as close to the sur-
face as is consistent with protection of
drains.

(b) Length of Drain. Where the efflu-
ent is disposed of through subsurface drain-
age lengths of drain lines in accordance
with Table 5 shall be provided.

walls, as shown in Fig. 13. Cleats B,
Fig. 13, are nailed to sides of forms, 16
inches from outlet end, to make grooves in
walls for placing of baffles, as shown in Fig.
14. Cleats A are nailed to the sides of
forms 12" from the outlet end to make
grooves for placing weir. Concrete should
be mixed in proportions of one part of ce-
ment to four parts of sand and gravel.

Make weir 24" high, make baffle 2'-ll"
high, extending from bottom of groove B to
top of tank, as shown in Fig. 14.

When bottom and walls are poured and
forms removed, plaster the entire inner sur-
face with 1 to 1 mixture of cement and sand.
Test tank for leaks, before placing cover.

Starting at the outlet elbow, dig trench
about 20' long. Beginning at and joining
with outlet elbow, lay 4" drain the full

TABLE 5.

Minimum Allowable Capacities and Dimensions of Septic Privy Tanks.

Sludge Chamber Effluent

j^Q Effective Distance Water Chamber Drain

Families Volume Depth Line to Cover Volume Length

1 100 gal. 30" 12" 45 gal. 20'

2 175 gal. 30" 12" 50 gal. 40'

3 250 gal. 36" 12" 55 gal. 50'

4 300 gal. 36" 12" 60 gal. 60'

(1) Joints. The drain lines shall be laid length of ditch, in accordance with specifi-
with abutting joints. cations for drains.

(2) Soil Distribution. In order to insure This privy tank has a capacity of 180 gal-
distribution and absorption, in clay and other Ions in the sludge chamber, and 60 gallons
non-porous soils the drains shall be laid on in the effluent chamber.

a bed of coarse gravel or cinders, 6" in In case one does not care to construct his

depth to the full width of the trench. In own septic privy, there are various commer-

case the drain is laid in sand, the gravel or cial types employing the same principle,

binder bed may be omitted. which may be purchased at reasonable prices.

Some general types are shown in Figs. 15,

North Carolina Privy le, and 17.

In Fig. 14 is shown the North Carolina L. Chemical Privies— Class 4

R S. privy. This type of privy is designed

for home construction. The tank is simply All chemical privies of the vault type in-

a rectangular concrete box provided with stalled after July 31, 1919, shall correspond

baffleboard, weir and overflow, constructed to the following specifications :

in a pit dug to the proper dimensions. ^ ^^^ Bowl

To build this tank, first dig a hole 5'-0"
long, 3' 8" wide, and 3' 9" deep. Then mix The bowl must be of good grade vitreous

and pour a 4" layer of concrete in bottom of china, or such material as may hereafter be
hole for the floor. After this concrete has approved, plain and sanitary, with connec-
become set, roughen a 4" strip all the way tion for vent pipe at the top, equipped with
around the' edge, to give bond between floor good grade of seat so constructed as to
and side walls. Place forms and pour side insure durability.

TABLE 6.
Materials Required to Construct North Carolina Septic Privy Estimated

Material ' Quantity Cost

Lumber for forms 64 bd. ft. $ 5.00

Board 2"xl2"xl6' for baffle and weir 32 bd. ft. 1.50

One 4" glazed elbow or quarter bend 1 •°"

4" drain 20 ft. 1.50

Sand and gravel 1 cu. yd. 2.00

• Cement "^ ^^^''^ ^-Q*^

Total $17.50

The Health Bulletin

S'-O'

SECTION- CC

S-O'

-/Z'

•2*

^ -* N

NORTH CAROLINA SEPTIC PRIVY

Fig. 14

The Health Bulletin

2. Connecting Tube

(a) The connecting tube is to be made of
the best available material to withstand cor-
rosion and effect of urine, such as monel
metal or lead, each properly insulated from
iron, enameled iron, or a metal coated with

non-corrosive, non-absorbent material.

(b) The tube must extend into the tank
a sufficient distance to prevent urine from
coming into contact with the tank.

3. Tank

(a) The tank must be made of iron or
copper bearing steel of the best grade, equal
to that made by the three leading American
manufacturers, and must be not less than
fourteen gauge thickness, or such material
as may hereafter be approved, and provided
with an agitator which will effectually mix
the entire contents. The capacity is to be not
less than 125 gallons per bowl. The shape
must be cylindrical or half-round. In steel
tanks all joints must be welded.

(b) Openings in the tanks for bowls are
to be spaced not less than thirty inches from
center to center.

phaltum paint free from acid or water to
cover the tank with two coats of the former
and three of the latter on installation, or be
thoroughly covered at the factory with some
approved coating that will unquestionably
furnish equal protection.

4. Ventilating Pipes

(a) Ventilating pipes must be so designed
and arranged as to give proper ventilation
regardless of atmospheric conditions. The
miuimum vent pipe to be used on single
bowls and urinals is four inches, and pipes
are to be made correspondingly larger as
bowls are added for multiple installations.

(b) All ventilating pipe is to run inside of
the building so far as possible and emerge at
the ridge of the roof. If impossible to
emerge at the ridge or in close proximity to
it so as to obtain unobstructed draft without
long extension of pipe above the point of
emergence from roof, a suitable ventilator is
to be provided to- insure good ventilation.
Ventilation into the smoke flue of a chimney
is not permitted.

(c) In placing pipes, right angled turns
must not be used, and an angle not exceed-
ing 45 degrees is to be worked to wherever
possible.

(d) Neither horizontal runs nor square
pipes will be permitted.

CBPflCITY Z05
Qals

uu^

Qci:::

Sub- SorfarcDrainTile-
Bedded in-Porou3
V\aTtr\a\

CH5T-Or-CEMf NT-^TFEL-RIINFOECEO-

PlG. 15. Commercial septic privy, employing baffle and weir in its construction.

The Health Bulletin

5. Drain

The drain valve opening is to be not less
than three inches in diameter. The drain
pipe leading from the drain valve is to be
not less than four inches in diameter.

6. Installation

(a) The distance between the top of tank
and bottom of bowl must not be less than 18
inches or more than 48 inches.

(b) The opening for the clean-out and for
the manhole must be readily accessible either
inside or outside of building, outside when

ing thereto from the tank, the fall of which
must be at least one-half inch to the foot.
The construction of the cesspool or leaching
well and its distance from the tank must be
made to conform to the conditions that pre-
vail in the case. However, a cesspool or
leaching well is not to be used when there
is any possibility of contaminating drink-
ing water through its use.

8. Chemical

The chemical used shall be a dry caustic
chemical of standard commercial quality
with a phenol coefficiency of at least 15, and

Oeia// of Commode

Oel9i/ of
N/fr/f/caf/on Bed

Note. Beveled hole in baffle.

Two overflow openings flush with tank.

Fig. 16. Commercial septic privy, employing baffle and orifice in its construction.

the tank is to be cleaned by pumping or dip-
ping.

(d) The installation must be made so as
to insure the tank ample protection against
frost.

7. Drainage

Drainage may be provided as follows :

(a) Tile. When absorption tile drainage
is used, sufficient lengths of 4" abutted joint
tile lines shall be provided to receive and
readily dispose of the entire tank volume.

(b) Cesspool or leaching well. Whenever
the cesspool or leaching well is used, a ca-
pacity equal at least to the capacity of the
tank should be provided, with a drain lead-

a minimum amount of 25 pounds of chemi-
cal of this standard per bowl is to be used.

9. Service and Guarantee

(a) Each manufacturer is to guarantee his
equipment against defects in material and
workmanship for at least two years, and that
it will operate effectively provided it is in-
stalled and used in accordance with his di-
rections.

(b) The manufacturer is to be notified of
defects, if any exist, and is to be given op-
portunity to make them good without charge
to the purchaser.

(c) In case difficulty arises which is clear-
ly due to the fault of the purchaser either In
installing or operating, he is chargeable for
tho service at regular rates.

The Health Bulletin

The general principles of construction of
the vault type chemical privy are shown in
Fig. 18.

All chemical privies installed prior to July
31, 1919, which do not correspond to the
above specifications will be allowed to remain
only with the approval of the State Board of
Health.

VII.

Double Compartment Concrete
Vault— Class 5

The double compartment concrete vault, for
family installation, shall be constructed in
accordance with U. S. Public Health Service
plans shown in Fig. 19, of such dimensions
as shown therein.

Openinq Scr-<?enea

The double compartment concrete vault
may be constructed either with plank floor
and seat risers, as shown in Fig. 20, or with
concrete floor and seat risers, as shown in
Fig. 21.

SUMMARY OF RULES FOR MAIN-
TENANCE OF DIFFERENT
TYPES OF PRIVIES

Certain features of maintenance
are common to all types of improved
privies, and therefore need to be
stated only once.

!■ So//^ Sof^fTt

Sect/ on

P/o

Fig. 17. Commercial septic privy consist-
ing of two tanks connected by overflow pipe.

In Fig. 20 is shown a double compartment
concrete vault with concrete poured, forms
drawn, and anchor bolts in place. Note
grooves in top of center wall and inner sides
of side walls. These grooves are for the
purpose of making union of concrete floor
with walls.

In Fig. 21 is shown concrete work of vault
finished, with floor and risers for seats in
place.

General Rules

1. The State Board of Health will
not approve any type of privy unless
it is housed in a building that will af-
ford a reasonable degree of protection
from bad weather conditions.

2. The walls, floor, and seat of the
privy, and the ground immediately

The Health Bulletin

adjacent to the building, must be kept
in a clean and decent condition. The
sanitary inspector will not compro-
mise on these points.

3. Never allow chickens or other
animals to harbor in the building.

4. Privy seat covers shall be kept
closed at all times when the seat is

4 in Veni

Z)ouhh Hinged
ny Tight Seat

Vitreous
China 3ow/

FJaor

fla'd Proofed Drop Tube — — f
Nan Hole
.Opening

'PP^OX/MAT£i;r:aSGML^^^

- Drain Valve Opening 3 "
Fig. 18. Vault type cUemical privy.

unoccupied. This should be set down
as the golden rule, as all the objects
of fly-proof construction are fmis-
trated if this point is neglected. In
certain types of privies, of course,
this is decidedly more essential than
in others, but no exception can be
made in any case.

5. Make frequent inspection of
the seat and seat covers to be sure
that there is no warping or shrinking
of planks that would give access to
flies. (See fig. 6, Faulty Seat
Covers.)

6. Screen wire coverings of vent
holes shall be maintained in such a
state of repair as to exclude flies, at
all times.

7. That portion of the privy build-
ing which houses the privy filth shall
be maintained at all times in such
state of repair as to exclude flies.

The Earth Pit

1. When the privy contents reach
within 18 inches of the top of the pit
the building must be removed to a
new pit and the old pit completely
filled with earth.

2. The pit must never be allowed to
fill with water to overflowing.

3. If the pit should cave in at any
time it must be promptly repaired.

4. During months from April to
October, sprinkle cupful of kerosene
each week into the pit to prevent fly
and mosquito breeding.

The Box and Can Privy

1. The can must never be allowed to
become filled closer than within four
inches of the top. A routine practice
of removal and emptying of the can
regularly once each week should be
adopted, no matter whether or not
the can be filled to the limit.

2. The privy filth must be disposed
of in a sanitary manner (a) by
emptying into sewer main, or (b) by
shallow earth burial, 6 to 12 inches
below the surface.

3. Cans must be reasonably clean
before being replaced in the privy box.

The Health Bulletin

4. The can is for the reception of
nothing but human filth and the neces-
sary toilet paper. Newspapers, rags,
sticks, cotton waste, or any other
waste or offal must not be deposited
in cans, as they clog the sewer sys-
tem when emptied into the disposal
plant,

5. By all means avoid the use of

lime in the cans, as this destroys
them in a very short time. A good
can properly handled will last about
two years or more. If a deodorant is
desired, use some one of the coal tar
disinfectants.

6. See that the top of the box, after
each removal of the can, is properly
adjusted so as to exclude flies.

\ Hoi'se F/oor

^Bacfi mffofHoi/se

ever W*//.
_ t~-l/ ' * '"'ber Dttfipecf

HKcttrpnef.

')fffrrf\im)w>

Vertical Section

Horizontal Section

Fig. 19. Double compartment concrete vault shown in sections.

The Health Bulletin

The L. R. S. or Septic Privy

1. The working
privy must not be

capacity of the
overloaded. The
minimum standard is an active ca-
pacity of 20 gallons per person in the
sedimentation chamber, provided the
total active capacity of the sedimen-
tation chamber be not less than 100
gallons.

2. A depth of liquid in sludge cham-
ber equal to the designed working

necessary toilet paper to be deposited
in the tank.

5. Use no disinfectants or deodor-
ants, as they will destroy the bacterial
action.

6. The collection of sludge must be
removed from the sedimentation or
sludge chamber whenever there is
reason to believe that it is hindering
the operation of the septic process.
This matter should be investigated at

Fig. 20. Double compartment concrete vault, with top open.

depth of said chamber shall be main-
tained at all times. That is, if the
tank is so designed and constructed
that when full the depth is 30", or
other measurement, as the case may
be, then that depth shall be maintained
at all times. This may be accom-
plished by adding water at regular
intervals, usually 3 to 5 bucketfuls a
week.

3. Encrusted collections of fecal
matter on the surface must be broken
up by addition of water.

4. The operation of the septic privy
can be totally destroyed in a very
short time unless the following cau-
tion is heeded: Allow nothing but
fecal mattei% clean water, and the

least once in every three or four
years.

The Chemical Privy (Vault Type)

1. This type of privy must not be
used without chemical substance of
proper quality and quantity.

2. The tank must be completely
emptied before each charge of chem-
icals.

3. Each charge must consist of at
least 25 pounds of caustic chemical,
as described in the specifications, to
each 125 gallons capacity or approxi-
mation thereof.

4. The chemical must be completely
dissolved before placing in the tank.

5. The agitator must be woi'ked
after each time the privy is used.

The Health Bulletin

6. The contents of the tank must
never reach into the tube connecting
the bowl and the tank.

7. The inside of the bowl must be
kept free from fecal matter.

Caution: In handling the dry chem-
ical do not allow it to come in contact
with the skin. It is well to tie two
thicknesses of handkerchief over the
nose and mouth to prevent irritation
of the air passages from the caustic

Chemical Commodes

1. For each five gallons capacity in
the can or approximation thereof, one
pint of caustic chemical as described
in the specifications must be placed in
the can, after each emptying of the
contents.

2. The caustic chemical referred to
in Rule 1 is dry caustic and must be
completely dissolved in water before
placing in the privy can. About three

Fig. 21. Double compartment concrete vault, with top and seat risers in position.

dust. Should any of the chemical
come in contact with the skin or cloth-
ing through splashing after being dis-
solved, or otherwise, wash with water
and apply vinegar, lemon juice, or
some other mild acid.
The Double Compartment Concrete
Vault.

1. Always allow one compartment
to stand idle while the other is being
filled, allowing storage of privy con-
tents in one compartment through
the period of filling the other.

2. Use enough dry earth or other
substance to absorb the moisture from
the privy contents.

3. Remove stored privy substance
at intervals indicated by the filling of
the compartment in active use.

quarts of water to one pint of dry
caustic is required.

3. The can must never be allowed to
fill to within less than four inches
from the top.

4. The privy contents must be dis-
posed of in a sanitary manner, either
by emptying into a sewer or by shal-
low earth burial.

5. The can must be reasonably clean
before being replaced into the com-
mode.

6. Do not use lime in the can.

7. See that the top of the commode,
after each removal of the can, is
properly adjusted so as to exclude
flies.

8. The presence of offensive fecal
odors and of fly breeding, or absence

The Health Bulletin

of liquefaction of fecal matter in the
can are evidences of improper main-
tenance, and of violation of the above
rules.

Caution: In case of splashing the
chemical upon the skin or clothing,
wash with water and apply vinegar or
lemon juice.

ECONOMICS OF PRIVY CON-
STRUCTION AND MAIN-
TENANCE

In the following schedule the vari-
ous elements of cost for privy con-
struction and maintenance are esti-
mated as closely as possible and ex-
tended over a period of five years.
These figures will naturally vary
more or less widely on account of
differences in cost of material and
labor in different localities. This is
especially true of labor, inasmuch as
there is usually no well established
standard prices for this class of work.
The greatest factor of variation, how-
ever, is whether the work required for
construction or maintenance is done
by hired labor or by the owner of the
privy himself. The calculations that
have been made in the accompanying
table presuppose in each instance that
the labor necessary is to be hired.
Whenever the work is done by the

owner of the privy, labor deductions
may be made from the total five year
cost.

It will be further noted that the fig-
ures in the table make no provision
for the building itself, the privy filth
receptacle alone being considered. In
the majority of cases no extra cost for
this purpose will be necessary, as any
existing building in a good state of
repair will suffice. However, in case a
new building is desired or necessary,
the average cost, figured on the basis
of specifications given on page 17,
will amount to about $21.00, divided
as follows: Cost of material, $11.00;
cost of labor, $10.00.

MACHINERY AND METHODS FOR
ENFORCING THE LAW

In accordance with the provisions
of the law, the organization responsi-
ble for its enforcement consists of the
following:

1. The Secretary of the State Board
of Health.

2. Bureau of Engineering and In-
spection:

(a) Chief of the bureau in charge
of the work, (b) A corps of sanitary
inspectors to carry out the details of
the law.

ANALYSIS OF COST

Type of privy

Earth pit $ 4.50

Box and can. . . 11.05
L. R. S., North

Carolina .... 7.70
to
L. R. S., com- 10.10

mereial 12.10

Chemical 28.00

Double compart-
ment concrete
vault 15.20

First Cost

Maintenance

Cost 5

Years

■« in

6©

CO <a

o c

m ca
o a)

a
o

o a

d
o

a.h

Sis

o £

None

$ 7.50

$15.00

None

$15.00

$ 22.50

9.00

1.75

10.75

40.00

None

$ 4.50

44.50

55.25

17.50

35.00

3.50

None

3.50

38.50

40.00

47.00

50.50

50.00

7.00

57.00

3.50
Insignifi-

None

3.50

60.50

85.00

10.00

95.00

cant .

45.00

140.00

16.00

10.00

26.00

50.00

76.00

The Health Bulletin

It will be noted that the law became
effective upon the date of its passage,
namely, February 24, 1919. Its re-
quirements, therefore, are present as
well as future. But in order to give
every one ample opportunity to com-
ply with it, the State Board of Health
is deferring the date for insisting
upon compliance with the law to Oc-
tober 1, 1919. Upon that date the in-
spectors will be put into the field.

The inspector, on visiting the home,
will find the privy either sanitary or
insanitary.

Privies Found Sanitary

The procedure is simple in such in-
stances. The inspector posts the
State privy license number upon such
privy, after having collected the li-
cense fee of forty cents.

Privies Found Insanitary

Such privies will be found insani-
tary, due either to faulty construction
or faulty maintenance. In such in-
stances the responsible parties will be
subject to immediate prosecution, but
it will be within the discretion of the
sanitary inspector to follow one of
two courses, as follows:

1. If reasonable evidence is fur-
nished to show that the responsible in-
dividual is acting in good faith, but
for some unavoidable reason has been
unable to meet the requirements, the
inspector will be given authority to
waive prosecution temporarily. In
this case the inspector will collect the
license fee as usual, and affix to the
privy a sign bearing the words, "Li-
cense pending." Upon the next visit
of the inspector he will naturally ex-
pect the requirements to have been
met, at which time few, if any, ex-
cuses for non-compliance will be con-
sidered.

2. All other privies insanitary in

construction or maintenance will be
placarded with the sign, "Insanitary:
Unlawful to Use." The inspector will
specify the date after which this no-
tice becomes effective.
Procedure With Privies, "Insanitary:
Unlawful to Use"

1. Where condemnation is due to
defective construction, the owner will
be held legally liable.

2. Where condemnation is due to
defective maintenance, the user will
be held legally liable.

Procedure, Residence Without a Privy
1. The Owner. It is a misdemeanor
to maintain a residence coming within
the provisions of this law until such
time as it shall be provided with a
sanitary privy, of a type approved by
the State Board of Health.
Approved and Disapproved Privies
It is a responsibility upon the owner
of a residence coming under the re-
quirements of this law to satisfy him-
self that the type of privy which he
installs is one having the approval of
the State Board of Health. If it is
not, the requirements of this law are
not satisfied, and the case will be
handled as if there were no privy at
all.

It must be emphasized that the in-
spector will be a busy man. He will
have no time for parleys on points
either of construction or of mainte-
nance. The specifications on these
points, as set forth in this Bulletin,
are so clear that any one who reads
them can have no difficulty in settling
for himself the question of responsi-
bility in any case. The inspector will,
therefore, be charged by the State
Board of Health to apply the require-
ments of this law to the responsible
party or parties without argument or
hesitation.

DO IT NOW

This is the day to begin construction of a sanitary privy.
Read this Bulletin and learn how it is done

PubIi5}^^dbl^ T/\£./|OKinCAK9U/m STA TL 59ARD sTAEAHA
1 This Bulle-tinwillbe 3er\t free to oa\3 dfaen of the State xjpoATeguesti

Vol. XXXIV

AUGUST, 1919

No. 8

AVOID TYPHOID-BE VACCINATED

Average Monthly Variation In Number

of Typhoid Deaths in North

CaroUna During the

Last Five Years.

Janfck01ar.^frMaijJvin,dulA\xg.Sc]^.0c\,C^ov,pcc,

IVIEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

J. Howell Way, M.D., President, Waynesville
Richard H. Lewis. M.D., Raleigh
J. L. Ludlow, C.E., Winston-Salem
Thomas E. Atsderson, M.D., Statesville

E. C. Register, M.D., Charlotte

Chas. O'H. Laughinghouse, M.D., Greenville
Cyrus Thompson, M.D., Jacksonville

F. R. H.ARRis, M.D., Henderson
E. J. Tucker, D.D.S., Roxboro

OFFICIAL STAFF

W. S. Rankin, M.D., Secretary State Board of Health and State Health Officer

A. J. Warren, M.D., Assistant State Health Officer

Ronald B. Wilson, Director PuUic Health Education

L. B. McBrayer. M.D., Superintendent of the State Sanatorium

J. R. Gordon, M.D., Deputy State Registrar

G. M. Cooper, M.D., Chief of the Bureau of Medical Inspection of Schools

H. E. Miller, C.E., Chief of the Bureau of Engineering and Inspection

James A. Keiger, M.D., Chief of the Bureau of Venereal Diseases

Mrs. Kate Brew Vaughn, Chief of the Bureau of Infant Hygiene

A. McR. Crouch, M.D., Epidemiologist

B. E. Washburn, M.D., Director County Health Work

FREE PUBLIC HEALTH LITERATURE

The State Board of Health has a limited quantity of literature on health subjects for
free distribution. If jou are interested in one or more of the following gubjects, or -want
same sent to a friend, write to the State Board of Health for free lit*r<vture on that par-
ticular rubject.

Sanitary Peivies

UEliii.'rsTiAi Sewage
Disposal Plants

I^;:s

Flies

Colds

Teeth

Cancer

Malaria

Smallpox

Adenoids

Measles

WHOOPINa-COUGH

Hookworm Disease
Public Health Laws
tubeboulosis laws
Tuberculosis
Scarlet Fever
Inpantilb Paralysis
Carb op the Baby
Fly Placards
Typhoid Placards
Tuberculosis Placards
Clean-up Placards
Spitting Placards

SEX HYGIENE BULLETINS

Set a — ^FoB Young Men

A Reasonable Sex Life for Men.

Sexual Hyoriene for Young Men.

Vigorous Manhood.

Smash the Line. (The case against the re-
Btricted district.)

List of Reliable Pamphlets.

Set B — For Public Officials and
Business Men

Public Health Measures in Relation to Ve-
nereal Diseases.

Venereal Diseases — A Sociologic Study.

Smash the Line. (The case against the re-
stricted District.)

The Need for Sex Education.

A State-Wide Program for Sex Education.

List of Reliable Pamphlets.

Set C — For Boys

Vigorous Manhood. (Especially for boys 12
years of age and over.)

Note. — For boys under 12, see "When
and How to Tell the Children" (Set D) ;
portions of "Vigorous Manhood" also may
be read to younger boys. Boys 15 years
and over may be given Bulletin "A Rea-
sonable Sex Life for Men" (see Set A),
at the discretion of the parent.

Sexual Hygiene for Young Men.

List of Reliable Pamphlets.

Any of the above will be sent without charge

which you have definite use.

German Measles

Typhoid Fe\'ee

Diphtheria

Pellagra

Constipation

Indigestion

Infant Care

Child of Pre-School

Age
Corner Stone of

Child's Future
Prb-Natal Letters

Set D — Foe Parents
When and How to Tell the Children.
Venereal Diseases — A Sociologic Study.
The Need for Sex Education.
List of Reliable Pamphlets.

Set E — For Girls and Youno Women

Your Country Needs You. (Especially for
girls 11 years of age and over.)

Note. — For girls under 11, see "When
and How to Tell the Children" (Set D) ;
portions of "Your Country Needs You"
also may be read to younger girls. Girls
15 and over may be given "The Nation's
Call to Young Women" at the discretion
of the parent.

The Nation's Call to Young Women.
List of Reliable Pamphlets.

Set F — Foe Teachers

The School Teacher and Sex Education.
Sex Education in the Home and High

School.
Venereal Diseases — A Sociologic Study.
Smash the Line.
The Need for Sex Education.
List of Reliable Pamphlets.

Please send for only those bulletins for

IDWARDS t SROUGHTON PRINTINS CO.. RALtlSH. N. C.

. PUBU5MLb bY TAL HQI^TM CAI gQUhA 3TATL FyQ^fgD »^MEALJA l [fol

Vol. XXXIV

AUGUST, 1919

No. 8

EDITORIAL

POINT OF TIEW

"Point of view" according to the dic-
tionary means "tlie relative position
from which anything is seen or any
subject is considered." The definition,
however, does not tell how important
a thing point of view is: does not inti-
mate that a correct point of view
makes a man's work useful while a
false point of view may doom all his
efforts to failure. Public workers with
a broad and sympathetic point of view
do much to build up and improve liv-
ing conditions in the communities in
which they labor, while officials and
others who do not grasp the import-
ance of their positions may handicap
progressive movements which would
prove a blessing to mankind. It all
depends on the breadth of his point of
view whether a man is a help or a hin-
drance and whether his work is worth
while to himself and to his neighbors.
In North Carolina, point of view has
played an important part in our de-
velopment and we should all be thank-
ful that the majority of our leaders
have had humanitarian and broad, in-
stead of selfish and narrow, points of
view. Two little stories will illustrate
some of the meanings of point of view.
It was in front of the grocery store
in a small town. The story of a ser-
ious accident in which a boy had been
run over and killed by a train was be-
ing told. It seems that the boy was
carrying a large watermelon and had

stopped on the railroad track to plug
it, in order to find out whether or not
it was ripe. While he was doing this
the train came along and struck him.
The narrator had just finished telling
of the incident when a negro in the
crowd asked. "Boss, did yer happen
ter hear whedder 'er not dat water-
melon wuz ripe?"

A teachers' meeting was in progress
and a prominent school ofHcial was
complaining to the teachers that at
many schoolhouses the boys had
broken out window-panes. The county
is in a section of the state where mos-
quitoes and flies are found. The teach-
ers were advised to raise money or ob-
tain it from their school committees
in order to have the windows screened
so the boys could not throw rocks
through them. Flies or mosquitoes
were not worthy of consideration! Or,
at least, no mention was made of them.
The comfort and health of the pupils
seemed to be small matters and in-
significant when compared to damage
to school property.

It is point of view which makes com-
mitteemen and school patrons build
schoolhouses near the woods so that
they will not need to build privies. It
is no matter, of course, that the teach-
ers and children may contract hook-
worm, typhoid fever, tuberculosis, or
become victims of chronic constipation
which may handicap them for life.
These things are not considered of any

The Health Bulletin

value in many rural communities; but
to save a few dollars on the school
building and its up-keep is something
worth while! And, again, it is point
of view which causes a man to pay to
have his hogs vaccinated against
cholera while he can't be persuaded to
have his wife and children vaccinated
against typhoid fever even when the
health officer does it free of cost.

But, every day shows an increase in
the number of people who have or ac-
quire a good, wholesome point of view.
And for this we should all be thankful.

B. E. W.

OUR INTERDEPENDENCE IN

KEEPING WELL

"Now this is the law of the Jungle,

As old and as true as the sky;
And the wolf that shall keep it shall
prosper;
But the wolf that shall break it must
die.
As the creeper that circles the tree
trunk,
So the law runneth forward and
back;
For the strength of the pack is the
wolf.
And the strength of the wolf is the
pack."

The above lines by Kipling describe
in a very striking way the interde-
pendence of all citizens in keeping well
and in educating the community in
which they live and work regarding
infectious diseases. We have had an
excellent example in our army of what
cooperation under skilled supervision
means in keeping a group of men in
good health and "fit to fight." Our
soldiers are returning home in much
better physical condition than when
they entered the army. And if we do
not work together to better sanitary
conditions and promote health in our

families and communities we are going
to lose one of the most important and
most pronounced lessons of the war.
Right now is the time to urge our gov-
erning bodies to provide health de-
partments with trained health officers
in order that we may be kept well and
allowed to produce larger results from
the work we do; and this means that
we can make more money and be able
to save it.

You have probably heard the remark
from some diseased individual, in re-
ply to a question regarding his health:
"I am pretty well for me." This brings
up the question, how do you know you
are well? or how do you know that
you are sick? These things are deter-
mined by applying certain standards.
These standards come from the great
averages of experience of mankind.
For example, we know that the normal
temperature in the human being is
about 98.6 degrees. We know this
because the record of temperatures
taken of many thousands and perhaps
millions of people shows the average to
be 98.6. The same thing is true when
we speak of the normal blood pressure
or the normal diet or anything else
regarding health.

Before men are discharged from the
army they are required to stand a com-
plete physical examination in order to
determine whether or not they have
any hidden disease, or whether any
condition exists which might later on
produce ill health. A man who is
found defective, even in a small degree,
is given appropriate treatment and
made well before he is returned to civil
life. If this is important in the army
and for our soldiers, why isn't it im-
portant in our counties and for our
citizens?

You may be interested to know that
ten counties in the State are cooper-
ating with the State Board of Health
and have provided health departments

The Health Bulletii^^

under the supervision of trained medi-
cal men. As part of the program of
work in these counties any adult citi-
zen can go to the health officer and re-
ceive a complete physical examination
free of cost. This examination is not
for the purpose of making a diagnosis
or of giving treatments. The indi-
vidual is examined solely for the pur-
pose of finding any latent physical de-
fect which may exist so that he can
go to his family physician or a special-
ist and receive treatment before the
defect becomes serious or permanent.
The counties with such work are,
Davidson, Forsyth, Lenoir, Nash,
Northampton, Pitt, Robeson, Rowan,
Vance, and Wilson. Why can't other
counties follow the lead of the progres-
sive ten?

Many other, in fact any, phase of
public health work will show that an
individual is not independent in the
matter of keeping well. And it doesn't
require much study to readily see that
the responsibility for the health of the
citizens, whether they be rich or poor,
white or black, rests upon the com-
munity and upon the public health
officials. In North Carolina such re-
sponsibility is with the Board of
County Commissioners who by provid-
ing funds to the County Board of
Health can, in the words of chapter
62, section 9, of the Public Laws of
North Carolina of 1911, "make such
rules and regulations, pay such fees
and salary, and impose such penalties
as in their judgment may be necessary
to protect and advance the public
health." B. E. W.

AN APPRECIATION

The bravest battle that ever was
fought!
Shall I tell you where and when?
On the maps of the world you will
find it not —
'Ttvas fought by the mothers of
men.

Joaquin Miller.

In all the great social reforms that
have come as great blessings to our
country the women have always fur-
nished the initiative in thought, and
most times, in action. And in their
undertakings they have ever been
successful. They have been successful
because they were not inspired by
motives of personal gain, or desires to
play petty politics. Their motto has
been simply to do that which was
right for the great mass of humanity.
And the courage with which they have
diligently performed their tasks should
be an inspiration to us all.

The State Board of Health is duly
aware of and deeply appreciative of
the endorsement given to it and its
fight against disease and vice by the
Federation of North Carolina Woman's
Clubs in its recent session at Hender-
sonville, where they adopted a resolu-
tion pledging themselves to cooperate
with and be guided by the State Board
of Health in all health and anti-vice
plans and campaigns.

The club women of the State can
bring about any reform to which they
set their hands in earnest, and the
unqualified support of such an organi-
zation will certainly advance public
health work in North Carolina.

A. J. W.

The Health Bulletin

A CONVERSATION THAT

TOOK PLACE IN

YOUR TOWN

Typhoid: "Were you at the confer-
ence yesterday?"

Jonnie Fly: "What conference?"

Typhoid: "You don't know about
it? Well, there was a big conference
between the flies, the hookworms, the
typhoid bacilli and the dysentery
bacilli down at the mayor's open privy
yesterday, to formulate some plan to
retaliate against the State Board of
Health for passing a law that does
away with the open privy and thereby
depriving us of the homes of our child-
hood. It simply means that if this
act is enforced it will almost com-
pletely annihilate us in this State."

Jonnie Fly: "What decision did you
reach?"

Typhoid: "Mr. Hookworm sug-
gested that we boycott North Carolina
and all move into the neighboring
states. You know the hookworm
crowd is about done for in North
Carolina anyway, so they are willing
to give up, and then, too, they are not
willing to cooperate with us to any
great extent, because we carelessly
stood back and allowed the State
Board of Health to almost wipe them
out without even raising a protest."
Jonnie Fly: "It is true that no other
state has acted so drastically towards
wrecking our homes, and we could
easily boycott North Carolina, but if
we give up without a fight it will make
the enforcement of the act much easier,
and this would tend to influence
other states to pass similar acts and
we would then be continually on the
move, and some day we would realize
that our last move was close at hand.
This, of course, would not occur in our
lifetime, but we have to think of the
future of our race. I am not willing
to give up without a fight to the finish."

Typhoid: "Your position, though,
Mr. Fly, is different from mine. You
are not absolutely dependent upon the
human excrement and open back
privies for the propagation of your
species and for your life's vocation, as
we are. And I feel, my dear Mr. Fly,
that our race is going to be compelled
to follow Mr. Hookworm's suggestion.
I an indeed sad, because I feel that
our comradeship, the comradeship
between your people and my people
in this State, I\lr. Fly, will soon begin
to wane. And when I think of the
State Board of Health, my sorrow is
intensified, because I know that crowd.
I know they are fearless fighters for
that which they in their convictions
believe to be right. And I know that
they are going to enforce the privy
ordinance to the letter. My despond-
ency is great."

Jonnie Fly: "My dear friend and
comrade, Typhoid, your predicament
is indeed precarious; your future in
North Carolina looks extremely dis-
appointing, but remember 'A friend in
need is a friend indeed,' and I pledge
you and your allies, dysentery and
hookworm, the support of the flies."

A. J. AV.

THE VETERAN

From Bethel clean to Appomattox,
through four long years, I done my
turn of fightin'. I wa'n't but a strip
of a boy then. Mother said I shouldn't
go, but how did she know? She never
had seen a war before. Well, any-
how, I found out she knowed more
about it than I did. What I saw and
went through with wasn't fit for a
beast, much less a boy. But somehow
we got through with it, and I got back
home to find everything all gone but
the home folks. Me and dad and
brother Bill all come through pretty
well used up, but all whole. 'Course,

The Health Bulletin

the Yankees stole everything we had
and burnt the barn, but they didn't
do no harm to Mother and the kids.
In them days the Germans didn't have
nothin' to do with It, and* so they
played the game sorter fair, you know.
But say, do you know what happened
along in '75, when we had almost for-
gotten about the war? Well, sir, the
fever struck our house, and not one
escaped it. Brother Bill was first,
and him that had went through all
that war didn't last but about two
weeks. There was Bill, and me, and
Mother and Dad, and Sister Sue, and
Sister Jane and her two kids, and
Mary, the cook, all had the fever at
the same time. I ain't never seen the
war do nothin' like that to a family.
Well, as I was tellin' you, Bill was the
first one to go, and then Sister Jane,
and by and by her little girl. Even
old Phil Sheridan didn't kill women
and children. And me? Well, I ain't
never been no account since then.

Then comes on the fuss with Spain,
and my fightin' blood riz up agin,
and so I got my finger into that pie,
too. Tell you the truth about it, that
wa'n't no war at all. It was simply
a disgrace. Think of it — 150 killed by
bullet wounds and over 2,000 by the
fever.

When this here fracus with the
Kaiser and his crowd come up. Uncle
Sam ruled me out, 'cause they said I
was no good. But my two boys, John
and Bill (that was named for Brother
Bill that died of the fever), they was
rarin' to go just like I did back in the
sixties. I didn't mind their goin',
so far as the fightin' was concerned,
'cause a man feels like he'd had a fair
chance if he gets killed while he's
tryin' to kill the other feller. But
thinkin' back to the days of '98, when
the fever hung around the camps like
the breath o' Hell, I don't mind tellin'
you it gave me a sinkin' feelin' in the

pit o' my stomach to think of my two
fine lads havin' to go into somethin'
like that.

But say, folks, I've found out that
it's all different now. There ain't as
many gets the fever in camps now as
if they'd stayed at home. John and
Bill writes me about all these things,
and besides I do a little thinkin' of my
own when nobody's lookin'. John he
tells me about gettin' vaxinated for
the fever the very first day he landed
in camp. 'Course, I didn't say nothin'
to nobody, but that struck me like a
funny way to start out fightin' Ger-
mans. Still, I knowed how vaxina-
tion keeps off smallpox, and I says
to myself that there might be some-
thin' in it after all. Bill writes me
about this, too, but tells me some other
things more in my line of thinkin'.
You see, I ain't never had much
schoolin', so I ain't in shape to know
much about such things as vaxination,
but some things I can understand as
well as them that's been to college.
When we all had the fever back in
'75, old Doc Jones said we got it from
an old pond with green scum on it.
He 'lowed that somehow it must have
traveled through the air. When the
boys all had it in the camps in '98,
they told us then it come from the
hot sun which we wasn't used to, and
from eatin' green cucumbers and such
like. Last summer, when they all had
the fever over at Amos Brown's, Doc
Wilkins said it come from their pig
pen, which had got into a pretty bad
shape, to be sure. Old Ty Fold, what's
Justice of the Peace, said he knowed
better. He 'lowed that the only place
they could have got it from was that
old pile of rotten wood that they had
in the back yard. He said he guessed
he had ought to know, 'cause he had
the fever three times hisself. I've
puzzled over the thing a heap. Sure
thing, they can't all be right. Fact is.

The Health Bulletin

none of these Ideers looks right to me.
You'll call me an old fool for settin'
up my opinion against Doc Jones, Doc
Wilkins and all them army doctors,
but I ain't hardly ever seen it fail that
when there's typhoid fever there's
plenty of flies around, and I just made
up my mind to it that them pesky
critters has somethin' to do with it.

Now, just as I was tellin' you, Bill
writes me how things is worked in
the camps. He says they fight flies
as if they was Germans, and says that
all the vittels is kept so that flies
can't get to 'em. And he was also
tellin' me about what they call latrines.
I reckon they must be what we call
privies, but he says they're fixed so
that flies can't get in and mess over
the privy stuff, like they do in these
here privies of ours.

Well, I know one thing for certain.
They ain't got no fever in the camps
now like they used to have. The boys
tells me it's due to vaxination and them
latrines, and I think they're both
worth tryin' at home. K. E. M.

A TWENTIETH CENTURY
FAIRY TALE

Once upon a time there was a
wicked, savage nation of Huns called
Disease. The Kaiser, whose name was
Typhoid, called together his lords and
generals, among them Diarrhea, Dy-
sentery, and Hookworm, and with
their assistance set about to conquer
the world. They speedily gathered
around them many lords and warriors,
who with their vassals eventually
formed a mighty army.

The conquering ariiiies of disease
and death penetrated all parts of the
world. Their spies and agents gained
entrance to all public gatherings and
to practically every home in the land.

It is possible that the world might
have been eventually defeated had not
the wicked Kaiser Typhoid and his
ministers made use of an infernal
engine of* warfare, a bombing machine
called the housefly, which flew into
the very kitchens, dining rooms, fruit
shops, and dairy houses, and dropped
deadly bombs of pestilence and disease
to kill neutrals, noncombatants, and
women and children.

The hearts of the noncombatant
nations, not only of the old world,
but also of the new world, sickened
at such infernal practices of warfare.
In the new world there was a nation of
lofty ideals. This nation, whose
name was Sanitation, dwelt upon the
continent of Education. They pro-
tested with the Kaiser against such
ruthless practices of warfare, but re-
ceived only insulting notes in reply.
The people of this nation then realized
that this was not and never had been
a restricted warfare, but that it was a
ruthless, savage warfare, waged with
the object of conquering the world.
Therefore the nation of Sanitation
declared war upon the wicked Hun,
in order to assist the harassed and
devastated peoples of the world.

On awakening to the emergency,
however, they found themselves beset
with spies, under the name of open
surface privies, who had long been
considered desirable citizens in every
community In which they were found.
The true character of the open surface
privy was first discovered and brought
to light by intelligence bureaus called
Health Departments. Their investiga-
tions revealed the open surface privies
to be spies of the most despicable
character. It was found that under
cover of what was supposed to be
legitimate business they had gained
entrance to practically every home in
the land and left unseen the deadly
germs of disease. It was learned also
that by virtue of their business

The Health Bulletin

standing they had obtained positions
of public trust, whereby they were
sufficiently removed from suspicion,
that they harbored, undetected, in
and about their premises, great multi-
tudes of marauders, and raiding par-
ties, which had been secretly sapping
the health and strength of the whole
world. They also furnished landing
places, food supplies and ammunition
for the enemy's bombing machines.
With systematic propaganda these
spies led the people to believe that the
tales of savagery and ruthlessness
from across the water were false, in
order to keep them from entering the
war against the Hun. When the
people of the nation of Sanitation
learned all these things, they rose up
in mighty anger, and cast the once
trusted enemy agents and spies out
from their midst to a death of disgrace.
At this time, however, the power of
the wicked enemy seemed to be at its
highest. The hordes of Huns had long
been coming on, in drive after drive.
It seemed that their enemies' resist-
ance would soon be broken, whereupon
they would be pushed into the sea.
A dark cloud of dejection hung over
the world. The new allies of the
harassed nations found themselves
unprepared for warfare, on acccount
of the propaganda of the open privy.
They speedily turned every effort to
making ammunition and war material
and training soldiers. Men, women
and children worked day and night,
hoping to get their armies into the
field before it was too late. Mean-
while, their allies held on, being
pushed steadily backward, clinging to
the hope that the new ally. Sanitation,
would enter the field before it was
too late. Finally the armies of Sani-
tation, under the leadership of Gen-
eralissimo Sanitary Privy, came, and
continued to come with ever increas-
ing numbers until they occupied all

parts of the field, whereupon the tide
of battle turned, until in February,
1919, after having encountered count-
less losses, the wicked enemy saw
that it was useless to resist longer,
and asked for an armistice, which was
granted by the General Assembly of
North Carolina in February, 1919.

Peace terms were formulated by the
State Board of Health and formally
presented to the enemy on July 1,
1919. The terms presented shattered
the power of the wicked enemy and
forever banished the Kaiser Typhoid
from the world as represented by the
portion of North Carolina's population
coming under the provisions of the
new law. They also provided for the
wholesale destruction of his infernal
machines of warfare, including the
deadly housefly. The provisions of
these peace terms demanded compli-
ance by October 1, 1919.

The following summer found Ty-
phoid and his chiefs shorn of their
homes and power. They had become
outcasts, never to be allowed upon the
face of the earth again.

Their wicked people are still paying
the debt of reconstruction and resti-
tution, while the world once so ruth-
lessly harassed and beset by spies,
traitors and savagery, lives in peace
and joy, protected by the league of
sanitation, which is presided over by
the sanitary privy. H. E. M.

CIVIC CONSCIENTIOUSNESS

BY REV. G. W. LAY.

Good health in a community does
not depend alone on physical condi-
tions, and cannot be controlled merely
by efforts to enact and enforce regu-
lations that deal with material things.

There must be, first, Civic Intelli-
gence. AH the people must be edu-
cated to know what to do and why to

The Health Bulletin

do it. But beyond and above all this
there musl be the cultivation of the
moral and spiritual qualities. The
right will not win in the Health War,
or in any war, unless each citizen,
not only knows and holds the right,
but also feels from the bottom of his
soul the moral obligation as an indi-
vidual to give all that he has and all
that he is in order that others may
live and live well.

There must be, second. Civic Con-
sciousness, that is, the feeling that we
are all members of a community and
that if one member suffers, all the
members suffer with it. One may
have this civic consciousness and only
be interested in what other people are
doing for the health of the community,
hoping to reap the benefit thereof.
It might exist where each man was
entirely selfish.

There must, then, be, third. Civic
Conscience, that is, a feeling of moral
responsibility for the welfare of others,
a high sense of the duty that each
owes to all the rest. A community
that has advanced thus far is doing
well. But this is not enough. I
may know what to do and my con-
science may tell me I ought to do it,
and yet I may lack the strength of
character to do as I know I ought.

There must, therefore, be, fourth.
Civic Conscientiousness. This is the
ultimate compelling force that drives
everything before it to success. The
conscientious man makes himself do
that which his intelligence tells his is
proper and his conscience tells him he
ought to do.

This quality cannot exist with
health and sanitation as its only
object. If it exists at all, it will show
itself in conscientious obedience to all
laws, whatever their object, and only
by the cultivation of a universal con-
scientiousness towards all duties will
it be possible to produce a body of
citizens devoted to the performance

of those particular duties that concern
the one object of the preservation of
life and health.

Here is a vast field for the teacher
and the writer. The schools and the
press can do a noble part. But above
all, it is the opportunity and the re-
sponsibility of the preacher. He who
has the care of souls must also have
a care for the body. To save the
bodies of his people, he must first
cleanse, instruct, and inspire their
souls, and then, ultimately, he will
save both soul and body. Health work
is based on a religious foundation
without which its efforts fail. When
completely carried out, it is the prac-
tical application of the whole scheme
of Christian doctrine and a demonstra-
tion of what follows from the Royal
law: "Thou shalt love thy neighbor
as thyself."

In the terrible influenza plague re-
cently, one of the difficulties was to
know what to do. There seemed little
connection between this plague and
material, sanitary conditions. And
yet, curiously enough, those commu-
nities which had already achieved
most success in health work and in
lowering their death rate seemed on
the whole to suffer least from this
plague. There was a remarkable cor-
respondence between the death rates
of different cities in recent normal
years and the rate of cases and deaths
from influenza. If this be so, and the
papers called attention to it, is it not
reasonable to conclude that the decid-
ing factor in both rates was the moral
character of the citizens? A commu-
nity that had been raised to a high
level of civic intelligence, civic con-
ciousness, and civic conscientiousness,
in order to lower the death rate, pos-
sessed the very qualities which alone
could be efficient in the struggle
against the influenza. The qualities
which made the influenza spread were
ignorance, selfishness, disobe Hence to

The Health Bulletin

laws and instructions, and other dis-
regard for the dangers to which one
might expose others. The production
of high moral character and of all
the Christian virtues, which is the
business of the church, will furnish
the basis on which alone every suc-
cessful campaign for health must be
waged.

A young Hebrew once told me that
his mother was so strict that she
would not even eat an apple without
first washing her hands and saying a
prayer. If everyone washed his hands
before every meal, it would be a great
step forward in the prevention of
disease. I thoroughly believe in the
efficacy of prayer, though I do not
know just how it works. But I am
very sure that the man who says grace
before meals, thereby acknowledging
his dependence upon God and his duty
towards him, is more likely than one
who neglects this to be conscious of
his true relation towards his fellow
men. Truly, cleanliness is next to
Godliness.

It takes good, conscientious men
to secure good health for a community.
There is no glory in it; you never
know what you have done except by
the bare figures of the annual death
record, and you get no credit for what
you have done. Besides, if ten men in
each thousand have been saved, no
one man feels that he was the par-
ticular one who was saved. No one
feels grateful, and if any one felt
grateful at all, he could only feel so
in a general way towards the commu-
nity as a whole. The man who
picks up a piece of glass from the road
does not know whose tire did not get
punctured, and those who follow him
are ignorant of the danger from which
they were saved. But if a doctor
saves a man's life by performing a
difficult operation or by carrying him
successfully through a dangerous ill-
ness, the doctor gets credit for what

he has done and has a right to feel
proud of it, while the patient will
always feel truly grateful to the man
who saved his life.

Prevention requires intelligence of
a docile and humble kind. The man
who holds tenaciously and expresses
vehemently half-baked opinions on
matters of which he is really ignorant,
is a danger to the health of a commu-
nity. He thinks he knows more than
the doctor who is a specialist, and he
feels that his empty utterances are
entitled to respect. He opposes good
doctors and is a follower of the latest
school f quackery, and does not be-
lieve in vaccination against smallpox
or typhoid, or that malaria is caused
by a mosquito and typhoid carried by
flies. He is a great clog against any
forward movement. He is a wicked
man. God has no use for a fool, and
it is made clear in the Bible that the
fool is a sinner just as plainly as that
the sinner is a fool.

Success in the prevention of disease
depends on that universal feeling of
moral responsibility that believes in
the necessity of obedience to every law
just because it is the law. There is
no direct connection between health
and cutting across the grass and spoil-
ing the neighbor's lawn, or dropping
paper on the sidewalk. But where
people perform these amiable tricks,
or leave the road and make ruts in
the lawn with their automobiles, or
try to beat the cop and evade the traffic
laws, the health record will probably
be poor.

To secure health every citizen must
feel that the town is his town and that
he has a duty towards every one in it
just as much as towards his own wife
and children. He must obey every
law himself and he must see that
every one else obeys the law and that
every law is enforced on everybody
all the time. If the best citizens play
cards for money or allow liquor to be

The Health Bulletin

sold in their clubs or match nickels
tor soda water, while the poor negro
is severely punished for shooting craps
or for getting a drink for a thirsty
stranger, it is not to be wondered at
if the average man concludes that no
moral principle is involved and that
law enforcement is a mere matter of
expediency and favoritism.

One of the greatest things that e\er
happened was when one of the highest
ecclesiastics in Havana was arrested
for not having a cover to his garbage
can. He proved that he had had a
cover and that he did not know
it had been taken. The answer was
that it was his duty and that of no
one else to see to that particular gar-
bage can; that Havana would not be
kept healthy with open garbage cans,
and that he must pay the fine. Unfor-
tunately, while we may ascertain who
breaks a specific law, we can seldom
tell who was the direct cause of a
particular case of contagious disease.
Someone has caused the sickness and
perhaps the death of a fellow-being,
usually an innocent child. No one
can be sued for damages or prosecuted
for man-slaughter. The guilty escape
punishment and even the conscious-
ness of guilt. In health matters,
there is no answer to the time-honored
questions: "Who killed Cock Robin?"
and "Who hit Billy Patterson?"

Behold on how high a plane stands
the campaign for health! It fails
unless conducted on the highest
grounds of Christian Charity for all
men. It is useless to appeal to merely
selfish motives. I cannot be safe un-
less I make my neighbor safe; his
health is necessary to my health. I
must work for the good of all, even
though there may be some slight
underlying selfish motive, and thus I
am compelled to live the Christian life.
I am foolish if I do not protect myself
absolutely against smallpox and

typhoid, and, when necessary, against
diphtheria; but for most communi-
cable diseases I must depend on the
condition of all in my community.
Complete success will only come with
entire unselfishness. I must be vac-
cinated against typhoid, not simply for
my own sake, but to support the right,
to set a good example and to prevent
the possibility of giving the disease
to others.

Finally, each man is personally re-
sponsible to God for his neighbor's
health. I cannot put it off on "they"
or "Put it up to God." That mysteri-
ous "they" is the bugbear of all re-
form. When a citizen says "They
ought to do something," we know we
have found some one who evades con-
tentedly his own moral responsibility.
"They" means "me." "They" to this
man means everyone except himself.
If everyone takes that ground, every-
one is exempt and no one is respon-
sible.

God is all-powerful, but He has taken
each of us into partnership. It is His
will that all men, including you,
should be saved. But He is not going
to compel it. He has left you free.
You must even "work out your own
salvation with fear and trembling."
It is so with life and health. Do we
dare say that it is God's will that the
cruel murderer shot down the harm-
less man? Is it not then a profane
impertinence to say it is God's will
that a little child died of preventable
disease when it was given him by
another child whose parents deliber-
ately allowed him to> break quarantine
and give the disease to passers-by?
It is God's will that we should keep
His laws and obey religiously the laws
of man. If I live by the Christian
law, I am working for health; and I
cannot work successfully for health
unless I feel my full moral responsi-
bility to live in all ways by the Chris-
tian law.

The Health Bulletin

l.*?

THE AIMS OF THE BUREAU

OF INFANT HYGIENE TO

BE ACCOMPLISHED

THROUGH COUNTY

NURSES

Bj' Mrs. Kate Brew Vaughan
Chief of Bureau

The most important aim of all pub-
lic health work is that of making
stronger, better citizens. Needless to
say that the great burden of this task
rests upon the mothers, and they are
showing continually their readiness
to assume the responsibility as rapid-
ly as they are prepared for it. The
first step, then, in this branch is edu-
cation — the instruction of the mother
in the care of herself during the ex-
pectant period, not only that the child
may be well nourished at birth, but
that the chances for maternal nursing
during the nine or twelve months
after birth will be enhanced.

The next step is the instruction in
the care of babies. The bureau of
Infant Hygiene of the State Board of
Health believes the best results are
obtained by personal advice given by
the county nurse in home demonstra-
tions or in small groups.

The way to accomplish this may
perhaps be best expressed in the fol-
lowing instructions, which it is hoped
every nurse will have in her posses-
sion and try to live up to.

We aim —

1. To instruct expectant mothers in
the hygiene of pregnancy:

a. To encourage medical atten-
tion;

b. Urine analysis; attention
called to danger signs of preg-
nancy;

c. Proper feeding, rest, clothing,
exercise, etc., to insure normal
development of baby and safe
delivery and to make possible
maternal nursing.

2. To supervise and instruct mid-
wives:

a. Precautions for septic condi-
tions — method of scrubbing
hands and using disinfectants.

b. In conducting a safe delivery
and advising regarding danger
points at which a physician
must be called.

c. Attention to cord dressing and
method of dressing the newborn
baby.

d. Introduction of two drops of
two per cent silver nitrate in
each eye. Furnished free by
State Board of Health.

e. Advise against castor oil or
teas for baby until mother's
milk is established.

f. Establishment of regular feed-
ing hours — 2% hours for a
newly born baby.

g. Separate sleeping quarters for
newly born baby. (Padded
basket will answer.)

h. Proper ventilation of the sick

room,
i. Proper care and bathing of

the mother first 5 days,
j. Advise against encouraging

mother to leave the bed before

the 10th day.

3. Encourage breast-feeding in every
case.

a. Teaching the mother the value
of diet, hygiene and exercise
which will enable her to nurse
her baby.

4. Where artificial food is necessary,
to impress the importance of mod-
ified cows' milk, the feeding to
be directed by a reputable physi-
cian. In case no physician is
employed, "The Cornerstone of a
Child's Future," by Dr. A. S.
Root, to be used as a guide.

a. To demonstrate preparation
of food, observing mother as she
prepares the food until she has
mastered the process.

b. To make sure that mother
understands how to care for the
milk after the initial prepara-
tion — sterilized bottles, cotton
stoppers, temperature below 50
degrees. Explain to mothers
why boiled milk allowed in
temperature above 50 degrees
may become infected.

c. Teach mother proper care of
nipples and bottles.

The Health Bulletin

d. To discourage use of pacifiers.

e. To insist upon regularity in
feeding.

f. To forbid the feeding of solid
food to children under 12
months.

5. Where artificial food is necessary,
cows' milk is unobtainable, or con-
ditions for preserving same are
inadequate, nurse v/ill advocate
the use of dry milk, advising 21/2
tablespoons per pound body
weight every 24 hours, diluted
with an ounce of water for each
tablespoon of milk, milk to be
prepared each feeding on this
basis:

a. The heating of milk (fresh
milk boiled or dry milk) has a
tendency to rob the food of the
vital principles or vitamines.
These are replaced by the use
of small quantities (continu-
ously increasing) of orange
juice, sweet lemonade, potato
water, cabbage water, or tomato
juice boiled and strained.

6. Demonstration of baby comfort:

a. Bath.

b. Making of bed.

c. Ventilation of room (impor-
tance of fresh air to baby).

d. Buying or making of suitable
clothing for baby.

7. Advice for the child of pre-school
age as to feeding, defects, cloth-
ing and habits.

a. Care should be taken to de-
termine tuberculosis or syph-
ilis in mother, baby or older
members of the family. Where
the fact is established, advice as
to precautions and care tact-
fully given.

8. A thorough knowledge of all
agencies in a county working for
Child Welfare — charitable, philan-
thropic, private institutions, hos-
pitals, dispensaries and doctors,
and cooperation with same offered.

9. Organization of mothers' clubs,
where none obtain, or regular
meetings with organized bodies
in a county.

10. Where no mothers' meetings ob-
tain, occasional demonstrations —
preparation of milk, care and
washing of bottles, etc., in the
homes.

11. A simple exhibition of clothing
for different seasons should be
given in prenatal cases.

12. Mother should be encouraged to
regularly weigh and measure her
baby, keeping for comparison a
written report each week.

The order in which these things are
taken depends upon the needs and
condition of the mother and baby.
Great discretion on the part of the
nurse has to be used not to insist upon
more being done at a time than the
mother is able to understand and
carry out. The main object of the
work is the education of the mother
and her ability to carry out instruc-
tions depend^5 largely on her social
condition.

ECZEMA

Many mothers are writing to this
bureau for information regarding
eczema and most of those writing
seem to regard it as a trivial but irri-
tating ailment. Many others who do
not write are called upon to give it
attention.

Eczema is the commonest skin dis-
ease in babies under two years of age.
The skin of infants is extremely deli-
cate and more easily affected by exter-
nal irritants. While all children are
susceptible, there are some especially
sensitive to irritation and to digestive
disturbances. It is prevalent in some
families and often inherited with
other evidences of diathesis. It very
rarely occurs in poorly nourished chil-
dren, but is common in fat, healthy-
looking babies, breast-fed or bottle-
fed, and it is more often on the face
and scalp than upon the body, though
it appears often on other parts of the
body.

The face becomes raw and moist
and a sticky, watery fluid comes from
it. This dries and forms a thick,
dirty-looking crust over the sore
places. Itching is intense and causes
great suffering. The baby scratches
the sores and this makes them bleed.

The Health Bulletin

These children cannot sleep well at
night. They often have diarrhea,
lose weight, and their health becomes
affected.

It is often hard to say what causes
eczema; it is sometimes due to over-
feeding, sometimes to giving the child
too much sugar or fat, sometimes to
using too strong soap on the skin and
sometimes to uncleanliness.

Treatment: Cut down the food in a
breast-fed baby by not nursing so
often. In a bottle-fed baby cut down
the sugar and partly skim the milk.
See that the baby's bowels move
every day. Don't wash the sores with
plain tvater, or soap and water. Wash
them gently with equal parts of milk
and water, but not often. Anoint with
olive oil to soften crusts, so they may
be removed in order to reach the dis-
eased surface. Cut out some stiff
pasteboard slips and bandage them
around the elbow joints. This allows
free use of the hands but makes it
impossible for the child to reach the
sores. A soothing application is
composed of equal parts lime water
and sweet almond oil.

Salves recommended should be ap-
plied in this way:

Make a mask of muslin for the
face (if the eczema is on the face)
and smear the salve on the muslin
and tie it on. It should stay on day
and night for a few days, until the
sores are improved, and then put on
every few days until they get well.
Clean the parts gently with olive oil.

Holt advocates as a simple protec-
tive ointment, one containing starch,
zinc oxide, or bismuth, either alone
or in combination, may be used. An
excellent formula is zinc oxide oint-
ment with 2% of salicylic acid. Later
when inflammation is less acute and
the itching severe, tar in the strength
of ten to twenty per cent may be
substituted for the salicylic acid.

THE COST OF NEGLECT

Report of the Provost Marshal Gen-
eral:

Total men called by draft... 3,802,946
Total examined by local

boards 2,510,706

Total rejected by local boards

for physical reasons 730,756

Pex'cefttage of those examined

rejected 29.11

Add 5.8 per cent rejected at

cantonments (estimated) . . 33.11

There is no disputing these figures.
There is no sentiment attached to
them. They are the cold facts ob-
tained by military machinery. If
one-third of American manhood be-
tween the ages of 21 and 31 is so
physically defective as to be rejected
for military srrvice, what is to be
expected of those under 21 and past
the age of 31?

The most superficial analysis of the
causes for which men are rejected
for service shows that more than 60
per cent of these defects are prevent-
able; that 30 per cent are due to poor
general physical condition, which can
be remedied by proper feeding, by
proper attention to personal hygiene
and physical training; that another
30 per cent are due to defective eyes
and teeth, including bad mouth con-
ditions; and that only 10 per cent are
due to neglected surgery.

An analysis of the purely prevent-
able defects for which these men have
been rejected shows that they are not
acute or of recent occurrence, but that
they are chronic conditions; that is,
they have existed for years, many of
them from early childhood. A little
more attention to the physical needs
of children, correction of their minor
defects while they are still easily
remedied, and proper health protec-
tion of the growing boys and girls
would result in a very different health
and efficiency analysis of the adult
population.

The Health Bulletin

The Percentage of Venereal Diseases Among
Approximately the Second Million Drafted Men

By States.

Examinations at Mobilization Camps showed that 5.4 per cent of these men had a venereal disease
at the time of examination upon arrival in camp. This percentage includes only obvious cases of syphilis
and gonorrhea and chancroid. Wassermann examinations were not given. Furthermore, this percentage
does not include those who had been previously cured or who may have become infected later. The
record for each State follows:

According to the statement of the Surgeon General of
the War Department, venereal diseases constituted the
greatest cause of disability in the army. For this con-
dition, civilian communities have been responsible.
Virtually all cases of venereal diseases were contracted
within communities ever which civil authorities have
control.

It will be noted that the percentages are much higher,
as a rule, than the percentages for the first million men.
This is due to the fact that, as a result of experience
gained by the Examining Medical Boards, the medical
officers in the Army were able to make more careful ex-
aminations of the second million men and to record more
carefully diseases detected than was possible at the time
of the sudden mob lization of the first million men.

The Army has done more than its part in combating

venereal disease. Civil communities must continue

the fight vtith vigor.

Reports from your State and city w\\\ be watched

with interest by the nation.

EXPLANATION OF GRAPH

Taking Mo
hundred draft

vhich they
enerral d>sea
33 who had

mple, out of every
t the various mobili-

!real disease.

The figures here
Medical Records Sec
OfSce of the Army.

ere furnished by the
the Surgeon CeneraTs

^V AY

This BiJlelirvwillbe 3e?\1 free to oraj Q-tken of tha State upon "requesU

Vol. XXXIV

SEPTEMBER, 1919

No. 9

GO TO IT!

Here is the ivay a prominent merchant in one North Carolina
town feels about the efforts of the State Board of Health to abolish
the insanitary, open-back privy in the State. For obvious reasons
his name and town are omitted. Writing straight from his heart
he says:

"Seems you are going to get busy about October 1st and
have some privies looked after.

"It should be DONE.

"Anything worth doing at all is worth doing WELL.

"DO IT WELL.

"My, you got a job!

"Suppose every landowner in North Carolina should see
your last Bulletin. Would it not wake them up?

"Wake 'em up!

"Sheriffs of the counties ought to distribute about one
hundred thousand copies at once. I will pay my part for such
work to be done — and I will get out cheap, if it does the work.

"I know a man worth $25,000, five in family, one a
teacher in graded school, owns a touring car, have no more
privy than a monkey in Africa. His flies eat dinner with
sanitary neighbors every chance.

"IS IT RIGHT

"Roll up your sleeves and,

"GO TO IT!"

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

J. HowEix Wat, M.D., President, Waynesville
Richard H. Lewis, M.D., Raleigh
J. L. Ludlow, C.E., Winston-Salem
Thomas B. Anderson, M.D., Statesville

E. C. Register, M.D., Charlotte

Chas. O'H. Lauqhinghouse, M.D., Greenville
Cyrus Thompson, M.D., Jacksonville

F. R. Harris, M.D., Henderson
E. J. Tucker, D.D.S., Roxboro

OFFICIAL STAFF

W. S. Rankin, M.D., Secretary State Board of Health and State Health Officer

A. J. Warren,' M.D., Assistant State Health Officer

RoNAXD B. Wilson, Director Public Health Education

L. B. McBrayer, M.D., Superintendent of the State Sanatorium

J. R. Gordon, M.D., Deputy State Registrar

G. M. Cooper, M.D., Chief of the Bureau of Medical Inspection of Schools

H. E. Miller, C.E., Chief of the Bureau of Engineering and Inspection

James A. Keigkr, M.D., Chief of the Bureau of Venereal Diseases

Mrs. ICate Bbew Vaughn, Chief of the Bureau of Infant Hygiene

F. M. Register, M.D., Chief of the Bureau of Infant Hygiene

B. E. Washburn, M.D., Director County Health Work

FREE PUBLIC HEALTH LITERATURE

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

Sanitary Privies

Bb^idbktial Sew.\ge
Disposal PijAnts

Eyes

Flies

Colds

Teeth

Cancer

Malaria

Smallpox

Adenoids

Measles

Whooping-oouqh
Hookworm Diseash
PtTBLio Health Laws
tubbboulosis laws
Tuberculosis
Scarlet Fever
Infantile Paralysis
Care of the Baby
Fly Placards
Typhoid Placards
Tuberculosis Placards
Clean-up Placards
Spitting Placards

SEX HYGIENE BULLETINS

German Measles

Typhoid Fever

Diphtheria

Pellagra

Constipation

Indigestion

Infant Care

Child of Pre-School

Age
Corner Stone of

Child's Future
Pre-Natal Letters

Set a — For Young Men
A Reasonable Sex Life for Men.
Sexual Hygiene for Young Men.
Vigorous Manhood.

Smash the Line. (The case against the re-
stricted district.)
List of Reliable Pamphlets.

Set B — ^FoR Public Officials and
Business Men
Public Health Measures in Relation to "Ve-
nereal Diseases.
Venereal Diseases — A Sociologic Study.
Smash the Line. (The case against the re-
stricted District.)
The Need for Sex Education.
A State-Wide Program for Sex Education.
List of Reliable Pamphlets.

Set C — For Boys
Vigorous Manhood. (Especially for boys 12
years of age and over.)

Note. — For boys under 12, see "When
and How to Tell the Children" (Set D) ;
portions of "Vigorous Manhood" also may
be read to younger boys. Boys 15 yeart
and OTer may be given Bulletin "A Rea-
sonable Sex Life for Men" (see Set A),
at the discretion of the parent.
Sexual Hygiene for Young Men.
Li«t of Reliable Pamphlets.

Any of the above will be sent without charge
which you have definite use.

Set D — For Parents
When and How to Tell the Children.
Venereal Diseases — A Sociologic Study.
The Need for Sex Education.
List of Reliable Pamphlets.

Set E — For Girls and Young Women

Your Country Needs You. (Especially for
girls 11 years of age and over.)

The Nation's Call to Young Women.
List of Reliable Pamphlets.

Set F — For Teachers

The School Teacher and Sex Education.
Sex Education in the Home and High

School.
Venereal Diseases — A Sociologic Study.
Smash the Line.
The Need for Sex Education.
List of Reliable Pamphlets.

Please send for only those bulletins for

IDWAUBS t IROUSHTOM PKlNTmB CO.. RALtiaH. H. C.

PUBU5AEJD 6YTME. HPRTM CAPQunA 5TATL PXy^D »^MEALXA iIR

Vol. XXXIV

SEPTEMBER, 1919

No. 9

EDITORIAL

DID 3I0SES KNOW HIS BUSINESS?

Thirty-five hundred years ago Moses,
writing at the dictation of Omniscience,
prescribed in Deuteronomy 23:12-13,
a means and a manner for the sani-
tary disposal of human excreta. This
law, divine in its origin, was regarded
as necessary for a nomadic people liv-
ing in a wilderness with an abundance
of space and natural privacy. This
law provided a manner of excreta dis-
posal which prevented (1) through its
immediate burial, infestation with fly
eggs and the breeding of flies; (2) ac-
cess to and contamination with flies
and insects that would visit, contami-
nate and infest the food and drink of
the people; (3) the washing of the ex-
creta over the surface of the soil into
water supplies; and (4) the contami-
nation of the feet and other exposed
parts of the body of the Israelites with
the infection of hookworm disease.

Thirty-five hundred years since
Moses, we find in a modern civiliza-
tion, in a civilization with public
schools, churches, colleges, and a great
university, in every unsewered block
of every village and town and city of
North Carolina, many, from three to
twenty, uncovered, unprotected, un-
hidden, buckets full, boxes full, and
uncontained accumulations of hu-
man excreta, alive with maggots,
loaded with the germ potentialities of
sickness and death, for domestic ani-

mals to scatter and for flies to bear on
encrusted legs and wings to the
kitchens of all living within three
hundred yards of the filth.

Moses was either right or wrong.
Our General Assembly of 1919 took
the position that Moses knew his busi-
ness; that his law disposing of human
excreta so as to prevent infection of
persons by flies, water and contact,
like old-time religion, was good enough
for North Carolina and so our progres-
sive State, in regulating the disposal of
human excreta, came abreast of the
times— the times of the Children of
Israel in the wilderness three millen-
iums ago. w. S. R.

TYHAT THE PBESS CAN DO

Fifteen million dollars can be saved
for the State of North Carolina each
year. In undertaking to effect that
saving the newspapers of the State can
play a most important part.

This is a statement in cold terms
of dollars and cents of a human prob-
lem that is pulsating with life. It is
figuring the economic loss to the State
that is now a steady drain, and does
not take into consideration the matter
of broken hearts and desolated homes.

To be specific, there are approxi-
mately 3,500 deaths each year in North
Carolina from fecal-borne diseases.
From the same source each year there

The Health Bulletin

are approximately 35,000 cases of ill-
ness.

In calculating the cost of these ill-
nesses and deaths only an approxi-
mation has been attempted. Econom-
ists calculate that the value of an adult
at the age of thirty is |4,000. In the
same manner it is calculated that an
average case of typhoid fever, includ-
ing those who die and those who re-
cover, costs $400. The cost of dysen-
tery and diarrheal diseases is approxi-
mately half as much.

Making the calculation on this basis
North Carolina has an annual loss of
virtually fifteen million dollars, a loss
that is a pure economic waste and one
that can be prevented. There is no
way of calculating the loss in terms
of suffering and sorrow. For these
we have no measure. For that matter,
who can calculate the value of a life
that is snuffed out? Who are we to
say that a tiny babe, or a grown
man, is worth so much in dollars and
cents? It is presumptuous, of course,
to attempt such valuation. Yet this
is the only standard of measurement
we have that is comprehensible, and
in estimating the loss it is probable
that an underestimation has been
made, rather than too high a value
set.

To overcome this dead loss from
an economic standpoint, to effect this
saving of such an enormous sum, to
prevent so many hearts from being
bowed down in sorrow because of the
suffering and death of loved ones, is,
I submit, an undertaking worthy of
the best efforts of every one in whose
heart there is love for others. It is
an undertaking worthy of the press of
North Carolina, which is guided by
men and women with a large vision
of life and service.

There are three primary sources of
communicable diseases: secretions of
the nose and mouth; insects; human
excrement. From the first is spread

tuberculosis, diphtheria, measles, scar-
let fever, whooping cough, and the va-
rious other diseases of the respira-
tory organs. Mosquitoes spread mala-
rial and yellow fevers. Through hu-
man excrement is spread typhoid fe-
ver, dysentery, diarrheal diseases and
hookworm. It is only with the latter
class that I am dealing.

With all reverence I say to you that
the hand of God strikes do^vn no man
with typhoid fever. A loving Father
in Heaven does not call a little baby
to the Great White Throne through the
means of weeks of sickness and suffer-
ing from "summer complaint." These
come only from the swallowing of in-
fected human excrement. To me there
is no greater blasphemy than to lay
the blame on the Lord.

"God helps those who help them-
selves" is an old saying, and true.
Here is where we have a wonderful
opportunity of helping ourselves and
our neighbors. The careful and p.'oper
disposal of human excrement means
practically the banishment from the
State of these diseases. Water sewer-
age is not possible for every home in
the State; a sanitary privy is. That
way lies the economic saving of fifteen
millions of dollars, and the adding of
untold happiness to our people.

It is true that every case of typhoid
fever or diarrhea did not have its ori-
gin from an insanitary privy. It is
also true that after the State has been
sanitated there will continue to be
sporadic cases of fecal-borne diseases.
But it is quite certain that the open
back, insanitary privy is the chief
source of propagation for the diseases
of fecal origin in North Carolina. In
abolishing this abomination we save
life and promote health.

There is nothing new in this. It is
no impractical theory of some dreamer.
It is just fact, recognized through the
centuries by those who stop to think.

The Health Bulletin

The trouble is that so few ever really
think.
Away back in the early dawn of the
- race Moses, the great lawgiver, or-
dained, as we read in Deut. 23:12-13:
"Thou Shalt have a place also without
the camp, whither thou shalt go forth
abroad: and thou shalt have a paddle
upon thy weapon; and it shall be, when
thou wilt ease thyself abroad, thou
shalt dig therewith, and shalt turn
back and cover that which cometh
from thee."

The General Assembly of the State of
North Carolina in its session of 1919,
some three thousand years later, has
enacted a law one section of which
reads as follows: "Every residence
located within three hundred yards
of another residence must have an im-
proved privy of a type approved by
the State Board of Health."

Frankly, in undertaking to carry
out the provisions of this law the State
Board of Health feels that it is un-
dertaking one of the biggest pieces of
work for the protection of the public
health that has been inaugurated dur-
ing a period of ten years that has
been by ho means inactive. It more
intimately touches the homes of North
Carolina than any previous health leg-
islation. The enforcement of the law
will require an enormous amount of
real work, and even more of tact
and discretion.

The greatest ohstacle to the enforce-
ment of this law is ignorance and in-
difference on the part of a large por-
tion of the State's population. If the
people as a whole can be interested,
if they can be told just what the law
is, and the why and the how of it,
there is little danger of failure with
regard to this measure.

How to reach the greatest number
of people in the shortest time with the
facts about sanitation, and what the
law requires, is the problem. The
State Board of Health naturally turns

for aid to the press of the State. For
years the State press has effectively
helped every effort of the State Board
of Health in its work of promoting
the public health. There has been no
factor so potent for the upbuilding and
improvement of North Carolina as its
daily and weekly newspapers. No one
has more cause to realize this fact,
and I am sure no one has more ap-
preciation of all that it means, than
have the officials of the State Board
of Health.

Therefore, with the present big prob-
lem, the State Board of Health comes
to the men and women who direct the
power of the organized press of the
State and asks their help, confident
that it will be given generously as it
has been given in the past. The end
sought is that our people may have
life, and have it more abundantly.

R. B. W.

A HA^DBOOK ON CANCER

A new handbook for the medical
profession, issued by the American So-
ciety for the Control of Cancer, en-
titled "What We Know About Cancer"
has been published by the American
Medical Association press, and the
State Board of Health has a supply on
hand for free distribution to any phy-
sician who requests the same.

This handbook deals with the entire
cancer problem in short, concise and
practical way. It stated simply and
clearly what every doctor ought to
know about the cancer problem in gen-
eral, and the different types of cancer
as well, without incorporating so much
of the purely technical as to make it
unreadable and unintelligible to all
save cancer research workers. The en-
tire booklet can be read in thirty to
forty minutes, and it contains informa-
tion that would require hours of read-

The Health Bulletin

ing to digest from voluminous texts,
and yet it contains all the practical
information necessary for the general
practitioner.

The contents are classified under the
following seven heads:

1. Early consideration.

2. Early diagnosis and treatment.

3. Precancerous condition.

4. Carcinoma of different organs.

5. Sarcoma.

6. Other malignant tumors.

7. Treatment or inoperable and re-
current cancer.

The information is authoritative and
when given to your cancer patients you
know you are absolutely correct. The
advice or treatment above would make
of it a valuable collection of data,
based on the past experiences of the
cancer experts of the world.

No well qualified physician ought to
be without it. A. J. W.

WHAT ONE NEWSBOY DID

Now that the State Board of Health
is slowly perfecting an organization
under the new law providing for the
examination of school children, many
things are happening which more and
more vindicate the wisdom of the Leg-
islature in providing for free dental
treatment of a limited class of young
school children regardless of financial
or social standing of the children.
One of the latest arguments is con-
tained in the following human inter-
est story, tucked away in an ob-
scure paragraph, in a report of the
school nurse for the city of Asheville,
made to the "Bureau of Medical In-
spection of Schools. The nurse says
that "the interest manifested in the
care of the teeth by the children has
been most encouraging. A little boy
in one of the lower grades needed
dental work done but his pride would
not allow him to accept charity from
even a dentist. By arising early and
selling papers he has saved enough
to have the work done, and on inspec-

tion days at his school he proudly
displays those clean teeth and is most
liberal with his advice to the other
boys to do likewise."

This is the spirit that is manifested
all over North Carolina among the
children of every age, sex, race and
color. No child wants to be singled
out before his fellow pupils as an ob-
ject of charity; but when the State is
providing this treatment at public ex-
pense and when the rich man's child
along with the poor man's child pre-
sents himself for treatment by the
school dentist, it is recognized by the
most ignorant and sensitive as a public
obligation, and therefore there is no
stigma attached.

Only a limited number of little boys
in the State of North Carolina could
possibly have the opportunity of earn-
ing extra money with which to pay
for dental work. For 99 per cent, of
them the money for this service must
come out of the family treasury, and
if the family treasury is empty the
necessary dental work for the children
is delayed and in, literally, thousands
of cases never done.

The teachers, the school authorities,
the county authorities, wideawake peo-
ple in every profession, occupation
and calling, in every county of the
State should do all in their power to
cooperate with and aid the State Board
of Health in making available to as
many children as possible the free
dental treatment provided by the Leg-
islature, and also strive to get the
parents of children who need opera-
tions to take advantage of the club
operations conducted by the State
Board of Health. G. M. C.

A. P. H. A. IN NEW ORLEANS

The next annual meeting of the
American Public Health Association
is to be held at New Orleans, Louisi-
ana, October 27-30, inclusive.

The Health Bulletin

STATE PROTECTS YOU

AGAINST YOUR NEIGH

BORS FILTH

Recently when I was retui'ning from
a trip to a certain town in the eastern
section of the State, I had a very in-
teresting conversation with a travel-
ing man. I happened to run across
him at a junction point where we were
compelled to wait four hours for our
train which was delayed on account of
the high mark v/hich the waters of
Little River had reached.

As a result of our delay w6 were
compelled to seek a nearby hotel at
which we might purchase an evening
meal, and it was during this hour of
refreshment that I had an interesting
discussion with this .traveling man
about hotel inspection and the new san-
itary privy law.

When I took my seat at the table
I noticed a painful expression on this
gentleman's face; a second look con-
vinced me that it was an expression
of disgust and revulsion. I thought
probably he was offended at my pres-
ence, but while I was deciding whether
or not to move my seat to another
table, he addressed me as follows:
"This is the filthiest hotel in North
Carolina. The State Board of Health
ought to inspect it and condemn it."
My personal vanity was then relieved
because I knew the look of disgust
was caused by the eating place we
were forced to patronize. I told him
that I was a representative of the
State Board of Health, after which we
exchanged views relative to the hotel
inspection law and the new sanitary
privy law. I tried particularly to im-
press upon him the importance of the
privy law, in preventing typhoid fever,
dysentery, hookworm disease and other
preventable fecal and filth-borne dis-
eases.

He said, "Hotel inspection is more
important to me, because I have sewer
in my house." I said, "My friend, did
you ever have a case of typhoid fever
in your home?" to which he reluctantly
replied, "Yes, my son, William, who
is eleven years old, had typhoid fever
last July." I asked him what kind of
people lived on the street behind him.
He then described a condition that is
typical of every town in North Caro-
lina — the main street, where the more
fortunate people live, with its sewer
main and all the homes connected
with it, while in the rear, on the same
block, are eight homes with as many
open back, overflowing, filthy, stink-
ing, germ laden, fly breeding surface
closets. Yet this intelligent man was
falsely impressed with the idea that
because his house was connected with
a sewer main he was protected and, the
eight surface closets of his neighbors
were powerless to harm him. I said
"My friend, where did your boy get
typhoid fever?" He replied, "I don't
know." I then explained to him how
his son contracted typhoid fever from
his neighbors' open closets — that even
though his home was sanitary, he was
not protected against his neighbors'
filth and he was powerless to protect
himself. The only thing he could do
by saying anything to his neighbors
about their filthy closets would be to
start a neighborhood row. I then ex-
plained to him how, by this new privy
law, the State is going to protect him
against his neighbors' filth, by making
his neighbors install sanitary closets
that will make the spread of typhoid
and dysentery impossible, and thereby
insure him that his family will in
the future be spared from further un-
necessary expense and anxiety like
that incurred last July when William
was sick.

This man's case is typical of hun-
dreds of annual occurrences. His own
home was sanitated, yet through the

The Health Bulletin

carelessness and ignorance of his
neighbors typhoid fever was thrust
into his home. He needs protection.
You, "Mr. Head-of-the-House": you
and your famiy need protection, be-
cause you are in the same fix as my
"traveling" friend. You are entitled
to it, and we are going to give it to
you by seeing that your -neighbor
either connects to the sewer or builds
a sanitary privy. That's what we
mean by "State Protects You Against
Neighbor's Filth."

My friend, the traveling salesman,
said: "My case, though, is an unusual
one, and why is it necessary for the
State to undertake this problem when
the cost of everything is so high?" I
replied, "Your case is not unusual. It
is only typical of what exists at thou-
sands of North Carolina homes today.
It is necessary for the State to protect
its citizens because our latest statis-
tics show that during the year 726 peo-
ple died from typhoid fever, while
7,260 people had the disease; that 607
people died from dysentery, while
6,070 had the disease; and 2,226 babies
under two years of age died from en-
teritis or dysentery, while 5,000 must
have had these diseases. All of these
diseases are of fecal origin and there-
fore they all originate from the care-
less disposition of human filth, and
this occurs principally through the
open-back, surface closets. These dis-
eases are draining the State's vital re-
sources, both economic and human, and
they can and must be prevented. Let's
figure the yearly cost of these diseases
— 18,330 cases of sickness that cost,
in medicine, doctor's bills, time lost
from work, etc., let's say the ridicu-
ously low figure of $25.00 per case.
This equals an expenditure of $467,-
250.00. Three thousand five hundred
and fifty-nine lives lost. We will
value them at the lowest estimate
placed on human life— $1,700.00 each
—and this would total $6,049,600.00,

making a total loss of $6,516,850.00.
If we prevent one-third of this loss we
will save the State $2,138,950.00. The
State will probably spend $35,000.00,
which will be raised by the license fee
of 40c, in the enforcement of this act,
so you see the sum spent is insignifi-
cant compared to the returns we may
expect." A. J. W.

THE LABELED PRIVY

There may he many types of privies,
but there are just two kinds. Either
a privy is sanitary, or it is insanitary.
Either it is propery constructed and
maintained in accordance with regu-
lations adopted by the State Board of
Health, or else it is not. There is no
half-way state. The label on the privy
tells the story;

The labeled privy is an innovation
in North Carolina, and in the United
States. Heretofore there have been
privies that were good or bad, and that
could be easily recognized as such by
any passer-by. But there were also
many privies that could not be so eas-
ily classified. Many that looked all
right were quite the contrary. In the
future there will be no difficulty about
this. The label will tell at a glance.

This will be true all over North
Carolina with the exception of two en-
tirely different classes of communities.
The law enacted by the last Legisla-
ture specifies that every residence lo-
cated within three hundred yards of
another residence must have an im-
proved type of privy approved by the
State Board of Health. A city having
a population of twenty thousand or
more may be exempted from the opera-
tion of the law provided its govern-
ment officially requests such exemption
before October first. The law does not
apply to farms where residences of
owner and tenants are within the dis-
tance specified. But elsewhere, all

The Health Buleetin

over the State, in city, in town, in vil-
lage, in rural community, the label
must go, bearing witness to the v/orld
that the privy to which it is affixed is
either fit or unfit for use; that the
privy is either a protection to the
health of the folks living close by, or
else it is a source of danger to the lives
of every resident. There is no dis-
crimination. Upon the privy of the
rich and the poor, of the white and the
black, the label must show.

The label will be aflixed by a spe-
cial inspector representing the State
Board of Health. These inspectors
will be officers of the State of North
Carolina, acting under special author-
ity conferred by the General Assem-
bly of the State. It will be their duty
to carefully examine each privy to as-
certain, first, if it is properly con-
structed, and, second, if it is properly
maintained. In accordance with their
findings the privy is labeled.

The labels are of two kinds, each
quite distinctive. One has blue letters
on a white ground and bears the le-
gend "Licensed Privy No. , North

Carolina State Board of Health." The
other has black letters on yellow
ground and bears the legend "Insani-
tary Privy, Unlawful to Use, North
Carolina State Board of Health."
The white label is a silent declaration
that the owner and the tenant of the
property are fully complying with the
law that seeks to abolish the source
of typhoid fever, "summer complaint,"
and allied diseases. The second shrieks
aloud the warning that it is upon the
property of a person who has not com-
plied with the law, or that it has been
misused by a person wantonly careless,
so that it has become a hotbed for the
propagation of disease and death. The
story the label tells is simple, and one
that can be understood by any person.

The labeled privy will begin to ap-
pear in North Carolina on October
first. At that time the inspectors of

the State Board of Health will begin
their duties in the field, working all
sections of the State and making as
rapid progress as possible. The label
is the sign of their work. Thereaf-
ter inspections will be made from time
to time, from two to four times a
year, or as often as practicable.

Each year in North Carolina there
are approximately 3,500 deaths and
35,000 cases of illness caused by fecal-
borne diseases. Among these are ty-
phoid fever, hookworm disease, diar-
rhea, colitis, "summer complaint"
among children and other intestinal
diseases. These are caused in just
one way, by swallowing infected human
excrement. They can be prevented by
the proper disposal of excrement.

Against these diseases the labeled
privy gives protection or warns of dan-
ger. The blue and white label spells
safety. The black and yellow spells
danger. The blue and white label
means the saving of an enormous
amount of money lost through illness
and death. But much more than that,
it means the saving of heartaches,
the saving of homes, less sorrow and
more joy for the people of the State.
The black and yellow label will be
the more conspicuous by the infre-
quency of its appearance. R. B. W.

THE SANITARY INSPECTOR

The sanitary inspector is the field
representative of the State Board of
Health in carrying out the provisions
of the state-wide privy law. For the
purpose of identification, each sani-
tary inspector will carry upon his
person a card bearing his photograph
and a statement of his identity, cer-
tified to by the Secretary of the State
Board of Health. He will also wear
at all times when on active inspection
duty a blue-and-whlte arm band on the
left arm, bearing the words, "Sanitary
Inspector."

The Health Bulletin

Each sanitary inspector is a man fa-
miliar with the details of privy con-
struction and maintenance and with
the general principles of sanitation.
Each man is carefully selected after
an exhaustive investigation of his
character and experience.

The State will be divided into ten
districts, to each of which there will
be assigned a sanitary inspector who
will be directly responsible to the Bu-
reau of Sanitary Engineering and In-
spection for the sanitary conditions
within his district. Each inspector
will go into his respective district on
October 1, 1919, to begin the inspec-
tion of privies in accordance with the
provisions of the state-wide privy law.
The inspector will proceed in accord-
ance with the following:

Privies Found Sanitary
The procedure is simple in such in-
stances. The inspector posts the State
privy license number upon such privy,
after having collected the license fee
of forty cents, for which a receipt will
be issued, bearing a serial number and
the privy license number, which will
be recorded in the office of the State
Board of Health.

Privies Found Insanitary
Such privies will be found insani-
tary, due either to faulty construction
or faulty maintenance. In such in-
stances the responsible parties will
be subject to immediate prosecution,
but it will be within the discretion of
the sanitary inspector to follow one
of two courses, as follows:

"License pending." Upon his next
visit he will naturally expect the re-
quirements to have been met, at which
time few, if any, excuses for non-com-
pliance will be considered.

2. All other privies insanitary in
construction or maintenance will be
placarded with the sign, "Insanitary:
Unlawful to Use!" The inspector will
specify the date after which this no-
tice becomes effective.

Procedure with Privies, ''Insanitary:
Unlatvful to Use."
1. Where condemnation is due to de-
fective construction, the owner will be
held legally liable.

2. Where condemnation is due to
defective maintenance, the user will be
held legally liable.

Approved and Disapproved Privies

It is a responsibility upon the owner
of a residence coming under the re-
quirements of this law to satisfy him-
self that the type of privy which he in-
stalls is one having the approval of
the State Board of Health. If it is
not, the requirements of this law are
not satisfied, and the case will be han-
dled as if there were no privy at all.
IT CAN NOT BE TOO OFTEN
EMPHASIZED THAT THE CON-
STRUCTION OF A SANITARY
PRIVY SHOULD NOT BE DEFERR-
ED UNTIL OCTOBER FIRST, BUT
SHOULD BE ATTENDED TO
PROMPTLY, INASMUCH AS THE
STATE-WIDE LAW BECAME EF-
FECTIVE UPON THE DATE OF ITS
PASSAGE, FEBRUARY, 24, 1919. In
waiting until October first to begin the
inspection of privies, the State has

The Health Bulletin"

given ample time for construction or
repairing privies in accordance with
the rules and regulations of the State
Board of Health. The inspector will
therefore be charged by the State
Board of Health to apply the require-
ments of this law to the responsible
party or parties without argument or
hesitation. H. E. M.

THE SIN OF MODERN
DENTISTRY

BY 6. W. HOLLIDAY, D.D.S.

The greatest sin of modern Dentistry
is committed against children. Nearly
every dentist in the land refuses to
work for them because they are such
disagi-eeable patients. The fact that
they are disagreeable can not be denied,
but when a dentist tells a mother that
temporary teeth will be all right with-
out treatment he Is making a state-
ment that can be denied.

Recently there has come under my
observation an eight-year-old boy with
three of his second molars in extreme-
ly bad condition. The pulps in two
were nearly exposed and aching and
the third was abscessed with a swol-
len place on the gum as big as an al-
mond and a profuse stream of pus con-
stantly flowing into the mouth. I be-
gan mildly to censure the mother for
neglecting his teeth. But she ably
defended herself by saying she had car-
ried the boy to two dentists and they
both refused to work for him, assur-
ing her that they were only temporary
teeth and that it would be all right
to leave them untreated, for they
would soon be lost. It is absurd
enough to refuse to do the work for
children in this condition, but it is an
unpardonable crime to teach the laity
such false ideas about the care of
children's teeth.

In the summer of 1918 I examined
the mouths of over 600 school children.

In practically every case where there
were badly decayed teeth and two or
three abscesses the child suffered from
headache. Intestinal disorders, nerv-
ous irritability, stomatitis and tonsi-
litis. There were two under the age
of twelve who had carried five or six
abscesses for several weeks. Both had
undergone operations for appendicitis.

There is little doubt that such ab-
scesses are the sole cause of the heart
lesions which so suddenly and prema-
turely clip the thread of life. The
late Theodore Roosevelt carried a
blind abscess twenty years, and au-
thorities claim this is the indirect
cause of his untimely death.

If an "ounce of prevention is worth
a pound of cure," why not give the
children a dose? In their ignorance
they are not able to defend themselves.
They have a right to the best there
is, especially to the truth about their
teeth.

Editor's Note. — The above article
was pulished as the leading editorial
in Skull and Bones, the college paper
of the Medical College of Virginia, in
its issue of May 23, 1919. Dr. HoUi-
day is one of the instructors in the
Dental Department of that institution,
and has had a great deal of experience
in treating the teeth of children. He
is now doing some special work for
the North Carolina State Board of
Health in Guilford County.

BAD EYESIGHT AND
CROSSED EYES

BY H. M. BONNER, M.D.

Bad eyesight is due to disease of
the eye — past or present, or to an er-
ror in the makeup of the eye. The
clear surface of the eye in front of
the pupil may have been the seat of
an ulcer in days gone by, and the ul-
cer gotten well, but all ulcers getting
well leave a scar. Whether the scar is
white and ugly or' almost impercep-
tible depends on what germ caused

The Health Bllletust

the ulcer and how intelligent was the
treatment.

If the scar is small or just on the
edge of the pupil, or if the scar is
fine, hardly to be seen, the eyesight
is disturbed. If the scar is thick and
covers the area of the pupil, the eye
for all practical purposes is blind.
These scars sometimes cause dancing
eyes. Useful vision can frequently
be afforded these cases by operation.

Bad eyesight may be due to disease
on the inside of the eye (in the back
of the eye), the outside of the eye
being apparently normal. On the other
hand, bad eyesight may be due to what
is known to eye men as the "sick"
eye, (the nearsighted eye).

The child may have been nearsighted
from birth, or the eye may have been
of normal length until it started to
school— nearsightedness developing by
use (school myopia). The child that
is nearsighted at birth does not see so
well as the child that develops this
condition at the school age. In both
cases, the outer coat of the eye is
weak and tends to stretch more and
more until after the child is of age.
The eyes grow larger from before back-
ward.

The farsighted eye did not grow
long enough — hence it is the short
eye. It will never grow longer un-
less some disease attacks it. If the
eye is just a little short, the child will
see perfectly well, and by reason of
its shortness will give rise to no trou-
ble, but will require reading glasses
at an earlier age than the eye of nor-
mal length.

If the eye is "moderately" short, one
eye will probably cross (not always).
The crossed eye, staying crossed all
the time, is not used and goes blind
by non-use at about seven years of age,
sometimes a little later. The other
eye will see as well as anybody's eye.

If both eyes are'very short, neither
eye will see well, not half so well as

the normal eye. A few of these eyes
will cross — not one, but both. These
children look at you first with one
eye then with the other. These child-
ren cannot read at the usual distance,
but hold their books close to the eyes,
and the parents think them near-
sighted. They do not see clearly, but
in diffusion circles. They are "false-
ly" nearsighted.

In the moderately short eyes with
one eye crossed all the time, the
crossed eye can be straightened by
glasses up to six or seven years of age,
in nine cases out of ten, and the vision
in the crossed eye will be preserved
(about as good as the other).

In the alternating cross in which
the child looks at you first with one
eye then with the other, the eyes
can be straightened by glasses up to
twelve or fifteen years of age, and the
eyes can be made to see wonderfully
better.

These children with very short eyes
are frequently clumsy until after they
have proper glasses.

In the case of the nearsighted eye,
the eyes should have intelligent, care-
ful and thorough examination, and the
parents should have such advice as
will tend to preserve the vision and
tend to avoid further lengthening of
the eyes as much as possible, and the
child should have that glass which
will best conserve its vision.

Other eye troubles affecting school
children that are due to errors in the
makeup of the eye come from "astig-
matic errors."

These erors give rise to headache,
red eyes, sore, scaly eye lids, and to
crops of styes (one stye after another).
Sometimes, as the result of astigmatic
error, the child squints. The headache
and other refiex troubles above men-
tioned may be relieved almost or alto-
gether by proper glasses.

One observer of large experience in
the medical inspection of school chil-

The Health Bulletin

dren says that at least four-fifths of
the habitual headaches occurring in
school children are due to eye strain.

FEEDING THE BABY

BY MBS. KATE BREW VAUGHN

"Does Grod fix the death rate? Once
men were taught so, and death was re-
garded as an act of Divine Providence,
often inscrutable. We are now com-
ing to look upon infant mortality as
evidence of human weakness, igno-
rance and cupidity. We believe that
Providence works through human agen-
cies, and that in this field, as in others,
we reap what we sow — no more, no
less." — D)\ L. Emmett Holt.

If asked what one thing in my opin-
ion causes more deaths of babies under
one year in North Carolina, than any
other, I'd say artificial feeding, or the
giving of solid food by mothers who
do not know that there is any dan-
ger in this sort of food. With a faith
that is frightful some mother whose
baby frets a little, gets a couple of
bottles and nipples and stirs up some
of one of the dozen patent foods on
the market, and confidently believes
she is doing all that is humanly possi-
ble to start the weak child off right.
The more ignorant people are of
health problems, the more inclined
they seem to believe in the efficiency
of "mother instinct" to guide them in
raising their babies. If they start to
raise chickens these days, and have
any money invested in the venture,
they attend lectures by county agents,
subscribe for poultry magazines, and
in one way or another get real in-
formation to save the money invested,
insure success and increase profits.
"Mother instinct" would be consider-
ed nonsensical in poultry work and is
no more dependable in raising babies
than chickens. Mothers who add to
natural mother love all the real knowl-
edge regarding care and feeding of
babies obtainable, and follow the ad-

vice secured from experts, will find
it a rather difficult job to raise a baby.
It is not to be wondered at, then, that
so many babies die needlessly but
surely, because mother is too engaged
or too little informed to give that in-
telligent care which a thrifty poultry
raiser gives his flock.

The different methods employed in
feeding babies are— maternal feeding
(mother or wetnurse), mixed feeding,
that is, maternal feeding supplemented
with some artificial food, and artifi-
cial feeding exclusively.

Maternal nursing is the natural and
the ideal method of infant feeding.
Every mother should nurse her baby
unless there is some very grave ob-
jection, assented to by the attending
physician. Physicians strive to have
mothers nurse their babies, but fre-
quently do not see the patient suffi-
ciently often to guide and influence
them. If husbands knew how im-
portant maternal nursing is, and on
what foundation its competency rests,
there is reason to believe that many
more mothers would enjoy that immu-
nity from hard labor, fatigue, worry
and grief necessary to its success.
To these latter may be attributed the
necessity for resorting to supplemen-
tary feeding, or weaning babies and
putting them on artificial food entire-
ly. Husbands would procure proper
diet, rest, regular habits, sleep and a
simple life for the wife, if they real-
ized that four-fifths of the deaths un-
der one year of age are infants who
are artificially fed. In addition to
the success attending maternal nurs-
ing we have the financial cost of arti-
ficial feeding to militate against.

The most important advice given
a mother must be such as to cause her
to strive to nurse her baby, and to do
so, follow as nearly as possible rules
to increase her own health. This
nursing should not be supplemented
by any solid food, and if given regu-

The Health Bulletin

larly every three hours until baby is
three months of age and every four
hours thereafter, feeding seven times
in twenty-four hours until three
months old and six times daily after
that age to nine months, five times
daily after nine months with baby
sleeping alone in well ventilated room.
The mother should procure eight hours
of unbroken rest at night, which, to-
gether with proper food and freedom
from hard work ought to make it pos-
sible for her to nurse her baby un-
til its ninth month in winter, and
every effort should be made to con-
tinue to the twelfth month in sum-
mer.

"Where it is shown that a baby
is not gaining in weight, and this con-
dition lasts for three weeks, it is safe
to suppose that mother's milk is in-
suflicient, it is then necessary to give
two feedings of artificial food, follow-
ing regular feeding and sleeping
hours.

The best supplementary food is mod-
ified cows' milk, boiled and kept cold
until used, and then reheated. For
the modification of cows' milk this
Bureau suggests "The Cornerstone of
a Child's Future," which will be sent
on request.

Nothing is better established than
the close relation existing between
artificial feeding and diarrheal dis-
eases. It is however not the artifi-
cial feeding as such, but ignorant and

improper feeding, which causes the
high mortality. Among infants who
are properly fed on artificial foods,
diarrheal diseases are common. It is
criminal negligence on the part of a
parent to put a child on a food of
which they know practically nothing.

Many men are prone to give babies
bites of solid food because the little
tots put out their hands. These same
men would not think of opening a
young calf's mouth and ramming hay
or corn down its throat. A little re-
flection will prove that a calf is quite
as capable of digesting hay at three
weeks, as a baby of six months is able
to digest biscuit, candy or any of the
many articles of food given it by fond
relatives.

I am anxious to see the father be-
come vitally interested in the rearing
of the babies and believe that it will
have a wonderful effect on reducing
death rate. A sick baby is not only
pitiful to see and sad to contemplate,
but is an evidence of poor business
sense. A sick baby is the cause of
much lost time by mother, loss of sleep
and rest by family and entails finan-
cial loss by requiring medical atten-
tion. A well baby is a joy, the cause
of much congratulation to parents, in-
creases their self respect, and, while
requiring intelligent care, demands
less actual nursing attention of mother
and practically no expense for medical
attention.

North Carouna State Board of Health

Bureau of Infant Hygiene, Raleigh, N. C.
Please send me a copy of the following bulletins without charge:
PRENATAL CARE Cornerstone of Child's Future

INFANT CARE How To Keep the Baby Well

Child of Pre-School Age Advisory letters (for expectant mothers)

Please place cross opposite bulletins wanted.

NAME

Address _

Age Of My Baby _

Date of Confinement _

The Health Bulletin

BARLEY, OATMEAL
RICE WATER

AND

The best general diluent for cows'
milk in infant feeding is a cereal
gruel in which, the starch has been
dextrinized or rendered soluble by ac-
tion of diastase. Gruel made from any
cereal renders curd of cow's milk
more flocculent and increases the
quantity of tissue building protein
which the infant can digest. This
amounts to fifty or one hundred per
cent, which is of great value in feed-
ing.

Diluting cow's milk, which contains
less soluble nutriment than woman's
milk, reduces the quickly absorbable
part of the food to almost nothing.
This then is partially replaced by the
digested starch of the dextrinized
gruels, which is easily absorbed and
assimilated. The youngest infants
can usually assimilate these gruels.
No other form of nourishment is so
well borne in many cases.

Barley water may be made either
from grains or from barley flour.
When grains are used, the following
formula is used:

2 tablespoons pearl barley

1 quart water
pinch salt.
Boil six hours and keep quantity of
liquid up to quart by adding water
from time to time. Strain through
coarse muslin cloth. The time for
cooking may be decreased if pearl bar-
ley is soaked in water two to three
hours before boiling (the water ysed
for soaking should be thrown away).
When this is cold it makes a thin
jelly.

An identical product may be easily
obtained by using barley flour:

1 level tablespoon barley flour
12 ounces of water.

Cook twenty minutes. A thicker jelly
may be made by doubling amount of
barley flour. Rice, oatmeal, or wheat

water may be made in same manner.
These waters or jellies are useful in
feeding healthy babies of five or six
months or over. Also good to be given
in case of indigestion when milk must
be omitted or used very weak. When
there is a tendency to constipation,
oatmeal may be used; when a tendency
to looseness, barley is always prefer-
able.

Lime Water Made At Home
Get a lump of clean lime which has
not been exposed and pour on a quart
of water in open vessel and allow to
slake. When this is completed and
lime has settled, pour off clear liquid
at the top, as this contains potash,
soda and other soluble impurities in
the lime. Stir up the lime with
second quart of water and pour off
as before. This will leave the lime
quite pure. The lime may then be
placed in a large mouth quart bottle
or fruit jar filled with water. When
the lime water is clear it may be
poured off into any convenient bottle
for use and more water poured on the
lime. This may be repeated as long'
as any lime remains undissolved, but
it is well to use a new lump of lime
every two months or so.

Mothers make a mistake in nursing
baby too long. Dislike on the child's
part to a change of food or diSiculty
of obtaining that food is no excuse
for nursing after twelve months.

Remember that with a baby on an
exclusive boiled milk die*-, scurvy is
guarded against by giving from two to
six tablespoons diluted orange juice,
sweet lemonade, or where these are
not obtainable, juice of fresh or canned
tomatoes, heated to boiling and strain-
ed. Baby one month old can bear
one teaspoon, increasing daily accord-
ing to age.

The Health Bulletin

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CHAPFL HILL, N. C.

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This BunelinwiUbe aerxt free to arwj citizeA of "the State xjpoix request j

Vol. XXXIV

OCTOBER, 1919

No. 10

THE WAT THE GERMANS DID IT AT CHATEAU-THIERRT

During tke recent vrar approximatelT lOOO man from North Carolina ^^ere killed in battU

THIS BULLETIN WAS PBEPAHED JOINTLY BY THE HEALTH ACTHORITIEP OF VinOINIA, NORTH AND SOUTH CAROLINA

ffiMii

^^a^^

PUBLI.5AE,D BTTAEL noRJA CAROUriA 5TATL. BQM^D s^MEALTM

Vol. XXXIV

OCTOBER, 1919

No. 10

EDITORIAL

WILL THE EPIDEMIC RECUR
THIS WINTER?

The epidemic of influenza will recur
this winter, if the germ that causes it
is not worn out in killing people, if
we have no artificial means — quaran-
tine or vaccination — for controlling
the disease, or if it has not already
affected all of the population that is
susceptible. But note the three "ifs";
any one of them can prevent or limit
the recurrence of the epidemic. It is,
therefore, necessary, in arriving at a
satisfactory answer to our question,
will the epidemic recur this winter,
that we understand the three possible
factors that limit the duration of epi-
demics. As suggested, these three
factors are:

First: The loss of virulence by the
infective germ which causes an epi-
demic as a factor in the cessation of
the epidemic, is an extremely remote
probability — almost too remote to dis-
cuss. The writer is unable to find
any references in the literature avail-
able to him on this question; indeed,
the science of bacteriology teaches the
reverse, that infective germs gain
rather than lose virulence during an
epidemic. Germs are small vegetable
forms, and it is a matter of common
observation that successive genera-
tions of plants, the soil in which they
grow remaining the same, become

more vigorous rather than less vig-
orous. It, therefore, does not seem
reasonable nor probable that epi-
demics, including influenza, stop be-
cause of the exhaustion of the infective
germs.

Second: Artificial means, such as
quarantine and vaccination, may be
effectively applied in the control of
some epidemics, as diphtheria, typhoid,
scarlet fever, yellow fever, etc., but
there is no evidence to show, and
there are no health officers of de-
pendable reputation who believe, that
any epidemic of influenza has ever
been or can be controlled or stopped
with our present means. The most
that can be done by artificial means,
such as preventing public assemblages,
is to retard the progress of an epi-
demic so that available medical and
nursing care may be adequate to the
emergency.

Third: The consumption of the in-
fective material, susceptible fuel, ren-
dering it immune like the unstricken
portion of the population, is, by the
exclusion of the other two possible
factors, the responsible factor and the
sole factor in limiting the duration of
an influenza epidemic. To recur to
the illustration above used: The
farmer knows what clover sick land
is; that it is land on which clover
has been grown for a number of
years until some of the chemical ele-

The Health Bulletin

ments of the soil necessary to the life
of the clover has been so completely
consumed by the successive crops that
the soil can no longer produce the
clover which for several seasons grew
luxuriantly; and in the same way and
for the same reason the soil becomes
sick, unable to produce any crop
raised continuously upon it for a
number of years. So with epidemics;
they can begin, spread, and exist only
on non-immune, susceptible popula-
tions, and when the susceptible popu-
lation has been affected and made
immune, the epidemic, under natural
laws, must stop.

Now comes the real question: What
percentage of the influenza susceptible
population did the epidemic of last
winter affect? On our ability to an-
swer this question would seem to rest
our right to draw conclusions as to
the prevalence of influenza this fall
and winter. The history of influenza
extending back over a period of 800
years and recording about 100 epi-
demics, indicatas that an epidemic
usually involves about 40 per cent of
the population. Recalling the more
recent epidemics (that of last year
excepted), the epidemics of 1890, '91,
and '92, and that of 1900, '01, and '02,
we had an involvement during the
entire course of these epidemics of
perhaps 40 per cent of the population,
possibly 50 per cent. In both of these
last two mentioned epidemics there
was during the several years of their
prevalence a total of less than 100
deaths per 100,000 population. In the
epidemic of last year there was an
involvment of at least 35 per cent of
the population, and there were 400
deaths per 100,000 population. These
figures would indicate that the epi-
demic of last fall and winter consumed
the major portion of the susceptible
material, and that there remains but

a small percentage of susceptible
material to be affected this fall and
winter. It, therefore, appears reason-
able to assume that we need not look
for more than one-seventh, certainly
not more than one-fifth, of the cases
of the disease and deaths from the
disease that we had during the last
year. It is likely that we will see
local and, in some places, rather In-
tensive epidemics; however, these
local epidemics will in nearly all
cases occur in those places that were,
comparatively speaking, but slightly
affected last winter, and, fortunately,
there are only a few such places.

On the other hand, judging from
the teachings of history, we must
expect the pneumonia death rate for
this winter to be exceptionally high.
In the epidemic of 1899 to 1892 we
find that while that epidemic stopped
in the year 1892, the pneumonia death
rate in '93, the year following the epi-
demic, was unusually high.

The above has been written with a
considerable degree of hesitation; in
fact, with a distinct embarrassment,
feeling that in setting forth our rather
hopeful attitude toward the possible
recurrence of influenza this fall and
winter we would discourage prepara-
tions for meeting epidemic emergen-
cies, that we would substitute opti-
mism for preparedness, hope for
safety. Therefore, it seems well to
point out the fact that the history of
this disease teaches consistently, al-
most without any exception, that its
epidemics extend over several years,
and from a study of recent articles
on influenza it appears to be the belief
of the majority of the health officers
of this country that we shall see a
recurrence of the epidemic this
winter. Under these circumstances,
our attitude should be one of hopeful-
ness, our position one of safety.

INFLUENZA

IMRODUCTORT

Historical: Man has had a long and
bitter experience with influenza. His-
torical record describes the disease
over a period of eight hundred years,
during which time there have occurred
about one hundred world-wide inva-
sions, or pandemics. In pandemic form
the disease has suddenly appeared,
struck down millions, buried hun-
dreds of thousands, and gone, leaving
man tragically impressed with its
wholesale destruction and puzzled as
to its real nature.

Definition: Influenza is a disease
characterized by its tendency to ap-
pear in world-Tvide epidemics, that is,
pandemics, involving usually from
thirty to fifty per cent of the popula-
tion. The disease has a marked ten-
dency to involve the respiratory organs
and differs usually from colds and
bronchitis in the more marked pros-
tration which it causes.

CAUSE

Commniiicable : The disease is com-
municable. No disease spreads so
rapidly and involves so large a per-
centage of the population as does in-
fluenza. The communicable character
of the disease is a matter of comjnon
observation. On this point there is
no question — all agree.

Source of Infection: Because (1) of
a considerable amount of unfounded
popular speculation as to the source
of infection in this disease and (2) on
account of an apparent conflict of
certain recent and important experi-
ments with the generally accepted
scientific position that the disease is
carried through the secretions of the
respiratory passages, it seems desir-
able here to point out the basic facts
as to the source of infections generally,
and then by a process of elimination

reach a satisfactory conclusion as to
the source of the infection in influ-
enza. There are four principal
sources of infection: (1) discharges
from the bowels and bladder, excre-
Qxent infections; (2) infections from
the blood, the blood being conveyed
from the sick to the well by suctorial
insects, as in the case of malaria and
the mosquito; (3) infections from the
discharges of the genital organs,
venereal infections; and (4) dis-
charges from the mouth and nose,
spit, and the secretions coughed or
sneezed out through the mouth and
nose.

Now by elimination : First, influenza
is not an excrement-borne disease.
If it was, it would prevail where and
when typhoid fever, dysentery and
cholera, the excreta diseases, are
found. Those places with good water
supplies, with sewerage, with few flies
and with well-regulated milk supplies
would escape, and those places lacking
in these sanitary conditions would be
hard hit. Influenza, as we all know,
involves alike cities that have little or
no excreta diseases and cities that
have a high death rate from such
diseases. And again, excreta diseases
are warm weather diseases, coming on
the wings of the fly and leaving with
him, whereas influenza is, for the
most part, a cold weather disease.
Second: influenza Is not an insect-
borne disease. Insect-borne diseases
are tropical or semi-tropical In their
distribution, whereas Influenza is
world-wide in its distribution, and
absolutely ignores the geographic
lines and conditions of climate and
season that determine the habitat and
activity of insects. Third, influenza
is not a sex disease. It Involves both
sexes alike, disregards the active

The Health Bulletin

period of sex life, and makes no dis-
tinction between the chaste and the
unchaste.

Thus we arrive by exclusion at the
only conclusion that is tenable and a
conclusion that is accepted by all
students of this disease, namely, THAT
THE SOURCE OF INFECTION IN IN-
FLUENZA IS THE MATERIAL SPIT
AND SNEEZED OUT, OR TRANS-
FERRED TO THE HANDS.

Infectious Stage of Influenza: In-
formation on this point is capital
for dealing with the all-important
matter of prevention. Recently some
intensely interesting experiments have
been done which strongly indicate,
if not prove, that the INFECTIOUS
STAGE OF INFLUENZA IS, AS A
RULE, BEFORE THE SYMPTOMS OF
THE DISEASE APPEAR.

The experiments above referred to
were performed by eight carefully
trained, thoroughly qualified medical
officers of the Navy and the U. S.
Public Health Service, four represen-
tatives of each branch of the govern-
ment.

The experiments were carried out
with two hundred volunteer men
whose ages ranged between eighteen
and thirty years, the most susceptible
age for influenza, and who, after care-
ful questioning, gave no history of
having passed through an attack of
the disease. Of the two hundred sub-
jects for the experiment, one hundred
were selected from in and around
Boston, and one hundred from in and
around San Francisco.

The report of the investigators
says, with respect to the selection of
cases of influenza to which the volun-
teer subjects were exposed:

"We always kept in mind the fact
that we have no criterion of influenza;
therefore, I would like to emphasize
the fact that we never took an isolated
case of fever, but selected our donors
from a distinct outbreak or focus of

the disease, sometimes an epidemic
in a school with one hundred cases
from which we would select four or
five typical cases in order to prevent
mistakes in diagnosis of influenza."

The influenza cases varied in dura-
tion from one to three days, some of
the cases being in the earliest hours
of the disease, that is, easily within
the first day.

The investigators tried by every
conceivable means to transfer infec-
tion from the sick to the volunteers.
They took the secretions, coughed up
material, from the nose, throat and
lungs, mixed it in solution, put it in
atomizer, and sprayed it in the
throats, noses and eyes of ten of the
volunteers. At first they used fifteen
drops of the infected solution, and in a
later experiment used ninety drops, so
much that some of it was swallowed.
In neither of the experiments did
any of the volunteers contract the
disease. The investigators then took
nineteen volunteers directly to the
bedside of the patients and with swabs
transferred secretions from the noses
and throats of from two to three in-
fiuenza patients to the nose and throat
of each of the nineteen volunteers.
None of the volunteers showed the
slightest evidence of the disease, and
they were all held under closest
observation for more than a week.
Next the investigators took the blood
from patients through hypodermic
syringes and injected it directly into
the veins of volunteers with the same
negative result as in the foregoing
experiments. The remainder of this
series of experiments may be given in
the words of Dr. M. J. Rosenau, Pro-
fessor of Preventive Medicine at Har-
vard University, and one of the medical
officers of the Navy interested in the
investigation:

"The next experiment was designed
to imitate the natural way in which
influenza spreads, at least the way in

The Health Bulletin

•which we believe influenza spreads,
and I have no doubt it does — by human
contact. This experiment consisted in
bringing ten of our volunteers from
Gallops Island to the U. S. Naval Hos-
pital at Chelsea, into a ward having
thirty beds, all filled with influenza.

"We had previously selected ten of
these patients to be the donors; and
now, if you will follow me with one of
our volunteers in this ward, and re-
member that the other nine were at
the same time doing the same thing,
we shall have a picture of just what
was happening in this experiment.

"The volunteer was led up to the
bedside of the patient; he was intro-
duced. He sat down alongside the
bed of the patient. They shook hands
and by instructions, he got as close
as he conveniently could, and they
talked for five minutes. At the end
of five minutes, the patient breathed
out as hard as he could, while the
volunteer, muzzle to muzzle (in ac-
cordance with instructions, about two
inches between the two) received this
expired breath, and at the same time
was breathing in as the patient
breathed out. This they repeated five
times, and they did it fairly faithfully
in almost all of the instances.

"After this had been done five times,
the patient coughed directly into the
face of the volunteer, face to face,
five different times.

"I may say that the volunteers were
perfectly splendid about carrying out
the technic of these experiments. They
did it with a high idealism. They
were inspired with the thought that
they might help others. They went
through the program with a splendid
spirit. After our volunteer had had
this sort of contact with the patient,
talking and chatting and shaking
hands with him for five minutes, and
receiving his breath five times, and
then his cough five times directly in
his face, he moved to the next patient
whom we had selected, and repeated
this, and so on, until this volunteer
had had this sort of contact with ten
different cases of infiuenza, in different
stages of the disease, mostly fresh
cases, none of them more than three
days old.

"We will remember that each one
of the ten volunteers had that sort of
intimate contact with each one of the
ten different influenza patients. They

were watched carefully for seven
days — and none of them took sick in
any way."

Bj^ the process of elimination which
we followed in arriving at the conclu-
sion that the infection of influenza
exists in the secretions of the nose
and throat and mouth, and in the
light of the experim^ents above de-
scribed WE SEEM FORCED TO ONE
OR ALL THREE OF THE FOLLOW-
ING CONCLUSIONS AS TO THE
SOURCE OF THE INFECTION:

(1) Inflaen^a is an Infectious dis-
ease, the infectious agent existing in
the respiratory passages of persons
usually before they are affected with
the symptoms of the disease.

(2) Influenza is an infectious dis-
ease, the infectious agent existing in
the respiratory passages of persons
who are themselves immune to the
disease, but who are carriers of the
infectious agent.

(3) Influenza is an infectious dis-
ease, the infectious agent existing in
the respiratory passages of both (1)
and (2), that is, susceptible persons
prior to their illness with the disease,
and immune persons who are carriers,
but not victims of the disease.

Mode of Infection: There are four
ways in which infectious secretions
from the nose and mouth may be
transferred to others: (1) spray-borne
infection; (2) dust infection; (3) direct
contact; and (4) indirect contact in-
fection.

Spray-Borne Infection means that
the discharges from the mouth and
nose are expelled in acts of coughing
and sneezing, and sometimes in loud
talking, and are conveyed by currents
of air to another person. These dis-
charges are in the form of microsopic
droplets, many of which are visible
even to the unaided eye when caughc
by sneezing or coughing against a
mirror. Recent evidence tends to show

The Health Bulletin

that the infected droplets are not, as
a rule, expelled on a level from the
mouth and nose more than eighteen
inches before they begin to fall toward
the floor. Other evidence indicating
the circum,scribed area in which the
infected droplets are active is the
experience obtained in the treatment
of different infectious diseases, known
to be carried by droplet infection, in
the same hospital wards and in beds
only eight or twelve feet apart and
surrounded by screens only six or
eight feet high. Under such an ar-
rangement a child with whooping
cough, who is susceptible to measles,
may be placed in a neighboring bed
to a child with measles, who is sus-
ceptible to whooping cough, without
danger of transfer of infection. This
hospital practice, which is now becom-
ing quite general, could not be carried
out if infected droplets floated for any
considerable period of time in the
air, or if such droplets were thrown
any considerable distance from the
person expelling them. Where a
person cannot cover the mouth and
nose with a handkerchief in acts of
coughing and sneezing, the head
should be held toward the floor so
that the droplets will be directed
downward.

Dust Infection means the expulsion
in acts of coughing, spitting and
sneezing of the respiratory, nasal and
oral, secretions, the drying of these
secretions on the floor, street, or
elsewhere, and the grinding of them
by feet, brooms, dusters, and other
objects into dried, floating particles
of infected dust, some of which ulti-
mately reaches the air passages of
another person.

There is this great difference be-
tween spray-borne infection and dust
infection which should not be lost
sight of: in spray-borne infection the
infectious agent is in a moist condi-

tion and reaches the second person in
a short time after expulsion. The in-
fectious germ is fresh, moist, and in
a condition but little changed from
that in which it existed in the in-
fected person. In dust infection, on
the other hand, the infectious germ
has been separated from its normal
habitat and food supply for hours, or
days. It has been exposed to the air,
and in many cases to the sunlight,
and is, therefore, a weakened, en-
feebled, sick germ. The germ in the
infected droplet is more restricted in
its area of infectivity, but is probably
more infectious, while the germ in
the dust has a wider area of infec-
tivity, but is less infectious.

Direct Infection means the transfer
of respiratory secretions from one
person to another in acts of kissing.
In this way we have the possibility of
massive infection with fresh infectious
material.

Indirect Contact Infection means the
transfer of infectious agents from an
Infected to an uninfected person in
one of the following ways:

(1) Eating and drinking utensils:
common drinking cups, insanitary
soda-fountains and insanitary eat-
ing places afford abundant means
of indirect contact infection. An in-
fected person uses a drinking cup
or a glass at a soda-fountain, or a
plate or a knife or a fork or a cup at
a restaurant, and these things, without
being sterilized, are served to a second
person, who becomes infected. At
soda-fountains and in restaurants the
wash water in which the unsterilized
and infected utensils are dipped and
washed becomes more and more
heavily polluted and infected, and more
dangerous the longer it is used — its
spit content becomes denser and
deadlier all the time.

(2) Hand infection: bacteriological
examination of the hands of the aver-

The Health Bulletin

age person shows the hands to be
contaminated with most of the
germ-life which is ordinarily found
in the nose and mouth and throat;
moreover, there are more of these
germs on the hands in the cold months
of the year than in the summer
months, for the reason that in the cold
months there is more mucous secre-
tion, more coughing and sneezing,
and greater contamination of the
hands with spit. The habit that some
people have of "smothering" the cough
or sneeze by placing the hand over
the mouth brings about a heavily
contaminated condition of the hands.
The spit contaminated hand passes its
infection in hand shakes, and in hand-
ling those things, such as door knobs,
pencils, street car supports, etc., that
others must touch. The distance be-
tween the infected hand and the mouth
and nose of the second person is easily
bridged by both the imagination and
the germ.

The importance of indirect infec-
tion has recently been greatly empha-
sized in a report of an investigation
carried out by two Army officers, Col.
Chas. Lynch and Lt. Col. James G.
Gumming. These officers observed the
relative prevalence of influenza among
66,000 troops, which could be divided
into two groups of approximately 33,-
000 each, according to whether or not
their eating utensils were sterilized
after each meal and before food was
served a second time. The officers
found that influenza was five times
more prevalent among the 33,000
troops who used eating utensils that
were not sterilized than among the
33,000 troops whose eating utensils
were sterilized before food was served.
The two groups of soldiers lived other-
wise under practically the same con-
ditions.

Conclnsion as to Method of Infec-
tion; Influenza is conveyed through in-

fected secretions of the respiratory
passages, probably, as a rule, from
persons who either do not themselves
suffer from the disease or who have
not at the time developed symptoms
of the disease, and which are passed
to another, either in infected droplets,
dust, direct or indirect contact.

Incubation Period: By the incuba-
tion period we mean the period elap-
sing between the time a person is
exposed to an infection and the time
such a person shows symptoms of
the infection. In influenza the incuba-
tion period is exceedingly short, and
this is one of the important factors
In the rapidity of the spread of the
disease. The period of incubation in
this disease is regarded as usually
between thirty-six and seventy-two
hours, frequently forty-eight hours.

Germ, or Infectious Agent: Dr. Wil-
liam H. Park, Director of the labora-
tories of the New York City Health
Department, one of the best known
and one of the most reliable authori-
ties in this country on the subject of
bacteriology, or germ diseases, in an
article published in August this year,
in which he reviews the various in-
vestigations and literature bearing
upon germs possibly related to influ-
enza, concludes his article with these
words: "Our final conclusion is,
therefore, that the micro-organism
causing this epidemic has not yet
been identified." This is also the
conclusion of a commitee of sixteen
prominent public health officials repre-
senting and speaking for the American
Public Health Association.

PREVENTION

Our ideas of prevention must natur-
ally rest upon what we know or
believe as to conditions which cause
the disease. From what has been said
in regard to the cause of the disease
there seems to be but two ways for

The Health Bulletin

preventing influenza: one rests with
the individual and the other with
society.

Indiyidual: If an individual could
isolate himself absolutely on an island
during the prevalence of an epidemic
of influenza he would escape. His
liability to the disease is in direct
proportion to his intimate association
or contacts with others. Ordinarily,
a susceptible individual who has one
hundred more human contacts during
the day than another susceptible indi-
vidual is one hundred times more
liable to become a victim of the dis-
ease. It is, therefore, apparent that
the individual can do much toward
protecting himself by reducing his
human contacts, particularly his as-
sociation with crowds, to a minimum
during the course of an epidemic.

Social: Society may lessen its lia-
bility to this disease and the other
spray-borne infections by eliminating
the dirty and dangerous practice of
promiscuous coughing and sneezing
and spitting. This custom will grad-
ually die out as the average citizen
becomes more intelligent and realizes
the danger of spray-borne infections,
and when there develops a critical
and unfriendly attitude on the part of
the majority of citizens toward the
man who coughs and spits without
using a handerchief, or at least turn-
ing his head toward the ground, or
who, selfishly thinking of himself and
disregarding the rights and health of
others, attends public assemblages to
interfere with the accoustics of the
place, and with both the comfort and
the safety of his neighbors.

SYMPTOMS

The symptoms of influenza are
those of an ordinary "cold in the
head" (coryza) or "cold in the chest"
(bronchitis) with this difference: In
influenza the constitutional symptoms.

the prostration, the general, as con-
trasted with the local, sjonptoms pre-
dominate. As a rule the onset of the
disease is abrupt and the constitu-
tional symptoms, the chilly feeling,
the fever, the headache, the backache,
and pain in the limbs, are so pro-
nounced as to usually suggest the
correct diagnosis of the disease to
the patient himself. As this is in-
tended to be a popular and not* a
medical discussion of the disease we
shall avoid going into scientific detail
In the discussion of the symptoms.

COMPLICATIONS

Uncomplicated infiuenza rarely ever
kills; but from one to three per cent
of influenza kills through a common
and very fatal complication, namely,
pneumonia. In the Army camps from
eight to fifteen per cent of the infiu-
enza cases were complicated with
pneumonia. In civilian life, and in
the absence of hospitalization, perhaps
pneumonia was not more than half
so frequent a complication as under
the conditions of military life, that
is to say, pneumonia was a complica-
tion in probably from four to eight
per cent of the cases. The pneumonia
complicating influenza differed both in
symptoms and in the appearance of ■
the lungs from the ordinary lobar «
pneumonia and the ordinary broncho
pneumonia. It usually made its ap-
pearance from three to five days after
the onset of influenza. The pneumonia
was a highly fatal form of the disease,
terminating in death in from twenty-
five to thirty per cent of the cases.

DIAGNOSIS

The two diseases from which infiu-
enza must be differentiated are ordi-
nary colds and bronchitis. As already
stated, the difference between infiu-
enza on the one hand and colds in the
head and chest on the other hand is

The Health Bulletin

the more marked constitutional in-
volvement, the more pronounced chil-
liness, fever, and general pains in
influenza than in the colds. However,
there is no diagnostic criterion for
influenza, such as we have in finding
the germ of diphtheria, or tubercu-
losis, or malaria, in those diseases, or
the "Wassermann reaction in syphilis.
Between epidemics it is impossible to
separate mild cases of influenza, cases
where the constitutional involvement
is slight, from colds and bronchitis;
during epidemics most cases of colds
and bronchitis are "lumped in" with
the prevailing disease, being regarded
as influenza with mild symptoms.

TREATMENT

There is one DO and one DON'T In
the treatment of this disease which
the intelligent layman should be aware
of.

The DO: To quote Dr. Herrick, of
Chicago, one of the leading physicians
of that city:

"There is, however, one feature of
the treatment of influenza on which
all agree, namely, the importance of
early rest in bed and the continuance
of such rest until fever, cough and
other symptoms have for several days
disappeared. It is a common experi-
ence for the patient who does not at
once give up when attacked by the
disease, or who leaves his bed early
and attempts to go to work the mo-
ment he thinks he has the requisite
strength, to suffer from a recurrence
of symptoms, possibly to have pneu-
monia appear, or to be incapacitated
on account of persistent cough, irrit-
able heart or nervous and muscular
weakness. A few days added to the
period of rest would often save the
patient from a protracted convales-
cence or prevent serious sequalae."

The DON'T: One of the leading au-
thorities on drug action in this
country. Dr. Solomon Soils Cohen, of
Philadelphia, expressed the feeling of
a large group of medical men with
exceptionally good standing in their
profession when he said:

"Antipyrin and acetanilid were at
first advocated by great authority, but
their deadliness was soon recognized.
Unfortunately, in Philadelphia at
least, that lesson was forgotten. If I
may judge from what I frequently
heard in the consultation room, there
was a wide-spread tendency to use
two very harmful drugs, aspirin and
phenacetin. . . . Not that every-
one died who received these drugs;
quite a number survived both the di's-
ease and the medicine; some, no doubt,
to suffer later from weakened heart
and nerve depression. But in the ma-
jority of the cases in which they were
used, these drugs deprived the patient
of his chance to recover. Of that, I
have no doubt. Salicin and certain
of its derivatives, namely sodium
salicylate and quinin salicylate and
cinchonidin salicylate (not aspirin,
remember — that is a dangerous cardio-
vascular depressant) were very useful,
not as specifics, but as aids."

VACCINATION AGAINST
INFLUENZA

Dr. G. W. McCoy, Director of the
and the leading authority of the United
United States Laboratory of Hygiene,
States Government on the subject of
vaccines, in concluding an article
entitled "Status of Prophylactic Vac-
cines Against Influenza" published in
the Journal of the American Medical
Association August 9th, says:

"IN E\^RY CASE IN WHICH VAC-
CINES HAVE BEEN TRIED UNDER
PERFECTLY CONTROLLED CONDI-
TIONS, THEY HAVE FAILED TO
INFLUENCE IN A DEFINITE MAN-
NER EITHER THE MORBIDITY OR
THE MORTALITY."

The man with the concealed
pistol is dangerous, but the
man with the uncovered cough
or sneeze is deadly.

MANAGEMENT OF INFLUENZA EPIDEMIC

What the State Board of Health is Prepared to Do in Assisting Counties and
Towns in an Epidemic of Influenza

In a general way, the work of the
State Board of Health in an epidemic
of influenza may be classified under
two headings, namely, relief and ad-
visory.

Relief: In the absence of known
methods of preventing or cutting
short an epidemic of this disease, and
in the presence of an overwhelming
number of cases of influenza, as in
the epidemic of last winter, the work
of The State Board of Health must be
largely directed to relief. Relief
work in this disease was during last
year, and in the case of severe local
epidemics this year will continue
to be, largely rendering assistance
to stricken communities in securing
the necessary medical and nursing
attention and, sometimes, supplies of
drugs.

In assisting communities in securing
additional physicians and nurses, the
State Board of Health will serve as a
clearing house, having already ar-
ranged with a number of doctors and
nurses for their services at a mutually
agreed upon compensation, and with
the understanding that these doctors
and nurses will accept assignments
under the direction of the State Board
of Health for emergency service in
influenza. The stipulations agreed upon
are actual expenses and $15 per diem
for doctors and $5 per diem for
trained nurses. Assignments of doc-
tors and nurses for emergency ser-
vice in an epidemic will be made as
follows:

The official representative of the
county or town will call upon the
State Board of Health for such medi-
cal and nursing assistance as Is
needed. The State Board of Health
will recognize, therefore, as official

calls, requests from the chairmen of
boards of county commissioners, the
county health officer, and mayors or
health officers of towns and cities.
In the confusion of the epidemic last
year, calls for assistance reached the
Board of Health from all sorts of
people, men and women, white and
colored, official and non-official. Some
calls were made by persons whose
advice and whose diagnosis of local
needs were faulty. Therefore, in deal-
ing with epidemic conditions this
year, the State Board of Health wishes
to emphasize the importance of emer-
gency calls for assistance being made
through the regular official channels.
Townships needing assistance will get
in touch with the chairman of the
board of county commissioners and
have him call the State Board of
Health. Towns needing assistance
will get in touch with the mayor and
have him communicate with the State
Board of Health.

In assigning doctors and nurses to
stricken communities, it will be under-
stood that the financial responsibility,
assumed by the State with the doctor
or nurse assigned to a stricken dis-
trict, will be taken over by the official
making the call. It will be further
understood that on the arrival of the
doctor in a stricken commanity, the
official representative of the com-
munity will instruct the doctor to
keep an itemized account of all ex-
penses, to render medical need at the
regular rates for physicians' calls in
the community, to keep an account of
all collections and all unpaid visits,
the account to be turned over to the
official representative of the commun-
ity on the completion of the doctor's
assignment. It will be further under-

The Health Btjlletin

stood that in case the doctor has
collected less than $15 a day and
expenses, the responsible official of
the town or county will pay him the
difference. In case the doctor's ac-
counts amount to more than $15 a
day and expenses, the surplus will
be used by the community for other
relief work. In the case of nurses
assigned to stricken communities, the
official making the call will assume
all the financial responsibility which
the State Board of Health carries
with the nurse, and will make such
local arrangements to meet the ex-
penses and pay of the nurse as the
community forces may decide upon.

The above arrangement with respect
to financing a supply of relief physi-
cians and nurses has been adopted
for four reasons: First, it proved en-
tirely satisfactory last year; second,
it is necessary, the State Board of
Health being financially unable to as-
sume the responsibility of paying for
all the medical and nursing care which
may be made necessary under epi-
demic conditions; third, the need in
an epidemic of influenza in North
Carolina is not money, but medical
assistance. There were few individ-
uals and, so far as we know, no
communities in North Carolina that
suffered in the epidemic last year on
account of limited finances. The
individuals and communities had the
money to pay for doctors and nurses.
The trouble was that there were not
doctors and nurses to be had for the
money In hand. The State Board of
Health, therefore, in meeting local
calls for assistance, recognizes the
character of the call, that it is for
medical and nursing service and not
for financial help. Fourth, if, as was
the practice in a number of states
whose state board of health had large
emergency funds, the State should
furnish free doctors to stricken com-

munities, there would be practicing in
that community local physicians mak-
ing their regular charges in competi-
tion with emergency physicians equally
capable making no charge at all, and
this would result in the local physi-
cian working under unfair competi-
tion, losing a fair and just compensa-
tion when he was most needed, and
in the free horse pulling the heavier
part of the load. For the two classes
of physicians, the local and the emer-
gency physicians, to work on the
same remunerative terms means an
equitable distribution of work.

Advisory: The advisory work of the
State Board of Health will consist of
two parts:

(1) General educational work car-
ried on by the preparation and
publication in the Bulletin, special
pamphlets, and leaflets, and through
the newspapers of the State, of articles
descriptive of the disease, and sug-
gesting the best ways and means by
which both the individual and society
may conduct themselves under epi-
demic conditions.

(2) Conferences with any commun-
ity, county, or city that finds itself
in the grip of an epidemic and desires
the services of a representative of the
Board of Health for conference and
assistance in arranging for the local
plan of work described briefly but
clearly on pages 14 to 15 of this
Bulletin.

A final suggestion: The mayors of
towns and cities, the chairmen of
boards of health, and local health
officers, in communicating with the
State Board of Health with respect
to a local epidemic of Influenza,
should not hesitate to use the tele-
graph or telephone at the expense of
the State Board of Health when time
is a factor in dealing with the local
condition.

WHAT A COUNTY OR TOWN SHOULD DO IN CASE OF AN
EPIDEMIC OF INFLUENZA

Should influenza again visit the
State in epidemic form and become
as widespread in certain counties and
towns as it was during the fall of
1918, it will again become impossible
for the local medical and nursing
professions to meet the demands made
upon them by the sick. This will
make it necessary for the people of
each community to organize and care
for themselves. In order that such
organization may be uniform and
thorough it is necessary for it to have
official supervision, and such super-
vision should, and can only, be given
by the county or by an incorporated
town. The responsibility for the
health of the people — the responsi-
bility for this organization — rests,
under our State law, upon the Chair-
man of the Board of County Commis-
sioners for the County and upon the
Mayor for a town having a separate
organization.

In addition to organizing for relief
work the County or Town should
employ temporarily, at least, an ex-
perienced nurse to arrange for home
nursing courses for instructing the
women and girls, and should pass
regulations forbidding the use of the
common drinking cup and the common
towel.

To prevent the unnecessary spread
of the disease and to care for the sick,
for which the county and the town
are responsible, the Chairman of the
Board of County Commissioners and
the Mayor should arrange for the fol-
lowing organizational and educational
work in each county and town:

1. Information should be given the
people regarding influenza, its pre-
vention and cure, and the probability
of its return during the coming winter.

Such educational work may be done
through newspaper articles, through
notices read at schools, churches, and
other public meetings, and through
the distribution of bulletins prepared
by the State Board of Health and
placards prepared by the County Board
of Health.

2. Classes should be organized to
teach volunteer lay nurses the essen-
tials of home nursing. This can easily
be arranged in counties or towns
having active health departments.
The Red Cross is at present assisting
in this work in a number of places in
the State. A suggestive outline for a
course in home nursing is given in
this number of the Bulletin.

3. The Superintendent of Public
Welfare, or some other energetic
citizen, should be appointed County ,
Supervisor of the health organization I
work. The duty of the County Super-
visor should be to appoint a Local
Supervisor in each township and
through these organize the people of
each school district and each town

for relief work. The Township Super-
visors should organize the following
community committees, with definite
duties for each to perform:

a. INTELLIGENCE COMMITTEE.
The chairman of this committee should
be especially active and intelligent,
thoroughly acquainted with the com-
munity, and able and willing to gather
accurate information daily regarding
the sick. This committee should report
daily to the Township Supervisor upon
the number of new cases, the condi-
tion of previous cases, any emergency
need for food, medicine, or nursing
aid, or money. In communities with
a great many people sick at the same
time this committee can, through home

The Health Bulletijv

visits, ascertain which patients are
most in need of a visit from a physi-
cian or nurse and, in this way, provide
medical attention for the most serious
cases.

b. NURSING COMMITTEE. This
committee should have a list of all
available persons in the community
who will volunteer to do ordinary
nursing in cases of need. Many per-
sons ill with influenza do not need the
services of a trained nurse, even if one
could be obtained, but many families
do need the simple home attentions
which, can and should be supplied
through this committee. In an epi-
demic there is always great need for
emergency housekeeping and for visits
at country homes of people who will
care for livestock, provide wood and
water, and other such essentials.
This committee can greatly decrease
the number of relapses from influenza
and the large number of deaths occur-
ring during these relapses.

c. FOOD COMMITTEE. This com-
mittee should supply simple, whole-
some food to families in actual need.
In some communities of North Caro-
lina during the last epidemic the
entire membership of families was
stricken at the same time and com-
pelled to go without proper food and
home attention because there was no
one able to either prepare food or go
out and ask for aid.

d. TRANSPORTATION COM-
MITTEE. This committee should be
prepared to furnish means of con-
veyance and a local guide in case
either a doctor or nurse is sent to the
community from some outside point.
It should also be prepared to meet the
needs of the other four committees.

e. FINANCE COMMITTEE. This
committee should secure voluntary
contributions for the necessary relief
of afflicted families in the community

which may be destitute. There are
likely to be families who are tempo-
rarily in need of assistance because
of the epidemic.

In addition to the organizational
work, the County Supervisor should
keep in touch with the State Board of
Health and keep the Board informed
of conditions in his county. He should
also be of assistance to the County
Health Officer or County Physician
and the County Board of Health in
enforcing ordinances enacted by the
Board.

4. The County Board of Health
should enact and enforce ordinances
forbidding the use of the common
towel and requiring all soda fountains
and cold drink stands to use indi-
vidual paper cups, saucers, and spoons.
Sterilizers for soda fountain glass-
ware are of very doubtful efficacy and
should never be relied upon. No
chances should be taken — paper cups
should be required.

^8-AnnuaTMeetir4

American PuHiQ HeaitK Assn.
October 27-50

CJhe Public Health Mecca,
oflol^

A twmcan Fix Wir Uca i in Assn.

This Bulletin tells you how
to protect yourself. The Lord
helps those who help them-
selves.

What the Individual Should Do in
Protecting Himself from Influenza

TEN SIMPLE BUT VITALLY
IMPORTANT RULES

INFLUENZA IS CONVEYED BY THE SECRETIONS
OF THE NOSE AND MOUTH

1. AVOID PEOPLE WHO ARE COUGHING OK SNEEZING.

2. DO NOT ATTEND CROWDS OR LARGE GATHERINGS INDOORS

OR OUTDOORS.

3. KEEP THREE FEET FROM PERSON TALKING.

4. WHEN YOU COUGH OR SNEEZE, COVER TOUR NOSE OR

MOUTH WITH A HANDKERCHIEF, OR TURN TOUR FACE
DOWNWARD.

5. DON'T USE CUP OR OTHER EATING UTENSIL USED BT

. OTHERS WITHOUT THOROUGHLT WASHING AND BOLL-
ING IT.

6. DON'T PUT INTO TOUR MOUTH FINGERS, PENCILS OR

OTHER THINGS THAT DO NOT BELONG THERE.

7. WASH TOUR HANDS BEFORE EATING.

8. EAT PLENTT OF SIMPLE, NOURISHING FOOD.

9. SLEEP AND WORK IN ROOMS FILLED WITH FRESH ALR,

BUT KEEP THE BODT WARM.

10. IF TOU GET INFLUENZA, GO IMMEDIATELT TO BED TO
WARD OFF PNEUMONIA, AND STAT IN BED SEVERAL
DATS AFTER FEVER SUBSIDES TO AVOID SUBSEQUENT
WEAKNESS.

MEDICAL INSPECTION OF SCHOOLS NUMBER

^^^Publi5\edb4 TnE.^9RmCAK9LI/iA STATE. D^ARDs^AmLTA

This DiikliAwillbe 5er\1. free to qaij citizeA of "the State upoixrequestj

Vol. XXXIV

NOVEMBER, 1919

No. 11

^^^^^Wj

HHBHPBSKS^SkfiPli^Bli^^^^^*^

LiiiiiiinMit;

North Carolina State Board of Health Free Dental Clinic for School Children in Macon County, Septem-
ber, 1919. In our opinion, it would be hard to present a more pleasing picture than this photograph of
Dr. S. L. Bobbitt, representing the Department of Medical Inspection of Schools of the State Board of
Health, hard at work literally making "better teeth" for this group of school children gathered from among
God's eternal hills at a rural schoolhouse seven miles from Franklin.

DEVOTED TO THE CONSERVATION OF NORTH CAROLINA S GREATEST
RESOURCE HER CHILDREN

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

J. Howell Way, M.D., President, Wayuesville
Richard H. Lewis. M.D., Raleigh
J. L. LaoLow, C.E., Winston-Salem
Thomas E. xVnderson, M.D., Statesville

E. C. Register, M.D., Charlotte

Chas. O'H. Laxjghinghouse, M.D., Greenville
Cyrus Thompson, M.D., Jacksonville

F. R. Harris, M.D., Henderson
E. J. Tucker, D.D.S., Roxboro

OFFICIAL STAFF

W. S. Rankin, M.D., Secretary State Board of Health and State Health Officer

A. J. Warren, M.D., Assistant State Health Officer
C. A. Shore, M.D., Director Laboratory of Hygiene

L. B. McBrayer, M.D., Superintendent of the State Sanatorium

G. M. Cooper, M.D., Director of the Bureau of Medical Inspection of Schools

H. E. Miller, C.E., Chief of the Bureau of Engineering and Inspection

Millard Knowlton, M.D., Chief of the Bureau of Venereal Diseases

Mrs. Kate Brew Vaughn, Chief of the Bureau of Infant Hygiene

F. M. Register, M.D., Epidemiologist

B. E. Washburn, M.D., Director County Health Work
Ronald B. Wilson, Director Public Health Education

EXPLANATORY

The illustrated part of this issue of the Health Bulletin, together with a
portion of the text, is a simple description of how results have been attained by
the Department of Medical Inspection of Schools.

There may be, and probably are, many better ways of getting this work done
for the children, but the fact is we are kept so busy doing the things clamoring
for attention that we have little time and less inclination to undertake to tell
other folk what they ought to do.

We wish to take this means of recording our full appreciation for the help and
encouragement of so many people, especially those who have sacrificed time and
money in making the tonsil clinics a success. To the dentists who have helped
our field workers, the teachers, health officers, physicians and specialists, who
have made the work possible, and especially to the newspapers who have ren-
dered invaluable service, to one and all we wish to express our sincere thanks.

We hope to expand and extend this service to reach every North Carolina
school child that needs it. Therefore, we solicit suggestions and constructive
criticism from every citizen of the State interested in our children — and who is
not interested? In other words, while we carefully refrain from preaching, we
want everybody to be free with his advice to us. We may not accept it — all :
but we may take some of it with much resulting good.

The editorial and all other matter in this issue of The Bulletin, except where credit
is otherwise specifically given, was prepared by Dr. George M. Cooper, Director of the
Department of Medical Inspection of Schools.

PU6U5AE:D BYTML nOR.TA CAgOLIMA 5TATL BOaI?D ft^MEALTM

Vol. XXXIV

NOVEMBER, 1919

No. 11

NOT ABLE TO PAY!

Classification of School Children Into Well-to-do and Indigent is Un-American,
Un-Democratic, Un-Christian

No zygodactyl bird of the order Psit-
taci ever told himself "Pretty Polly !"
with more satisfaction than otherwise
responsible people derive from mouth-
ing "Not able to pay." It is unction
to their souls. It is balm for many a
troubled conscience.

"O, yes, this hospital offers free
treatment to those who are not able to
pay," says the President of the Board
of Visitors, adding, of course, "except
a small fee to take care of incidentals."

"Special provision for those who are
not able to pay" ; "the worthy poor" ;
"children of the poor" ; "for charity."
are a few of the canting generalities
wliich cover a multitude of the sins of
omission.

The North Carolina State Board of
Health is neither Bolshevik nor Prus-
sian ; nor is its mission the setting of
a wrong world right. But some of us
who have played the game of life in
the rough — who have practiced medi-
cine and occasionally ourselves bound
up a wound, as well as sat on "the rail"
and watched the big men operate —
have so often been balked in a sincere
attempt to render honest service by
the trite, satisfied reply, "Oh, yes, if
he is not able to pay," that we have
become convinced that the expression
itself is a howling hypocrite.

Suffering humanity means just ex-
actly nothing to us. l»ut suffering in-

dividuals wliom it is partly our duty
to assist mean everything. This pecu-
liarly applies to the correction of com-
mon physical defects of thousands of
school children in North Carolina.

About three years ago, upon comple-
tion of the medical inspection of
.3,847 school children in one county by
a representative of the State Board
of Health, in which 1,187 of them
had serious decay of permanent teeth,
and 315 were badly in need of opera-
tions for removal of diseased tonsils,
we received the following letters.

First letter from the head of a
family :

I would be very glad to have my boy
treated for defective tonsils and ade-
noids. I know that it needs to be done,
and has for a long while, but I am not
financially able. I have two other boys
in the same condition, age 3 years and

1 year. I liave written to Dr. B

of (a specialist in a near-by

city) in regard to the matter and he
said it would be cheaper to liave it
done at home.

Respectfully,

R. No. 1

Just a fair sample of how anxious
most of us are to work for those who
are "not able to pay."

Second letter, from a widow in a
different section of the same county,
received a few days later:

In regard to the recent medical in-
spection of County, it was

The Health Bulletin

found that Jane has defective

vision. I have consulted Dr ,

of Financially I am unable

to have this defect corrected. I am
very anxious that this be corrected. I
am appealing to you, the State Board

of Health and County to aid

me in having this work done at the
eailiest date. Let me hear from you.
I remain,

Respectfully,

(Mrs.)

The above letters, typical of many
received by the Board of Health during
the past several years, led us to see
the absolute necessity of establishing
dental and surgical clinics, especially
for the rural counties and sections.
But there is not one person in twenty
who will admit to his own State in a
confidential letter that his child needs
the service. On account of the Ameri-
canism of parents the children suffer
on in silence with the door of oppor-
tunity shut in their faces forever.

Looking back over the files, we re-
call that the writer, upon receipt of the
letter from the widow, immediately
made an appeal to the chairman of the
boai-d of commissioners of that comity,
one of the best men and officials in
the State, who courteously replied :
"An investigation of this case is being
made, both in its specific instance and
as representative of a class, and a re-
port of its conclusion will be made to
you as a matter of public interest."

Doesn't that soimd fine — and nat-
ural? Investigate to see if she were
"able to pay !" As we have never re-
ceived any report, the investigation,
perhaps, is still in progress. But,
would a report after three years do the
little girl's eyes any good now? All of
which leads us to the heart of the
who^e matter. Who is to decide who
"is able to pay"? One doctor told the
writer once that if a fellow had "more
than one razor-back hog and three
dogs, d — d if he didn't have to have
his money."

When the Rochester free dental in-
firmary for school children was first
organized the standard established for
those "able to pay" was the children
of parents with a total family income
of twenty dollars a month per capita.
For example, two brothers, each mar-
ried and having a wife and ^""0 chil-
dren, living in houses exactly alike in
the same block, sent their children to
the same school. One worked in a
bakery at seventy-nine dollars a month.
His children were entitled to free
treatment. The other brother worked
at an ice factory at eighty-one dollars
per month. He was deemed "able to
pay" and his children were denied the
free treatment.

Absolutely ridiculous, isn't it? Any
attempt to classify public school chil-
dren, the adopted wards of the State
of North Carolina, into well-to-do and
indigent is un-democratic, un-American,
un-Christian and must inevitably end
in confusion and failure.

Whose duty then must it be to see
that every child is given an even start
in the race? Clearly that of the Pub-
lic, the State.

The logical solution is a free hospital
and dental infirmary at every county-
seat town, providing free dental and
surgical service to every school child
regardless of class, color, social or
financial standing. It is a public re-
sponsibility and the public must meet
it. On this rock we build our platform.
Here we shall fight it out, hoping that
in a few years no little one with de-
fective vision in North Carolina shall
have to walk in the shadow or grope
in darkness while some Board officially
decides the question as to whether or
not its daddy or widowed mother is
"able to pay."

Finally, in the language of the great
Aycock in his last speech prepared just
before his death,

"It undoubtedly appears cheaper to
neglect the aged, the feeble, the infirm,
the defective, to forget the children of

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this generation, but the man who does
it is cursed of God, and the State that
permits it is certain of destruction.

"Equal! That is the word. On that
word I plant myself and my party —
the equal right of every child liorn on
earth to have the opportunity to bur-
geon out all that there is ivithin him.'"

STATE MEDICINE

The State Board of Health is finding
daily what every physician practicing
in the smaller towns and in the country

must prevail in the world from now on,
the heroic sacrifices they have been
making for a thousand years. The re-
sponsibility must be shifted to the
public.

No human being when stricken with
disease should have to get in a
bread-line, so to speak, before getting
medical aid. Dr. Richard Cabot, of
Massachusetts, one of the most eminent
physicians in the world, has recently
declared (we quote from memory)
that—

"The doctor of tomorrow will be a

Ward in the hospital at Waynes \ ule, clitic
ducted on June 27, 1919. Seventeen school chi
results. Misses Nora Pratt and Cleone Hobbs,

has always known, and that is the
urgent necessity for hospital and medi-
cal service which will reach the great
majority of the people in time to pre-
vent neglect and suffering, especially
among children. It is one of our im-
mediate sociological problems that
must be settled. The great mass of the
medical profession cannot continue,
under the new economic conditions that

Li olate Board of Health "Tonsil Club" was con-
Idren were operated on here that day with good
State Board of Health nurses, in charge.

public official, answerable to the State,
and his service will be free to the
people, paid for by themselves through
public funds exactly as the judges or
other public officials."

And is it not inevitable? The change
must come. It may be soon, it may
be long delayed ; but come it must.

Wealthy people there will be always.
Physicians and surgeons with great
private incomes we shall have forever.

The Health Bulletust

Therefore there will never be any lack
of incentive to personal endeavor on
the part of the profession, for the re-
ward will be sure.

This discussion therefore concerns
principally two classes of people in
North Carolina :

First. Ninety per cent of the phy-
sicians, the William McLures of the
profession, the physicians who patiently
labor in good weather and bad, who
cheerfully answer the calls of their
patients day and night, are continually
called on for sacrifices both personal
and public — Good Samaritans whose
lives are shortened through hardship
and exposure, and who finally lay down
their hypodermics and join the caravan
which travels only in one direction,
leaving the widow to spread out the
little life insurance as far as possible.

Second. The other class is the ninety
and nine who go to make up the great
middle and lower part of our State's
real people, who find the world a strug-
gle from the start. This applies to the
more than half of the State's popula-
tion who are born without inheriting
means and who are forced to start life
with a handicap, and more especially
does it concern the big majority of the
people who must live away from the
centers of population and who are
often forced to suffer without medical
aid.

Somewhere between these two ex-
tremes of sacrifice is a common ground
and it must be found.

This particular editorial outburst is
due ro the following letter recently re-
ceived by one of the State Board of
Health school nurses. It is simply one
of a thousand experiences the past
summer similar in character, occurring
in every part of the State.

, N. C,

9-25-1919.

Dear Miss W

I received your letter today and so
very sorry to learn that the throat and
nose work had already been done. Dr.

H advised me to take my two

children to the Johns Hopkins hospitiil,
he said they were needing attention
bad. And as I had sent two older chil-
dren to that hospital and borrowed
every penny of the money to send them
I simply am not ab'e to send these two
there. And the children are needing
attention so bad they have not been
able to attend one day of the public
school, and will not attend untill they
get attention. So you see how I feel
about not having the work done while
the Sergeons were doing the work this
time. I'm so worried about it. Til be
so glad when you visit the schools in
these parts, it's so very far to the
nearest physician, the children are so
neglected.

Miss W please don't be of-
fended at my sending stamps for you
to register letter to me as I sure want
to take the children next time, and
register letter so I will be sure to get
it, and be sure to let me hear from you
four or five days before the sergeons
are to do the work as the mail is
handled carelessy sometimes. I can't
rest a minuit untill I have the children
tended to. So I hope you can under-
stand and sympathise with me tho' a
stranger.

Thanking you in advance for any in-
formation.

I am very sincerely,

Mrs. R C ,

N N. Carolina.

The writer of that letter lives in the
mountains of western North Carolina,
twenty-five miles from a railroad.

The parents of such children may or
may not be "able to pay" (there is no
means of getting away from that dam-
nable expression) ; but the Department
of Medical Inspection of Schools of the
North Carolina State Board of Health
will not lose any time finding out that
fact. So long as we can scrape to-
gether enough dollars to attend to the
necessary details, and so long as we
can find specialists of ability with
hearts that beat in response to indi-
vidual suffering and who are not "out
for the cash." all such calls so elo-
quently voiced as the cry in that letter
for helpless children will be heard and
answered in the affirmative. It mat-

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ters not if tlie father is the "raggedy-
man" or the town's rich man living in
the big house on the hill.

THE TEACHER WAS FIRED

A wee little tcorm m a hickonj-nut

Sang, happy as he could ie:
"Oh, I .live in the heart of the whole
round world,
And it all belongs to me!"

— James Whitcomb Riley.

A few weeks ago the writer visited

turned to general school topics, such
as the antique desks and poor heating
arrangements, in an otherwise good
three-teacher building in a well-to-do
commimity. Knowing the young lady
who was principal there the past year
to be an exceptionally capable woman,
we inquired how it was she did not
get in behind the committee and make
them bring the equipment and sur-
roundings up to match the building.
The question happened to be directed
to the wife of the chairman of the com-
mittee.

One practical way to solve a difficult problem. Children in the William Hooper School of
Wilmington enjoying their hot lunch. See article elsewhere in this issue of the Bulletin on
"The Hot Lunch," by Mrs. Estelle T. Smith.

the dentist conducting a State Board
of Health Free Dental Clinic at a rural
school in an eastern county. Several
mothers were present with their chil-
dren, and while awaiting their turn at
the dental chair the conversation

"Oil. the comniittee couldn't .stand
her. So they fired her in the middle
of the session."

With considerable amazement, we
inquired wliat sort of conduct the
teacher had been guilty of to merit
such drastic punishment.

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Replied Mrs. Committeeman:

"The first thing she did was to de-
mand that two pit privies be built on
the schoolhouse plat, and you know
they would have cost forty dollars at
least, and Buck [her husband] said it
was a useless waste of money, and so
paid no attention to her. The next
thing she demanded was three-jacketed
stoves, one for each room."

At this point another woman from
the same neighborhood interrupted ex-
citedly :

"Cousin Buck said he never heard of
such a thing !"

But the blow that shipped the
teacher back to Pa's for the remainder
of the school year came down on her
like a thousand brick, when she forced
the pupils to sit quietly at their desks
at noon and spend twenty minutes eat-
ing their lunch, packing the scraps
back into the baskets to be carried
home for the pigs, thus teaching a prac-
tical lesson in thrift. The prevailing
custom, of course, as in most rural
schools, was for the children to scatter
around on the cold ground outside re-
gardless of weather, taking pot luck
with the tribe of dogs always on hand.

To shorten this story, it may be said
that the Chairman called a meeting of
the Committee forthwith and informed
the principal that she was "fired," to
take effect at once. Traditions must
be upheld, and none so sacred as the
way their daddies have always run the
average school, be it city, town or coun-
try, — in the opinion of the school board
the teacher is employed chiefly to obey
orders. We were just warming up to
remark that they would still be plough-
ing with wooden sticks if somebody
had not had the courage to at least try
something else, when Mrs. Commit-
teeman's ten-year-old boy was called by
the dentist. Four of the child's perma-
nent teeth were found badly decayed.
After an hour's hard work on the front
porch of this schoolhouse that hot July
day, seventeen miles from the county-

seat, three of the four teeth were saved
for the child ; but the fourth tooth had
to he extracted, thus making one-
quarter of his mouth a cripple for life.
At this point we demanded to know
why the head of the family and chair-
man of the school committee did not
have interest enough at least in his
child's teeth to come to the dispensary.
The answer was that he was spending
a month at one of the expensive health
resorts in western North Carolina.

Here is a man worth fifty thousand
dollars. A successful farmer, owning
one of the finest farms in his county
(to prove it his barn is twice as big as
his dwelling house) ; educated at one
of the great State colleges. Educated
did we say? Graduated is the word to
use. And yet his college training and
his success as a farmer have not taught
him a thing about the great funda-
mental things of life, not even to the
point of caring for the health of his
own child. As a school committeeman
he is a tyrant. At home he is a kind
father, but indifferent to the essentials
of fatherhood.

This man's type is duplicated in
every township in the State, otherwise
some other story would have filled this
space. Find him and see if he cannot
yet be educated.

PENCILING THE CHILDREN

Early in September a nurse doing
school inspection work for the State
Board of Health in a small town wrote
the county physician of that county the
following letter :

"There have been several reported
cases of diphtheria here, and certainly
there appears to be a good deal of sore

throat going the I'ounds. Dr. T

on his own initiative, so I am told,
visited the school here to examine the
throats of some first-grade children,
being zealous for the good health and
protection of said children. He used
his pencil as a tongue depressor, going
from one child to another with the

The Health Bulletin

same instrument (a lead pencil) and
wiping it off on the sleeve of each re-
spective victim. He examined a num-
ber of children in this manner. The
teacher suggested they would soon get
some tongue depressors. But he went
again next day, I believe it was, and
took some sticks he had prepared, using
them over and over again on a number
of children. Some clean depressors
were then urged upon him, and even
with these in plenty he persisted in
using these on more than one child. He
probably was bent on inoculating them
with, at least, the proverbial peck of

your consideration. Any publicitj' from
me on this in the way of going after
such personal ignorance or carelessness
would, as I see it, be worthless, but I
think that your office should promptly
and properly bring to task men who
would practice such ungodly methods."

The only comment we can make on
such procedure by a man holding
license to practice medicine in North
Carolina is that better men have been
hanged for less grave offenses. The
only fit place for such a man to be

North Carolina State Board of Health Free Dental Clinic for School Children. The dentist
and a bunch of his little patients, after the work is over, at the Park Avenue School, Asheville,
August, 1919. Photograph also shows Mr. Weber, Superintendent of the Asheville Schools, and
the school nurses. Children are never afraid of Dr. Schultz. not even the little tot on bottom
row, who is "just visiting."

dirt. Can you do anything to stop such
criminal practice on innocent children?
This is fine preface for my work, where
I urge individual use of cups, spoons,
and everything of the sort. I liave this
information first-hand."

The county physician thus appealed
to, and, by the way, one of the best
and most efficient in the State, immedi-
ately wrote us to this effect:

"I see nothing that I can do in this
matter, any more than swear to my-
self and refer this letter to you for

turned loose is in the penitentiary or a
hospital for the criminal insane. As
publicity is a cure for a good many
evils, in future it will be the policy of
the State Board of Health, when au-
thentic evidence of such practice is
presented, to publish the whole affair,
giving names and places.

It is interesting to note that the
same physician stirred up his town
some six months ago by stating to the
parents of a child who was paralyzed

The Health Bulletin

as a result of diphtheria, that the
paralysis "was caused by the anti-
toxin" and that the child "did not have
diphtheria." As a matter of fact,
which the most prejudiced physician
must admit, diphtheria autitoxin can
no more cause paralysis than could the
same amount of cold water. The simple
fact is that either through ignorance,
or prejudice, or carelessness a diagno-
sis had not been made until the con-
sulting physician called in at the
eleventh hour insisted on using anti-
toxin. The paralysis following proved
beyond a doubt that the child had diph-
theria and that the antitoxin was

simply used too late to be effective.
Osier once stated that as a fact there
are more cases of paralysis noted since
the use of antitoxin became general
than before, for the reason that the
patients which now have antitoxin ad-
ministered and are later paralyzed
were the ones that previous to the use
of antitoxin always died in the acute
stages of the disease, never living long
enough for the resulting paralysis, be-
cause of the severity of the attack.

O, Childhood, mortal man will prob-
ably never know the crimes committed
in thy name I

ABOU BEN ADHEM

ABOU BEN ADHEM (may his tribe increase!)

Awoke one night from a deep dream of peace.

And saw, within the m^oonlight in his room,

MaTcing it rich, and like a lily in bloom,

An angel writing in a book of gold.

Exceeding peace had made Ben Adhem bold.

And to the presence in the room, he said:

"What writest thouf" The vision raised its head,

And with a look made of all sweet accord.

Answered: "The names of those who love the Lord."

"And is mine one?" said Abou. "Nay, not so,"

Replied the angel. Abou spoke more loiu.

But cheerily still, and said: "I pray thee, then,

Write me as one that loves his felloivmen."

The angel wrote and vanished. The next night

It came again, with a great wakening light,

And showed the names whom love of God had blest.

And, lol Ben Adhem's name led all the rest.

— Leigh Hunt.

OUT AMONG THE FOLK

Letters and Reports, Boosts and Bumps; But All More or Less Personal,

and Interesting

REPORT OF WILKES NURSE

Covers a Period of One Forenoon in
County School

I weut to Mount View Saturday
morning, September 27, 1919, for spe-
cial examination of thirty-three school
children who have not been examined
in school. Obtained the names from

come. The child was a boy nine years
old. His mouth was open. I looked
at his throat. I don't think I have
ever seen a worse throat. It was al-
most closed. The tonsils met at one
point. The other part was submerged,
pushing against the pillars of the
throat so they bulged and looked taut
and shiny like a balloon. I asked the
mother how far they came and she said
eight miles. I asked her how she came
and was amazed when she replied, "We

Dr Schultz and Superintendent Wheeler, together with a few of the children treated during
one week in July in the North Carolina State Board of Health Free Dental Clinic at Farmville.
A handsome bunch of "better teeth" children.

Dr. Reece, the dentist for the State in
this county. Sent notices to the pa-
rents to meet me at the public school-
house. It is not in session and will not
be until November 1st. Has been sus-
pended since September 1st. Exactly
one-third responded by commg. Most
of them had dreadful throats. The
last one who came in before 1 p. m.
was a pitiful looking womaw and child
dusty and travel stained. The others
had gone and I was alone in the school-
house waiting for any others who might

walked." The child was lying on a
bench. I questiouetl her and found out
that she had four children. That her
husband worked at a sawmill for .$1.50
a day, and they owned forty acres of
land. She said her husband was not
well, had drojisy in his feet sometimes.
She said she had been telling her hus-
band for some time something would
have to be done for the child. He can-
not talk plain and chokes when he is
asleep. His pillow is always wet with
saliva. Dr. Reece treated his teeth.

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The child gave Dr. Reece the wrong
postofflce address the reason I called
them to this place. The postmaster
sent it to the right postoffice although
directed to the wrong.

Before I knew of all this I asked her
if they could afford to pay and she said
yes, they would manage it some way.
After I found out I told her we would
do him free.

I have shed the first tears I have
shed in this county over this incident.
That is saying a lot.
Sincerely,

Cleone E. Hobbs,
State School Nurse.

We suppose an investigation would
be in order in this case, or at least a
committee appointed to place a value
on the forty acres and to inquire about
the whereabouts of the mule before
arranging for a life-saving operation
for that boy. But we will cheerfully
leave all that to the coroner, or some-
body. Our business is to try to get
the child treated before it is too late.

CIRCUS DAY IN ALAMANCE,
FODDER PULLING IN
WILKES, AND TOBACCO
CURING IN PITT

Dentist reporting for one week from
Alamance said :

"Finished Hawfield school and moved
to Pinetop Friday morning where I
was scheduled to be Friday and Satur-
day. Found school closed and teachers
and children had gone to Burlington to
see circus."

Certainly more cheerful than a re-
port from there one year ago would
have been. Then the schools were
closed on account of influenza. But it
is not encouraging from a "better
teeth" standpoint. However, what ex-
cuse could tlie "Old Boys" at Pinetop
have found for going to the circus if
the children had remained in school?

From Wilkes the nurse reported on
one occasion, "I do not know how many
of the schools are stopping, a month,
for 'fodder pulling,' but I believe a

majority of the country schools." Later
exijerience proved her prediction abun-
dantly correct. But we respectfully
pass that report on to Dr. Clarence Poe
and his corps of Progressive Farmer
workers, with the suggestion that they
keep up the fight against the foolish
practice of fodder pulling by anybody,
let alone by the children who ought to
be in school. Lay it on, Poe ! The
darkest hour of course is said to be
before the dawn breaks.

From Pitt the dentist reported in
July that:

"Tobacco curing is the order of the

day in neighborhood. Worked

there two days ; first day very little
response, although one family of seven
children, four between 6 and 13. and
therefore entitled to treatment, lived
just across road from schoolhouse.
Father said all were busy in tobacco
and unless I moved my outfit across
road and worked at noon none of them*
could come. All had teeth in deplor-
able condition. None in this com-
munity seem to appreciate the need for
such work for the care of their chil-
dren. What a contrast to the experi-
ence at Griffon. There they have a
splendid school building, everybody
was interested, and Prof. W. G. Col-
trane was there to give me plenty of
assistance. It does not seem possible
that the two places could be in the
same county."

There you have an unconscious diag-
nosis and prescription all in one short
letter. If every school district in
North Carolina had a W. G. Coltrane
or a G. R. Wheeler in it as head of the
schools, in ten years the course of
North Carolina history would begin to
be written in a difl'erent vein for the
next thousand years.

There is no better place than just
here to state again that a majority of
men who are really able to take their
children to dentists regularly for
dental treatment never do it, and it
requires the hardest sort of urging to
get these same people to take their
children to the free clinics and get the
advantage of absolutely free treatment.

The Health Bulletin

Men who would walk a mile to pick
up a nickel in the road will suffer a
free clinic to be held within a hundred
yards of their door, and unless some
public worker urges them to take ad-
vantage of thirty dollars worth of free
work for their children's teeth (and
it will be worth that many thousands
to the children later in life), they pas-
sively fail to take advantage of the
opportunity. This we find to he the
prime need for educational work. Our

press is interesting enough to pass on :

"I want to tell you about a specialist
in this State 'knocking' State work
while operating on patients who were
found and examined by the State
School Nurse and who persuaded them
to have the operations done. They paid
forty dollars apiece, besides railroad
fare, a little over one hundred miles,
hotel bills, etc."

In the first place this specialist is
lonesome, and in the second "there's a
reason"' for his knocks, and the reason

Some of the negro school children appearing at the Free Dental Clinic at Durham during the

week in September, 1919.

idea is to get the little fellows of six
years old into the dental chair, and
therefore make a dental patient for
some dentist at regular intervals for
life.

LONESOME?

would be very interesting to all the
general practitioners of medicine and
most of the people in his section.

A BIG COUNTY SUPERIN-
TENDENT OF SCHOOLS

As a rule we pay no attention to
knocking, seldom ever read the lam-
bastings we get, and never worry about
it. But the following little extract from

One of our dentists at work in one
great county in July wrote that "the
two people in this county who seem less
interested in this movement than any-

a letter received just before going to body in it are " (here he

The Health Bulletin

named the county superintendent of
schools and the president of an educa-
tional institution). All of which leads
us to remark that in closing this sec-
tion with the publication of the follow-
ing unsolicited letter of Mr. M. D. Bil-
lings, of the Macon County schools, we
are introducing one of the greatest
county superintendents of schools in
North Carolina :

"Dear Dr. Cooper : — I am just writ-
ing you a word to say that you might
have sent some one else as good as Dr.
Bobbitt, but you certainly couldn't have
sent any one who could have done the
work any better than he is doing it.
He is as near 100 per cent etflcient as
a man can lie. He works from eight
to twelve hours, and it is work. too.

"I shall be glad to help him in any
way I can. I am letting a part of my
regular work go so long as I can help
any in this, because I know the work
the doctor is now doing is more badly
needed than anything else at this time.

"The people are friendly and anxious
for the work to be done, and the more
they hear of the class of work being
done by the doctor the more anxious
they are for him to reach them.

"I know just the proposition you
have to face, and know what it means
to try to do a lot of work with limited
capital, but if it can be done at all, I
would like very much to have him for
at least nine weeks. This will make it
possible for him to get into all the
schools of the county, and the work is
so badly needed. I wish you could be
up here for a few days and see just
what is needed and what he is doing."

AN APPRECIATIVE LETTER
FROM WILKES

Double Creek School.
W. L. Brewer, Prin.

ROSEFARM, AbSHERS, N. C.

September 10. 1919.

Dr. G. M. Cooper,

Director Med. Insp. Schools.
Raleigh, No. Carolina.

Dear Dr. Cooper : — I am writing to
say that we had Dr. J. F. Reece with
us last week. The doctor is a genial
good man and soon won the confidence

of the children. Some of the patrons
of the school were out to meet the doc-
tor and heard his talk to the school,
which was just splendid. He treated
28 of our pupils, and the work is
greatly appreciated. The children were
so anxious to have their teeth treated
that they could hardly wait until they
were called. This is one of the great-
est things the State could do for the
children, and it is to be hoped that it
will not only prove a very great bless-
ing to the individual child but to the
State as a whole, for healthy children
are the State's best assets.

Kiude.'^t regards and best wishes for
your success in this great work, I am

Cordially and sincerely yours,

W. L. Brewer.

PITT AND CHEROKEE

We are here publishing two personal
letters, both illustrative of what this
department has been and is trying to
do. We have many like them, but *
these two representing the extremes of
the State seem to state concretely just
the kind of encouragement we need for
this work. When everything gets
"lialled up" and we open a batch of
complaints and criticisms from sordid,
selfish persons in the morning's mail.
there is generally a letter of this char-
acter to balance, which makes the
fight seem after all worth while.

FROM CHEROKEE

r)uriug the early part of September
iliss Birdie Dunn, a State Board of
Health school nurse, wrote from Chero-
kee as follows :

"This was a very interesting week.
I cannot make more than one rural
school a day and do my duty toward
the children. All of the schools I
visited the past week were done on
horseback, the only means of transpor-
tation in this section. The children be-
have splendidly, in spite of wild rumors
as to stripping them, vaccinating, etc.
They soon discover I am quite harm-
less and are intensely interested in
themselves and others. They crowd
around and many of them confide

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symptoms which you know is the acid
test of a child's confidence. I am ex-
pecting to work next week in arrang-
ing for the clinic on the 20th."

In a later letter, written two days
after the tonsil clinic was held, Miss
Dunn wrote :

"We had a good response here con-
sidering everything ; 38 children were
operated on and everything went well.
Today, answering a complaint from a
specialist as to our not discriminating
against children of well-to-do people, I

FROM PITT

In July we received the following
letter from Prof. W. G. Coltrane, head
of the Grifton schools :

Dear Dr. Cooper : — We had a very
successful dental clinic here the latter
part of the week. The parents and
children were very much interested in
the work. Dr. Schultz seems to be
doing fine work and the people liked
him just fine. He worked three days
as hard as he could and had a day's
work to do when his time was out. I

Photograph in July, 1919, of Dr. G. W. HoUiday and his "waiting list" at a North Carolina
State Board of Health Free Dental Clinic for School Children, conducted at the Proximity Cot-
ton Mills, near Greensboro. Many persons and agencies contributed to the wonderful success of
our efforts in Guilford the past summer, but the chief credit belongs to the dentist for capable,
painstaking work, and to Dr. William M. Jones, County Health Officer.

told him that these clinics are reliev-
ing a few, but educating whole com-
munities, that eventually they would
voluntarily, and at a sacrifice, present
their children to specialists for private
treatment, and that but the smallest
per cent now accepting this service
would, without it, never have treat-
ment at all."'

don't believe there is anything more
important in the school work than to
look after the children's teeth and to
teach them to take care of the teeth ;
therefore I wish to express my appreci-
ation for the work you are doing. I
will be ready at any time to cooperate
with you in this work.

The Health Bulletin

About five years ago you came to Elm that the county commissioners must

City and made a medical examination provide the compensation to be paid

of the school children. I have two ^, „ „ , ^v.„„;^i f^^ +v,^ ^ i

boys, and you advised me that they ^^^ ^^^^^y physician for the work,

had enlarged tonsils and adenoids. You when not a whole-time official, and if

also suggested that I have them oper- not covered in the regular contract to

ated on. I did so, and they have im- perform the duties of county physician,

proved wonderfully The older boy is ^f ^^ ^^,^^^ ^ ^^^^^^^ ^^^^ ^^^
one of the finest physical specimens to

be found anywhere. He is nearly 13 examination by a private physician the
years old now, weighs 90 pounds, is compensation is a matter entirely be-
well muscled and is as hard as a brick, tween the teacher and the physician.
He is working in the field this summer. ^his is the form of the certificate :
Last year he led the class when they

took the seventh grade county exami- [Public Laws of 1919.]

nation. This year he won the medal Teacher's Health Certificate

for declamation. My younger boy has t^ ^^^^^^ ^^ ^^^ concern :

improved wonderfully. Dr , of „ „ ...... r i.

, operated on these boys and I ^^'^ '^ ™ Certify that I have made

think is a slick operator. I hope you « thorough physical examination of

will come down to see us as we would

like to talk with you about the work. N. G

Yours very truly, , "J J ■-—.-—-—, .

W G COLTRANE "''^^ ^^^ *^ ^^ f^^^ f^^"^

It is needless for us to say that an tuberculosis, or any other contagious

unsolicited letter like the above is <*'«^«^-^^-

worth much fine gold. (Signed) , M. D.

Address , N. C

Date 19

TEACHER'S HEALTH

CERTIFICATES

SHOP TALK

Taking effect October 1, 1919, the
law now requires a teacher to file with
the county superintendent of schools a
health certificate stating freedom from
tuberculosis or other contagious dis-
ease. Below we are publishing the
proper form upon which this certificate
may be written. The signature of any
reputable physician should be accepted
by the superintendent. In preparing
the form to be used we have not under-
taken to prescribe how a physician may
reach his conclusions, but properly
leave that for each physician to decide
for himself. The law requires that
when a teacher presents himself or
herself to the county physician or
county health officer, whether a whole-
time official or not, he must make the
examination without charge to the
teacher. This is fair because the law
is primarily devised to protect the pub-
lic. The Attorney-General has ruled

We hope a great many people in each
of the one hundred counties where
agents of the State Board of Health
and dentists sent out through this de-
partment have not already worked will
be interested In this service. The ques-
tion to be asked is, How may our
county obtain this assignment? The
answer is that the first thing to do is
see that a correct list of schools, to-
gether with the correct number of
pupils enrolled and the name and post-
ofSce address of each teacher, are
mailed to the Bureau of Medical In-
spection of Schools at once. This in-
formation must come through the of-
fice of the county superintendent of
schools. The law now requires that
each teacher of a grade or school shall
then fill out cards which will be sup-
plied by the State Board of Health, one
card for each child. The information

The Health Bulletin

desired must be carefully obtained and
recorded. This is now only required
once every three years, and is of the
utmost importance and value. It re-
quires about thirty minutes to properly
complete this examination, and a spe-
cial effort when possible should be
made to get the mothers present for the
examination. As soon as the cards are
all properly filled, the matter should
be sent direct to the Bureau of Medical
Inspection of Schools of the State
Board of Health, Raleigh.

In future, positively no schedule for
a county wUl be arranged and no
dentist, nurse or other worker will be
assigned until cards from every school,
white and colored, are in the office at
Raleigh. The only exception to this
rule will be in case of cities or counties
with well organized health depart-
ments, with whole-time health officers
in charge who have suitable filing cases
to take proper care of these records
whUe left in the county.

The fund available for this work is
very much limited, but we are doing
our best to get as much real work done
for the school children as possible. In
several counties it is proposed to sup-
plement the State funds, and thereby
get an extension of the time the nurse
or dentist may spend in the county.
This can be done through the Board of
County Commissioners, Board of Edu-
cation, Betterment Association (if
county-wide) or private funds. Prefer-
ably, of course, the public funds should
be used. Such an extension makes for
a much more thorough job on account
of additional time.

It is necessary for us to have notice
of the desire and provision of such an
extension at least six weeks in ad-
vance.

In conclusion, for the benefit of those
not keeping in touch with the efforts
along this line, we may state here that
this service by the dentist and nurse
is free to the school children of all

classes, from the poorest to the wealth-
iest ; we know no class in our en-
deavors to help defective children.

POINTEDLY APPRECIATIVE

A letter from a good woman to our
dentist at work in her town :

"May God bless you."

From Superintendent M. K. Weber,
head of the AshevUle schools:

"Permit me to express my keen ap-
preciation and deep satisfaction in the
plans that led to the selection of Ashe-
ville as one of the cities of the State in
which you have established dental
clinics.

"The first week of the clinic, closing
Saturday, with 260 children registered
at the one building alone, clearly de-
monstrated the great value as well as
the need of this work. With this al-
most startling object lesson of the
urgent need I wish to join in an unani-
mous public sentiment and appeal to
your office to extend the time of this
clinic in Asheville for at least two
weeks."

From Dr. F. L. Hunt, Secretary of
the State Board of Dental Examiners :

"I had the pleasure of visiting the
clinic being conducted by Dr. Schultz
in one of the Asheville schools yester-
day, and am certainly pleased with the
work being done."

From Doctor Warren W. Way. Rector
of St. Mary's:

"I have requested every teacher in
the St. Mary's faculty to comply with
the State law for public school teachers
which requires a health certificate. I
think it a wise law."

From Prof. C. C. Wright, head of the
Wilkes County schools :

"I am writing to know if you can
let Dr. Reece stay with us through the
first week in November? I have done
the very best I could in making his
itinerary, and am only sorry that I
cannot send him to all the places
clamoring for him. He lias done ex-
cellent work and our people are well
pleased and want him back."

ABOUT BOYS AND GIRLS

Topics of Vital Interest to Every Teacher, Parent, and School Child Discussed
by Thinking Men and Women

HEALTH, DISCIPLINE AND

TRAINING FOR ALL CHILDREN

By Roland F. Beasley,
State Commissioner of Public Welfare.

If you are one who believes that the
State's children are its most precious
possession, your heart must thriU and
your mind obtain a new satisfaction by
reason of the plans that are now on
foot in our State to carry physical
health, mental training, and moral dis-
cipline to every child within our
borders.

If you are one that does not see the
great vision of child welfare now
breaking upon the world, you should
get on your knees and ask God to set
you right on what His Son meant when
He said, "Suffer little children to come
unto me."

No longer is a wayward, neglected
or undisciplined child defined as a
criminal by the laws of North Carolina.

By act of the great Legislature of
1919 there is now a juvenile court in
every county in the State and a county
superintendent of public welfare. The
clerk of the Superior Court is ex officio
judge of the juvenile court and the
county superintendent of public wel-
fare is ex officio probation officer of the
court. This is the machinery which
the State has provided for caring for
all children who are without natural
guardianship.

The court is charged with the duty
of seeing that opportunity for physical
health, moral discipline, and mental
training is secured for such children.
The court has all necessary power to
do what it thinks best for the child.

The court has jurisdiction over every
<-hild under sixteen years —

(a) Who is delinquent or who vio-
lates any municipal or State law or
ordinance or who is truant, unruly,
wayward, or misdirected, or who is
disobedient to parents or beyond their
control, or who is in danger of becom-
ing so ; or

(6) Who is neglected or who en-
gages in any occupation, calling, or ex-
hibition, or is found in any place where
a child is forbidden by law to be and
for permitting which an adult may be
punished by law, or who is in such
condition or surroundings or is under
such improper or insufficient guardian-
ship or control as to endanger the
morals, health or general welfare of
such child ; or

(c) Who is dependent upon public
support or who is destitute, homeless
or abandoned, or whose custody is sub-
ject to controversy.

The juvenile court principle is now
being applied all over the United States
and in foreign countries. It is one of
the great forward steps of the age, and
the most important advance in court
methods in many years. It can be no
more checked than the publij school.
It is here to stay and be improved.

The juvenile court can't save every
child ; but it has been proven that when
the system is properly carried out it
will save 75 per cent of them. That
is more than worth the money.

It costs the taxpayers ten times more
to capture, try, punish, and maintain
an adult criminal than it does to save
a juvenile delinquent.

The court stands in the relation of
parent to such children, and will dis-
cipline, guide and control them through
probation just as a wise father would.

The Health BrLLExiN

The court may punish a child if it is
necessary, but wayward children are
more in need of wise guidance and just
discipline and friendly help than of
punishment.

The judge is the kind and wise
father, the probation otticer is the big
brother of the boy who is about to be
lost. Both are studying ways and
means to make a man of him.

because this is a practical application
of the brotherhood of man.

The juvenile court is really a part
of the educational system. It carries
opportunity to children who otherwise
would not have it.

The juvenile court does not ask what
can be done to a child, but what can be
done for him — to make a man or
woman instead of a human wreck.

THE DAY NURSERY

Dr. J. F. Reece, conducting a North Caro-
lina State Board of Health Clinic, together
with a couple of his little patients, was called
to the door of the Sulphur Springs School in
Wilkes County. The little fellow with his
hand against his face has just "got the worst
of it," but he is glad it's over now. Prevent-
ing premature loss of teeth on account of
neglected decay is the keynote of this whole
movement.

Do you believe in saving boys and
girls whose parents let them go astray,
or who have no parents?

If j'ou are a Christian, you certainly
ought to pray for and encourage this
work, for it is Christ's work.

If you are a good citizen you ought
to help it, for you believe in having
good citizens and not bad ones.

If you are a taxpayer you ought to
stand by this work, because it is
cheaper to save a boy than to maintain
a lifelong lawbreaker.

If you are a mother you ought to
help, because every wayward child is
a burden to some mother-heart.

If you are a man you ought to help.

An Urgent Necessity in Industrial
Communities

By Kate Brew Vaughn.

Too many women employed in our
factories are mothers of small children,
who, on account of conditions, are left
at home, cared for by the oldest of the
group ; sometimes the children are
locked in the house, and not infre-
quently have in the mother's absence
become holocausts in a burning build-
ing ; sometimes in summer the little
fellows are tethered to a tree in the
yard until the mother's return. All of
these methods are a grave injustice to
the children, a hardship on the mother,
and a short-sighted economic policy on
the part of the manufacturer. The
last suffer most from the "floating"
propensities of the operative, who
.seems to drift from village to village
looking for a safe place in which to
live.

A comparatively few manufacturers
in North Carolina have within a year
equipped an old building or built a new
one as a day nursery. Many more are
signifying their intention of doing so. A
properly ventilated and equipped day
nur.<ory for infants and small children,
in the care of a kindly, trained woman,
with regular throe-hour periods of free-
dom to mothers to visit the nursery
and breast-feed their babies; regular

The Health Bulletin

meals, baths, supervised play and
medical attention for the older ones
will require the expenditure of money
and thought, but it will in the end
prove not only a satisfactory contribu-
tion to humanity and command respect,
but will actually prove an economic
saving. If the mills are to absorb more
and more of the mothers and the
schools are to be filled with responsible,
normal children, this is an absolute
essential in North Carolina.

THE COUNTY SUPERIN-
TENDENT OF SCHOOLS

By W. H. PITTMAN,

Chief Clerk, State Department of Education.

The county superintendent is a busy
man if he is properly coupled up with
his job. His job demands all of a full
man's brain, energy and conscience.
Health? Why yes, he must be well.
The new law requires that he be ex-
amined annually. Of course he will
welcome a free physical examination,
for it is worth money to him. He will
likewise see to it that his teachers are
examined free. He knows how much
of their efficiency depends upon their
physical fitness. He will set the ex-
ample for teachers and he with the
teachers will set the proper example
for pupils — all must be examined. The
superintendent is the keystone of the
arch. He will require each teacher to
file with him a certificate showing free-
dom from tuberculosis or other con-
tagious disease, and he will see that
the physical examination of each child
is carried out in conformity with the
spirit of the law. He will do this be-
cause of his recognition of the basis
of physical soundness for efficient
school work. He must realize the im-
portance of this if he would perform
his whole duty in the matter of equal-
izing educational opportunities for the
children of his county.

Time and energy on his part spent
in cooperation with the health authori-
ties in instructing his teachers as to
their duties in this important matter
will give increased efficiency in the at-
tainment of the very end for which the
public school is established. Full co-
operation with the health authorities
in this matter and thorough supervision
of his teachers' work in this respect,
is the measure of his duty in medical
inspection in his county.

THE HOT SCHOOL LUNCH

By Mrs. Estelle T. Smith,
District Demonstration Agent.

A serious problem presents itself
when we consider the thousands of
school children who daily depend on
the box luncheon for one-third of their
food supply. So considered, it should
be as important as that of providing
any other meal. That this is not the
view taken by the majority of people
is, I am sure, apparent to all of us.

One of the biggest worries of the
mother is what to feed the baby, but
when a child reaches school age the
general impression seems to be that he
has the properties of an ostrich, and
that anything that comes handy will
do for his school lunch. This is a
great mistake, for the school child is at
the stage of development at which he
begins to work his brain, at the same
time he must be studied and given the
food which will make him grow and
thrive mentally as well as physically.

The expensive machinery of educa-
tion is wasted when it operates on a
mind listless from hunger or suffering
from indigestion. Much thought must
be given to the selection of food suit-
able for the needs of the school child.

A well balanced selection of foods is
the important requisites of a school
lunch. This does not necessitate a
great variety or quantity. The lunch

The Health Bulletin

should contain muscle-building and
heat and energy-producing foods. Min-
eral matter is also necessary as this
builds the bones and develops the teeth.
This balanced lunch can best be car-
ried out in the "Hot School Lunch."
It is impossible to make strong, healthy
young animals of our children unless
we provide the right kind of food.

Photograph showing Dr. J. E. Osborne
conducting a North Carolina State Board of
Health Free Dental Clinic for the school chil-
dren of the Hayne District in Sampson
County, July, 1919.

A cold lunch is unattractive and un-
appetizing. A school lunch should
please the palate and at the same time
meet the bodily needs.

It has been found possible to work
out a definite plan for lessons in the
preparation of practical dishes which
can be used to supplement the lunches
brought from home.

Each week a committee could be ap-
pointed to take charge of the work for
that week, planning which pupils shall
bring supplies, which prepare and serve
food, and which attend to clearing up.
One day each week the lesson should
be demonstrated by the teacher taking
thirty (30) minutes or more, and this
lunch dish could be served each day
for the remainder of the week. This
plan may be modified to suit conditions.

The hot school lunch means in-
creased mentality, increased vitality,
better attendance, less incorrigibility,
higher average in scholarship, better
team work, reaction on home life.

EXPERIENCE OF THE HOOPER
SCHOOL

"They are happier." That is the re-
mark made by the teachers of the
seven first and second grades of the
William Hooper School of Wilmington,
N. C, after hot lunches had been
served to the children for two weeks.

This work was started last year
under the direction of Miss Annie Lee
Rankin, City Demonstration Agent of
Wilmington, with the cooperation of
the school officials, the parents of the
children and the Red Cross.

There had been more influenza in
this section of the town and there were
more undernourished children. The
basement of the school was equipped
and one hot dish each day was served,
hot chocolate or cream soup, this being
prepared by a committee of women
from Wilmington, who were interested,
and the mothers of the children in the
school, three hundred to three hun-
dred and fifty being served each day.
Some thought the children would not
care for soup, but after it was once
tasted there was no further trouble.
By using two large home-made flreless
cookers the soup could be started the
day before and finished up in a short
time. In serving, cups and bowls were
carried to the room in large baskets
and the bread carried on trays. The
soup was put in large pitchers and
served in the room. Each child had a
sheet of paper on his desk and that
protected the food from the top of the
desk. One teacher had the children
ask a little blessing before having their
lunch together.

The teachers said the children at-
tended school better after the serving
of the lunch was started. Lunch was
sold to the older children, and while
the first week only one dollar ($1) was
collected, the second week showed
twelve dollars and a half ($12.50) to
have been collected.

The Health Billetin

DEFECTIVE HEARING

"One might think that most cases of
defective hearing would at once become
known to a teacher. The diffidence of
many cliildren, however, prevents them
from acknowledging that they do not
hear well, so that it requires consider-
able observation on the teacher's part
to detect all those with defective hear-
ing. Besides the necessity for having
the ears of all such children examined
by a competent ear specialist, such dis-
position in the classroom of the chil-
dren so affected must be made as will
overcome, as much as possible, the
handicaii — that is, they must be placed
at the desks nearest the teacher." —
School Health News, Neic York.

SCHOOL MEDICAL INSPEC-
TION

By Taliaferro Clabk,
Assistant Surgeon-General, U. S. P. H. S.

ADVANTAGES

The health of the growing child de-
termines largely the health and bodily
vigor of the grown man. The com-
munity, therefore, can take no more
important step to insure the future ef-
ficiency of its citizens than that of
growing healthy children. In the pres-
ent state of society an intelligent super-
vision of the health of the children dur-
ing the period of school life is probably
one of the most potent measures for
this purpose and is recognized as such
by law in an increasing number of the
States of the Union. This is especially
true since in but a very few fortunate
communities is any attention whatso-
ever given to general health super-
vision of children during the impres-
sionable preschool age covering the
period from 2 to 5 years of age, in-
clusive.

Intensive studies of the physical con-
ditions of children in many places have
shown large numbers of them to have

physical defects which were previously
uni-ecognized and unsuspected. Many
of the defects thus shown are prevent-
able and remediable. Their persistence
results not only in reducing individual
efficiency but also, in the aggregate, in
reduced national efficiency, as is so
clearly shown by the high percentage
of those found unfit for military service
in the physical examinations conducted
under the selective service law.

The conditions under which children
assemble in school, and not the school
itself, are largely responsible for much
of the sickness contracted during the
period of school life and for the per-
sistence of physical defects. The con-
trol of adverse causes during this
Ijeriod not only exercises an immediate
lieneflcial effect on the health of the
children but serves most effectively to
teach them the principles of personal
hygiene, the nonobservance of which
is now believed to be mainly responsi-
ble for the large annual increase in
the number of deaths from degener-
ative diseases that occur later in life.

Experience shows that the failure to
prevent and correct impairment of
hearing and vision and to detect ab-
normalities of color perception, to se-
cure dental attention, to alleviate pos-
tural defects, to place the normal child
in an environment best suited for physi-
cal development, greatly restricts the
range of industrial, business, and pro-
fessional opportunity in adult life.
Moreover, a number of defective chil-
dren are unable to take full advantage
of their educational opportunity. They
fall behind in school work, become dis-
couraged because unable to keep pace
with normal children in their classes,
and ultimately quit school poorly pre-
pared for useful citizenship. It is of
prime importance to the community,
therefore, to take cognizance of those
possibilities in order that steps may be
taken to prevent them.

The Health Bulletin

DUTIES OF THE SCHOOL NURSE

The school nurse should be directly
responsible to the school physician for
the proper discharge of her duties. Her
activities should supplement those of
the school physician and correlate with
them. She should have sufficient train-
ing to carry out the routine treatment

Nettie McCormick Industrial School Build-
ing at Burnsville converted into a temporary
hospital for a five-day State Board of Health
Tonsil and Adenoid Clinic the latter part of
July, 1919. Seventy-five Yancey County school
children were successfully operated on for
removal of tonsils and adenoids at that time.

of minor ailments in necessitous chil-
dren under supervision of the school
physician ; she should be required to
visit the parents of ailing children,
when necessary, to instruct them in the
care of the sick and in the prevention
of disease ; she should "follow up"
children recommended for treatment
by the school physician to induce pa-
rents to carry out his recommendations
in case of their failure to do so ; she
should from time to time visit children
who have been excluded from school
for purposes of treatment, to insure
their return without undue loss of
time ; she should be required to visit
children absent from school for three
successive days from unexplained
causes, and in case of sickness make
inquiry as to its nature in order to
guard against communicable diseases ;
she should report the results of follow-
up work to the school physician so
that they may be properly recorded.
The services of the school nurse may
be advantageously used during the va-
cation period in infant welfare work,
or in some other form of community
health supervision.

THE RURAL SCHOOL AND THE KINDERGARTEN

"Please do not forg-et the rural schools in this movement," a
Texas mother writes to those in charge of the kindergarten cam-
paign now at its height in Texas. ''I have just read where you are
launching a movement for better kindergarten work in Texas, and
I want to wish you godspeed. I am a country mother with two
small sons, and I have a horror of putting them in a school know-
ing they will have to sit on a seat from 8 a. m. until 4 p. m. with
perhaps two or three 10-minute reading lessons and maybe a little
number work. I believe every rural school should have a kinder-
garten teacher. They might combine kindergarten and first-grade
work." — School Life.

RESULTS

Report of Children Treated Through the Department of Medical Inspection
from January 1 to October 1, 1919

We are here setting forth a brief re-
port of the results of our efforts in get-
ting defective children treated after
having been found defective.

Believing that no matter how valu-
able advice may be it is worthless if
not taken, it has been our policy to
follow advice with treatment, whenever
possible. In this feature of the work
we have consistently refused to
classify school children into rich and
poor. The child of a delinquent father,
no matter what his financial standing,
shall not suffer for the lack of correc-
tive measures which may be in our
power to offer. Indeed, the ideals of
Calvin H. Wiley, the great educator,
who spent a lifetime in attempting to
free the State school system from the
stigma of charity, embodied in the
classical old phrase, "The Free
School," are and have always been our
own, both personal and professional.
Dr. Edgar W. Knight in his "History
of Public Education in North Caro-
lina," a book by the way that should
be in the possession of every teacher
in the State, says of the first of Wiley's
difficulties in the beginning of his offi-
cial duties as State Superintendent of
Public Instruction in 1853, that he had
" 'to purge' the idea of public educa-
tion of the fatal taint of charity once
adhering to it, and to lift it 'from the
position of a beneficence to a class to
that of a fundamental interest of all
the State.' " And again, "He (Wiley)
believed that education should be uni-
versal, free, and open alike to all, both
rich and poor."

Shall we, as public health officials
and as members of the great medical
profession, go back and adopt the pre-
vailing ideals of a century ago in deal-

ing with helpless, handicapped school
children. No! Wiley's educational
platform of 1853 is our public health
platform in 1919. "Universal," "open
alike to all." On the basis just stated
we have conducted this department this
year and the report by counties is here
given.

TONSIL AND ADENOID CLUBS

Recognizing that at least 75 per cent
or more of the children found most
seriously needing operative treatment
could never be brought to a specialist
for operation, even when within finan-
cial reach, we have devised the club
plan for bringing the specialist to the
child. Briefly, we fit out some place
like an armory, or any building capable
of being heated and lighted properly
and where quiet and privacy may be
had. The equipment consists of cots,
sheets, blankets, towels, pus pans, hot
water bottles, etc. An extra room is
fitted with table to use as operating
table and a heater for sterilizing in-
struments. The children are required
to come without breakfast, are put to
bed after a final examination by the
specialist, and the operations are all
done for the day for as many children
as the operator may be able to take
care of. The number done in one day
by one man has varied from 9 to 23.
The children are all put to bed and a
trained nurse remains on duty with
them all night. As a rule they are able
to go home the day following the opera-
tion. Under no circumstances are they
allowed to go home, especially in the
country, until the day after the opera-
tion. The specialists are employed for
the work by the day or by the trip.
About 80 per cent of the children oper-

The Health Bulletin

ated on are charged a fee of about
$12.50, the remaining ones are charged
notlaing. The operator does not know,
uor does any of the assistants In the
clinic, except the nurse who arranges
for the clinic and attends to details,
which children pay the fee and which
do not. By tliis plan a large number
of children who could otherwise have
never had the chance are reached and
get the benefit of a major operation by
a good operator.

The State Board of Health has been
employing good specialists who volun-
teer their services for this work.

Clinics were held in the following
counties :

Children
operated on

Sampson — March 21 14

Sampson — June 3 17

Sampson — June 4 -.. 19

Gaston — May 1 5

Pitt— May 24 9

Pitt— June 5 14

Pitt— June 6 15

Havwood — June 20 15

Haywood— June 29 17

Haywood — July 7 16

Swain — July 11 - 17

Swain — July 12 17

Transylvania — July 22 12

Transylvania — July 23 15

Transylvania— July 31 10

Transylvania — Aug. 1 13

Transylvania — Aug. 2 18

Transylvania — Aug. 7 29

Transylvania — Aug. 9 13

Yancev— July 29. 30, 31. Aug.

1. 15. 16 - 75

Madison— July 28 21

Madison— July 29 13

Madison — Aug. 14 12

Madison — Aug. 15 14

Madison — Aug. 16 15

Mitchell— Aug. 28, 29 33

Northampton — Aug. 27 21

Northampton— Aug. 28 19

Hertford— Aug. 29 23

Jackson— Sept. 17 20

Cherokee— Sept. 20 32

Cherokee— Sept. 21 6

Macon— Sept. 20 14

Macon— Sept. 27 9

Thus it will be seen that a total of
612 children had the advantage of this

important throat operation as a direct
result of the activities of this depart-
ment in fourteen counties. The opera-
tions have been successful and with the
exception of a few troublesome hemor-
rhages after the operation no compli-
cations have resulted. This record we
feel exceedingly proud of.

We have made no mention here ■ of
the activities of many local health de-
partments which have had many chil-
dren treated and of the great numbers
of private patients treated as a direct
result of the systematic plan of medi-
cal inspection of school children now
conducted through the teachers by the
State Board of Health.

In addition to the operations per-
formed the nurses of the department
have reexamined 10,803 children and
made 65 talks to people in every con-
ceivable kind of community and to
every age and class.

One of the most encouraging features
anywhere is the establishment in the
city of Asheville of an emergency hos-
pital with full equipment for the treat-
ment of school childi'en. This very for-
ward step was made possible through
the generous action of the city board
of commissioners, who provided the
funds. Their action was a just tribute
to the excellent work done there by
Dr. Margery J. Lord, school medical
inspector, and Misses Pearl Weaver
and Jane Brown and Mrs. Hanna, the
school nurses, who have done wonder-
ful work.

If space permitted and we knew the
names of them all, we would like to
publish the names of the scores of
people in all the named counties who
have helped us with their money, their
time, and their labor and their en-
couragement and moral support ; but
we shall have to be content with as-
suring them that their aid is fully ap-
preciated and we shall try to pass it on
by doing more and bettor work in the
future in the name of Him who said,

The Health Bulletin

"Inasmuch as ye have done it unto one
of the least of these, my brethren, ye
have done it unto me."

DENTAL CLINICS

Equipment for permanent dental
school clinics has been installed at
Kinston. Salisbury, Winston-Salem and
Durham, all paid for by the health de-
partments, the equipment of the first
three places being partly paid for by
the State Board of Health and the In-
ternational Health Board. The in-
firmary at Durham was equipped solely
•by the health department there, upon
the proposal by the State Board of
Health that it would pay the expenses
of the dentist for the first three months
work, provided the Durham authori-
ties would continue the service at its
own expense. The proposal was ac-
cepted and thus on July 1 was begun
what is the first permanent infirmary
to be open for a full year. Most ac-
ceptable work is being done there with
fine public response. The local chap-
ter of the Red Cross at Fayetteville
provided permanent equipment there
last winter and good work was done
by local dentists. As a result of the
splendid work done at Asheville by Dr.
A. M. Schultz, representing the State
Board of Health, with the hard work
and able assistance of the local nurses
and Dr. Lord, a permanent infirmary
will soon be equipped in the splendid
new high school building. This will be
open to children of city and county. As
we go to press, it is learned through
Dr. C. C. Hudson, the City Health Of-
ficer, that Charlotte will very soon have
a permanent equipment and the State
Board of Health will offer the same
assistance as at Durham and Asheville.

Beginning with the opening of the
first permanent infirmary in the State
to begin work on January 1 at Salis-
bury, followed one month later at
Winston-Salem and two months later
at Kinston, with nine dentists in the
field all the time during the summer.

working all their time, much progress
has been made. A total of 9,628 chil-
dren have been treated from January
1 to October 1. With the exception of
the three months at Salisbury, for
which the State Board of Health paid
only one-fourth, the remainder of the
work has been done at the expense of
the Bureau of Medical Inspection of
Schools of the State Board of Health.
The work from its beginning in July,
1918, has been done without having
any precedent to follow. Mistakes
have been made, difficulties of every
conceivable character have been en-
countered. It may be that a better
way of getting at this big undertaking
might have been devised ; however, no
one offered to woi'k it out for us. But
to sit still and allow 80 per cent of
the school children in North Carolina
with defective teeth to continue to neg-
lect them and make no earnest effort
to really offer them substantial assist-
ance did not exactly coincide with our
idea of public service. So a beginning
has been made. Some time wiser heads
with more experience will work out a
perfect method and they will be blessed
by their generation. Our idea for this
work is a permanent equipment in the
high school building of each county-
seat town provided by the local authori-
ties, together with heat, light and
water, and a State-wide organization
of capable dentists maintained, paid
and directed by the State Board of
Health, who shall do all the w^ork
necessary for all the school children
between 6 and 12 years old in each
countj' every year, the children being
brought to the county seat exactly on
the plan followed by the health officer
in Forsyth or the county superintend-
ent of schools in Macon. Such equip-
ment costs but a few hundred dollars
and will last with care for years. The
State could maintain an organization
capable of getting this job done each
year as it should be done on a surpris-
ingly less amount of money annually

The Health Bulletin

than is spent each day for coca-cola
and tobacco in North Carolma.

With proper attention to food selec-
tion and the feeding of babies, with
regular visits to the dentist before
school age, with an arrangement like
the outline above, in twentj^-five yeai-fe
North Carolina would be one State
with good teeth. We have not only
proved that the plan is practical, but
cheap as present values go.

Talk it over and let us hear from
you. you people out in the State who
think and do things.

For the information of those espe-
cially interested we are below submit-
ting a detailed report of dental work
from January 1 to October 1 :

No. children
County treated

Alamance ....- 401

Bunconibe 539

Cherokee 349

Cumberland 427

Durham 509

Forsyth 942

Graham 304

Guilford 836

Lenoir 469

Macon 671

Mitchell 391

Northampton 324

Pitt 665

Rowan 878

Sampson 899

Swain 84

Wilkes 513

Yancey 427

Total 9628

In nearly every instance everything
was done for each child possible in a
dispensary of the nature conducted, but
a great many children were referred to
private dentists in all these counties.
The work in Rowan was, as previously
stated, the only instance where the
whole expense was not borne by the
department of Medical Inspection of
Schools of the State Board of Health.

The Buncombe work was confined to
the city of Asheville, and the Guilford
work does not include all of Greens-
boro. At this writing (October 6)
dentists employed by^ the State Board
of Health solely are at work in Guil-
ford, Alamance, Swain, Pender. Jack-
son and Wilkes. At Durham, as stated,
the City and County Board of Health
is continuing for the entire year most
excellent work, six days in the week, in
its new permanent infirmary. The
same is being done in the same way for
six months at Winston-Salem by the
local city and county departments of
health.

It is hoped to extend the service dur-
ing the winter and early spring to Dup-
lin, Lee, Moore, Union, Person, Wake,
Randolph, Richmond, Columbus, Bla-
den, Craven, Carteret, Pamlico, Hali-
fax, Cleveland, Montgomery, Edge-
combe, Orange, and possibly a few
other counties.

FREEDOM

They are slaves who fear to speak
For the fallen ayid the weal: :
They are slaves who will not choose
Hatred, scoffing, and abuse.
Rather than tn silence shrink
From the truth they needs must think.
They are slaves who dare not be
In the right with two or three.

— James Russell Lowell.

LAUGH, LITTLE FELLOW

By Wilbur D. Nesbit

LAUGH, little fellow, laugh and sing
And just be glad for everything!
Be glad for morning and for night.
For sun and stars that laugh with hght.
For trees that chuckle in the breeze,
For singing birds and humming bees —
Be one with them, and laugh along
And weave their gladness in your song!

Let nothing but the twinkle-tears
Come to your eyes these happy years,
When you are free of task and toil
And all the frets that come to spoil
The hours of folk whose feet have paced
The road along which all must haste.
Laugh, little fellow, for it drives
The shadows out of other lives.

Go romping care-free as you will
Across the meadow, up the hill.
And shout your message far away
For all the world to join your play.
This is the time for laughter: now.
When Time has not set on your brow
The finger-prints that come with care
And leave abiding wrinkles there.

Laugh, little fellow, laugh and sing
And coax the joy from everything!
Take gladness at its fullest worth
And make each hour an hour of mirth.
So that when on the downward slope
Of life the radiant sky of hope
Will bend above you all the way
And make you happy, as today!

Thi5 Bunelirwvillbe .seAl free to ar\-g citizen of the State upoAregugatl

Vol. XXXIV

DECEMBER. 1919

No. 12

PUBLISAELD BY TML nPR.TA CAROLIhA STATE- BOAI?D s^MELALTM

Vol. XXXIV

DECEMBER, 1919

No. 12

THE NEXT TO GO!

Leprosy, smallpox, yellow fever,
typhoid, these in turn have scourged
the v^forld, but they in turn have been
conquered by science.

Now tuberculosis goes to the block.
There must be no reprieve, no par-
don. Tuberculosis can be prevented
and can be cured. To make the fight
against the white plague a success
each one must do all possible.

Last year in North Carolina 3,391
people died from tuberculosis. At the
same time there were more than
twenty-seven thousand open and active
cases of the disease in the State.
Compared with four years ago this is
a decrease both in deaths and cases
of about twelve per cent. Yet the
loss in the state is appallingly large.

The frightfulness of it comes home
to all of us when we stop to think.
Nearly every one of us has a loved
one, a friend or an acquaintance who
is suffering from this disease. We see
the outward marks growing more
noticeable as the ravages of the dis-
ease progress and we pity and won-
der a little just how long before the
funeral.

It doesn't enter our head to do
much to prevent the wounded one
from becoming a fatal casualty, nor
to prevent others from becoming in-
fected. Yet tuberculosis can be pre-
vented, and can be cured. A death
from it is utterly useless. The other
diseases that have scourged the world
are under control, and now tubercu-
losis must be made to follow the
others.

In this we can all assist. The first

ten days in December there will be on
sale here the Red Cross Christmas
Seals. Each seal is a penny's worth
of cure and prevention. Chiefly from
the sale of these seals are derived
the funds with which the campaign
against tuberculosis is conducted. Our
people can use Red Cross Christmas
Seals and help.— R. B. W.

DEATHS DECREASE

A decrease of approximately twelve
per cent in the number of deaths
caused by tuberculosis in North Caro-
lina during the past four years is
shown by a comparison of the figures.

The total number of deaths from
this cause in the state for the year
1915 was 3,710. In 1918 the total
number had been reduced to 3,391,
a difference of 319. This reduction,
considering the steady increase in
population during the past four years,
means an even greater proportionate
decrease in the tuberculosis death
rate.

The decrease obtained is undoubt-
edly largely due to the energetic
campaign waged by health authorities
throughout the state. This has in-
cluded a wide educational campaign to
instruct in methods of prevention and
cure, the holding of clinics for the
discovei'y of the disease, the installa-
tion of public health nursing in many
communities, and the establishment
of sanatoria for the treatment of the
disease.

Careful observations and experi-
ments have demonstrated that the
ratio of active open cases of tubercu-
losis to deaths are as eight to one.

The Health Bulletin

This means that while more than
three thousand died in the state during
the past year there were at the same
time in excess of twenty-seven thou-
sand suffering with the disease, and
menacing the health of many thou-
sands of others.

Tuberculosis is preventable and cur-
able. To save the unaffected from
danger of infection and to more ade-
quately care for those stricken is a
duty laid upon the state which it is
beginning to effectively discharge.
But only a beginning has been made.
There is need for additional sana-
torium facilities, for more field work-
ers and especially public health nurses
to reach those who may be affected.

— R. B. W.

THE TRAINING SCHOOL FOR
NURSES

The Training School for nurses of
the North Carolina Sanatorium for the
Treatment of Tuberculosis is char-
tered by the State of North Caro-
lina. It gives a two years course, and
is affiliated with general hospitals for
third year course. The school is in

good standing with the State Nurses'
Association.

The school furnishes text books to
its pupil nurses, as well as collateral
reading. It gives deserving and cap-
able girls who have had tuberculosis
a chance to enter an honorable and
remunerative profession. While it does
not limit its course to nurses who have
had tuberculosis, yet most of the pupil
nurses are from this class. To such
it gives an opportunity of growing
strong while they work and study, al-
ways under the guidance and watchful
care of physician and head nurse.

A graduate of the training school
is now in charge of a sanatorium.
Another will be occupying a similar
position by January, 1920. For the
next ten years there will be more de-
mands for our nurses to fill such places
than we can supply. One of our gradu-
ates is our laboratory technician, and
in addition to the chemical and micro-
scopical laboi-atory is fast gaining a
working knowledge of the X-Ray labo-
ratory.

The school also has a post-graduate
course of four months for graduate

NURSING STAFF AT STATE SANATORIUM

Thk Health Bulletin

nurses, giving a certificate on satis-
factory completion of the course.

The teaching faculty consists of:
Dr. L. B. McBrayer, dean; Dr. P. P.
McCain, vice dean; Miss Mamie O'Kel-
ly, RN, superintendent of training
school; Miss Elizabeth Connolly, RN,
assistant superintendent of training
school; Dr. J. L. Spruill; Dr. R. A.
McBrayer; Miss Maude Mann.

— L. B. McB.

TUBERCULOSIS WORK BY THE
WHOLE-TIME COUNTY HEALTH

OFFICER IN CO-OPERATION

WITH THE STATE BOARD

OF HEALTH

It was recognized by the State
Board of Health that no County Health
Department is complete without a
properly organized campaign against
tuberculosis. It was also recognized
that the average doctor did not have
sufficient training in medical college
to enable him to make a diagnosis
of pulmonary tuberculosis in its early
stages. Hence the Bureau of County
Health Work of the State Board of
Health made an agreement with the

Bureau of Tuberculosis of the State
Board of Health, the same being ap-
proved by the State Health Officer,
that all whole-time health officers co-
operating with the State Board of
Health should be given a course in
tuberculosis at the State Sanatorium,
and that the said health officers would
put on a campaign against tubercu-
losis in his county. For post-gradu-
ate course of instruction see article
in this issue of the Bulletin on "Clinics
at the State Sanatorium" by Dr. P. P.
McCain and for the plan of proce-
dure, see article in this Bulletin on
Forsyth County, and also article on
"Unit of Tuberculosis of State Board
of Health," by Miss Rose M. Ehren-
field. State Director of Public Health
Nursing.

In addition, the Sanatorium agrees
with the health officers to send a mem-
ber of its staff for consultation on
doubtful cases where such doubtful
cases can be gotten together in
groups of five or more. It also pro-
vides that cases in less than groups of
five or more may be sent to the Sana-
torium clinics for examination. There

SERVING OVERSEAS

Miss Connolly, Dr. R. A. McBrayer,

Miss O'Kelly

BACK ON DUTY

Miss O'Kelly, Dr. R. A. McBrayer,

Miss Connolly

The Health Bulletin

still remain a few cases doubtful.
These may come to the Sanatorium
for study over a period of ten days or
less when these few remaining will
be cleared up.

This is found to be a workable
plan and one that will cover the
ground entirely. It is working now
and we are hoping that it will become
more perfect as the days come and go.

One wonders why this stand-
ardized work by the whole-time
health officer should be limited
to those who work in co-opera-
tion with the State Board of
Health. We would certainly be glad
to have all whole-time health officers
come in on the plan, and county phy-
sicians or health officers who are al-
lowed to devote only a part of their
time to health work can get in on
the plan outlined by Miss Ehrenfield
by having his county employ a public
health nurse. So that this plan is so
arranged that it is workable in any
and every county in the state, and it is
our desire that it shall be. Let us
join you. — L. B. McB.

HOW TO PREVENT THE SPREAD
OF TUBERCULOSIS

Tuberculosis is spread from one per-
son to another only through ignorance
or carelessness. The germ which
causes tuberculosis, the tubercle bacil-
lus, is contained in the discharge from
the patient's mouth and nose — in the
sputum, the saliva, and the spray from
coughing and sneezing. If the patient
and those helping to take care of
him will follow carefully the directions
given below for disposing of the dis-
charges and of the things which come
in contact with those discharges, there
will be no danger whatever of his
giving tuberculosis to any one else.

1. Never spit except in a sputum
cup which can be burned when used.
There is danger in using a tin cup,
a bottle, or a spittoon. Both the
pocket sputum cups for those who are
up and the cups for those in bed can
be gotten at the State Sanatorium,
Sanatorium, N. C. for 50 cents a hun-
dred, postage prepaid, which is actual
wholesale cost when purchased in

SHACK FOR CONVALESCENT WOMEN AT SANATORIUM

The Health Bulletin

quarter million lots. The tin holders
for the bedside cups can be had at the
same address for 15 cents each. One
sputum cup will usually last a day, so
that the cost is negligible. After be-
ing used, the cups should be filled
with sawdust, wrapped in paper, and
burned in a closed stove. The kitchen
stove is usually most convenient and
perfectly safe for this purpose.

2. If any of the sputum should acci-
dentally be spilled, or willfully placed
on the floor, bed linen, or clothing
pour over it a five-per-cent compound
cresol solution and allow to stand for
one hour. Then wipe up with a rag or
cloth Avrung out of the same solution,
and burn the cloth. After this pour
over the place where the sputum was
more of the solution and allow it to
stand for one hour. Then finish wip-
ing the place with a cloth wrung out
of the solution. After burning the
cloth, wash your hands thoroughly
with soap and water. If the sputum
is on the bed linen, the linen can be
soaked for two hours in one of these
solutions and afterwards boiled.

3. Always cover your mouth and

nose with a rag or piece of gauze
when you cough or sneeze. Coughing
or sneezing emits a fine spray from
your respiratory passages. This spray
contains the germs, and unless you
catch this spray on a rag, the germs
will contaminate the air and others
will become infected. A clean rag, a
piece of gauze or cheese cloth, or a
paper napkin is suitable for this pur-
pose and is inexpensive. Whatever is
used should be wrapped in a paper and
burned in the kitchen stove. A patient
should never use his hand to shield
the mouth and nose when coughing,
because of the danger of getting
germs on the hand and transferring
them to whatever is touched. The
hands should be washed often, and al-
ways before meals. Should a patient
ever have to shield his mouth with his
hand when coughing, before he can
get his rag, he should wash his hands
immediately. A patient should never
use a handkerchief for this purpose
unless he burns it or boils it for five
minutes before putting it in the laun-

SHACK FOR CONVALESCENT MEN AT SANATORIUM

The Health Bulletin

dry. Each patient should have a sepa-
rate towel for his own use.

4. A patient who has any cough or
expectoration should not allow any
one to kiss him, and should never kiss
any one on the lips, even though he
does not cough or expectorate.

5. A patient should use separate
dishes and drinking vessels. It is bet-
ter to have dishes of a different color
or shape for the patient, so that they
won't get mixed with the others. After
being used, the dishes should be boiled
for five minutes and then washed in
a separate dishpan and with separate
dishcloths.

6. Put everything which the patient
has had in his mouth, such as apple
cores, grape hulls, toothpicks, or other
articles, in a paper to be burned.
Scraps of food which the patient
leaves may be fed to hogs, dogs, anc
chickens, if boiled first. Otherwise
they should be burned.

7. The water which the patient uses
for washing his teeth should either
be boiled after he has used it, or al-
lowed to stand for a few hours after
mixing with it an equal quantity of
five per cent compound cresol solu-
tion.

8. The patient's clothes, bed linen,
and towels should either be boiled for
five minutes or soaked in three per
cent compound cresol solution for two

hours before being washed or sent to
the laundry.

9. The patient should never sleep
with any one.

10. The person who waits on the pa-
tient should wash her hands thor-
oughly with soap and water every time
after handling the patient, the bed
linen, the sputum cups, or anything
else about the patient.

11. Do not use a duster in the pa-
tient's room. Use instead a cloth
moistened with a one per cent com-
pound cresol solution. Do not sweep
the patient's room without first sprink-
ling the floor or without using a moist-
ened broom. The best way is to scat-
ter sawdust soaked in a one per cent
compound cresol solution over the
floor before sweeping it.

12. Do not allow children to play
on the floor of the patient's room or
to lounge on his bed, since they are
much more easily infected with tuber-
culosis than adults.

13. Screen the patient's room so as
to keep flies out. If allowed to swarm
over the patient they will carry the
germs to the kitchen and dining-room
and will likely infect the other mem-
bers of the family.

14. If the patient has tuberculosis
of the bowels or kidneys, the stools
and urine need to be disinfected. This
can be done by adding twice as much
five per cent compound cresol solution

I 1>A66 i.. JiAii...li:Y DURING RECLINING HOUR

Making Pine Needle Baskets in Front of Shack for Women, With Miss McLawhorn,
the Class Instructor, in Charge

The Health Bulletin

or twice as much of a solution made
by adding half a pound of the chloride
of lime to one gallon of water and by
allowing it to stand for three hours.
If the bowels and kidneys are not
diseased, no such precautions are
necessary. — L. B. McB.

REST, THE MAIN ESSENTIAL

Do you have tuberculosis? Would
you like to know wherein lies the
secret of being cured? The belief
is almost universal that it lies in
swallowing raw eggs by the dozen,
in sleeping out in the fresh air and in
going to some special climate. Our
cemeteries are full of those who de-
pended upon these things alone.
Nourishing food, fresh air and a suit-
able climate are all important factors
in getting well, but the secret, the one
factor which is more important than
all others combined, is REST. Whether
or not you get well depends not on
your going West or North or South,
not on how fine a sleeping porch you
have and not on how much milk and
how many raw eggs you take, but on
how soon after the beginning of the
disease you begin to rest, how com-
pletely you rest and how long you
continue to rest.

The tuberculosis in your chest is
very much like a house on fire; and
rest is the water which will quench it
if you discover the disease early and
continue to rest not only until the
symptoms, or the flames, have dis-
appeared, but also until the lesions in

!^^Q^9i

OFFICE FORCE, 1919

your lungs, or the smouldering coals,
have been smothered out. If your
house were in flames, you would drop
all your other business, your pleasure
and everything else until the fire was
quenched. Just in proportion as your
life is more valuable than your house
is it necessary for you to drop every-
thing else and make it your one busi-
ness to get well.

If you are a man with a family to
support or a mother with a household
to attend to, you may think you can-
not drop everything and rest; but if
your family cannot get along in some
way during the months you are rest-
ing in order to get well, how are they
going to get along after one or two
years when you are dead or helpless,
as you will almost surely be if you
don't give up everything and rest.

Why is it that in a well run sana-
torium so much better results in treat-
ing tuberculosis are obtained than in
the home ? Why is it that 46.3 per cent
of all the moderately advanced cases

AMBULATORY PATIENTS AT SAXATORUM
In the Rear is Shown Infirmary Sleeping Porches, With Patients

The Health Bulletin

and 81 per cent of all the early cases
treated in the North Carolina Sana-
torium are living and at work, and
most of them back at their old jobs?
It is not on account of any special
medicine used. It is largely because
in a well run sanatorium a patient
is required to rest. It is one thing to
tell one how to rest and quite another
to see that one does it.

What, then, is the "rest cure," and
how is it carried out in a sanatorium?

The patient is put to bed as soon
as he is admitted and is kept at com-
plete rest in bed as long as he has
any fever at any time during the day.
After his temperature has been 99 or
below for several days, he is allowed
to sit in a reclining chair for an hour
a day. If this exertion doesn't cause
a "rise of temp." his "time up" is
increased after a few days to two
hours, then to three hours, etc., until
he is up most of the day. It may be
only a few days, it may be weeks or
it may be months before one's tem-
perature becomes normal, the length
of time depending very largely on how
soon after the onset of one's trouble
one begins to rest. Regardless of how
long it requires, every patient in a
sanatorium is kept in bed until his
temperature subsides.

If the patient has had no fever or
other active symptoms for some days
after getting out of bed, the physician
prescribes for him a small amount of
exercise, usually a few minutes slow
walking, being as careful in the pre-
scription as if it were a dose of medi-
cine. The remainder of the day the
patient spends resting. As his con-
dition improves his exercise is gradu-
ally increased.

But all patients, regardless of how
well they look or feel, are required to
take a rest period of one and one-half
hours on a reclining chair in the morn-
ing and a rest period in bed of at least
two hours in the afternoon. During
this latter period they must relax and
keep perfectly quiet, no talking, no

visitors, no games and no reading be-
ing allowed.

Of course the patient is kept in
the fresh air both day and night and
he is given plenty of nourishing food,
both of which are factors that aid
materially in restoring him to health.
But it is in the enforcing of the "rest
cure" which makes the sanatorium in-
dispensable.

Do you ask, "Why can't one take
the rest cure at home?" Do you say
you can get just as good food at home
and that you can build an up-to-date
sleeping porch, so what is to hinder
you from getting well at home as
surely as in a sanatorium? No mat-
ter how well your home may be equip-
ped, you will not take the prolonged
rest which is necessary for a cure, un-
less you are different from the other
ninety-nine in every hundred.

Early tuberculosis doesn't make one
feel very sick and it causes no pain un-
less there is pleurisy. After a few
weeks of real rest the symptoms all
disappear — the fever subsides, the ap-
petite returns, the weight is regained
— and one looks and feels as well as
he ever did in his life. On the con-
trary the tuberculous lesion inside of
his chest heals very slowly and it re-
quires months and months of rest
after all symptoms have disappeared
for the disease to be arrested.

It is comparatively easy for one to
take the rest cure when one feels sick;
but to act like a sick man when he
feels and looks perfectly well and
when there are hundreds of things
which he needs or would like very
much to be doing is beyond the power
of the average individual. Even when
a patient is disposed to continue the
rest cure himself his homefolks and
friends often make it impossible for
him to do so by insisting on his en-
joying himself or possibly on his help-
ing with the work around home. A
relaxation from the rest cure as soon
as a patient feels well means that he
will soon have another breakdown and

The Health Bulletin

will likely be in worse condition than
he was at the beginning.

In a sanatorium every one else is
taking the cure and it is comparatively
easy for you to fall in line. While
getting well you are forming good
habits, learning tuberculosis and
learning how to live when you go
back home so that you will never
have another breakdown. Let me
urge you, then, to go to a sanatorium
as soon as possible, for this is the sur-
est and quickest way to get well.
In case it is absolutely impossible
for you to raise the necessary funds,
you will need to summon to your aid
every ounce of will power you have
and determine that "in spite of the
world, the flesh and the devil" you are
going to rest and keep on resting
at home until your disease is arrested.

Above all don't think you have no
further need of your physician as
soon as your symptoms disappear and
you begin to feel well. Don't fool
yourself either into thinking he has
made a mistake in his diagnosis. Have
him examine your chest as often as he
thinks wise, keep him advised as to
your symptoms and never increase
your exercise except upon his ad-
vice.— P. P. McC.

THE SPUTUM AND THE GERM

A great number of North Carolin-
ians are today suffering with tubercu-

VOCATIONAL THERAPY

In Center. Mr. C. W. Hyde. Instructor,
With Students at State Sanatorium

IN THE WORKSHOP

Student-Patient Soldier Completing Center
Table at State Sanatorium

losis which has become incurable be-
cause they have been horribly misled
by the fact that no tubercle bacilli
(germs causing tuberculosis or con-
sumption) were found upon one or
more microscopical examinations of
their sputum (spittle). This prevail-
ing belief that the failure to find these
germs of tuberculosis in your sputum
means that you do not have tubercu-
losis is far more damaging than to be
told that you really have tuberculosis
when you do not have it. This one
error in deductive reasoning is costing
hundreds of lives in North Carolina
each year.

Can a man have real tuberculosis
(or consumption) and never show any
of these germs in his sputum — after
microscopical examinations? Most as-
suredly he can. This fact is proved
by the case and autopsy records of the
University of Pennsylvania Hospital
in Philadelphia.

In face of this proof, what does
the failure to find tuberculosis germs
in the sputum mean? It means noth-
ing at all — for you can and may have

The Health Bulletin

tuberculosis just the same. The germs
of tuberculosis (or consumption) are
in you, if you have the disease and,
if found by microscopical examina-
tion it is positive proof that you have
the disease — and no further examina-
tion is necessary by any one to make
the diagnosis positive; however a fail-
ure to find the germs means absolutely
nothing.

Doctor C. A. Shore, State Labora-
tory of Hygiene, Raleigh, N. C, will
examine your sputum for you free of
charge at any time, though he will
caution you not to believe that you do
not have tuberculosis even if he does
not find the germ of tuberculosis in
your sputum. — R. A. McB.

OCCUPATIONAL THERAPY— VO-
CATIONAL EDUCATION AT
STATE SANATORIUM

In the treatment of tuberculosis,
which of necessity extends over a long
period of time, it has been found that
what we term Occupational Therapy
is of much importance.

The mind in the treatment of tuber-
culosis is of so much importance that
one writer has said that half the treat-
ment should be directed to that part

of the body above the neck. The
mind to do or the will to do is the
large part in most any undertaking,
whether it be the securing of an edu-
cation, the amassing of a fortune, the
winning of a girl, or getting well of
tuberculosis. "An idle brain is the
devil's workshop," was a true adage
when it was written, is true today and
will remain true for all time. It is
true in the treatment of tuberculosis
and ofttimes, more often than any
other one thing, spells failure in tak-
ing the cure. So that anything that
will bring cheer and contentment to
a patient taking treatment for tuber-
culosis is a very valuable adjunct and
I might say a very valuable therapeu-
tic agent. You know we have long
since found out that drugs are a small
part on the therapeutic agents at our
command.

Homesickness in the tuberculous pa-
tient at a sanatorium is a very im-
portant thing, and hence should be
given earnest consideration. It is be-
lieved that homesickness interfered
more with the treatment and cure of
tuberculous soldiers in the U. S. A.
Sanatoria than all other things com-
bined. They were receiving the best

CLASS IN PINE NEEDLE BASKETRY WORKING

The Health Bulletin

treatment and care that science and
money could provide; the govern-
ment, we are unofficially informed,
spending quite $5.00 per day per pa-
tient. They had their clothes fur-
nished them in addition to their care
and treatment; they had the Red
Cross, the Y. M, C. A., the Knights of
Columbus aides, dietitians, nurses, doc-
tors, all in abundance, and besides
they were still receiving a soldier's
pay, w^hich for a private w^as $30.00
per month. But they were homesick.
They wanted to go home and it mat-
tered not that the home was far in
the country, where a doctor could only
be secured at long intervals, and a
nurse not at all; where the food to be
cooked and the methods of cooking it
were of the very crudest kind; where
the simplest methods of caring for the
sick had never been heard of, in fact
it mattered not if there were no home
to go to — the sick soldier wanted to
go home — was homesick.

The most pitiable patient that we
have ever had at the State Sanatorium

was a woman sent by a local Anti-
tuberculosis Association and whose ex-
penses were paid out of funds secured
by the annual sale of Red Cross Seals.
She had neither home nor loved ones,
but Elie did have friends in the tuber-
culosis association above referred to
who provided the funds, and the great
heart of the great State of North
Carolina who provided a place and
part of the expense which made it pos-
sible for her to have proper care. The
only relative she had was a nephew
of 12 years. The Association had
hired a negro woman to do the house-
work and such nursing as she could do,
pending admission to the State Sana-
torium. They had also provided food
and medicine and house rent, the doc-
tor giving his services as doctors al-
ways do under such circumstances.

When this woman came to the State
Sanatorium, the rented house was
given up and so the patient had no
home in this world — but she wanted
to go home — that was the burden of
her plea, and it mattered not that she

SOLDIERS discharged WITH ARRESTED CASES

These Men Are Leaving for Colleges and Other Places to Specialize In Vocational
Training Begun at State Sanatorium

The Health Bulletin

had no home on this earth. She was
homesick.

Contrast another woman, age 60,
who hadn't been more than two miles
away from her home in the extreme
eastern part of the State, in the last
twenty years. She too was homesick
for the first week after she entered
the Sanatorium, but another lady
patient, who might very well be de-
nominated an angel of mercy, called
on her, talked with her, read to her,
and as the days went by taught her
how to read and write, and a happier
patient we have never had at the
Sanatorium, and while she cried every
day for the first week of her stay on
account of homesickness, she cried
every day for the last week of her
stay because she had to leave such
pleasant environs and return to her
home. And since her return home as
an arrested case, each year she writes
the Sanatorium as sweet a letter as
ever a school girl wrote her alma
mater. That is an example of occupa-
tional therapy.

But that is only an example. Miss
McLawhorn, a former patient, is
teaching the women patients all kinds
of handwork; pine needle baskets,
trays, lamp shades, etc., raffia work
of many kinds, bead work, fancy
work, etc., etc.

Mr. Chas. W. Hyde was loaned to us
by the Federal Board for Vocational
Education to do occupational therapy
with the forty soldiers we are treating

OUTDOOR HANDWORK

Student-Patient Soldiers During Reclining
Hour at State Sanatorium

here for the War Risk Insurance Bu-
reau and now for the United States
Public Health Service. The forty re-
fers to the average carried all the
time. We have handled about a hun-
dred and twenty-five discharged tu-
berculous soldiers, all of them North
Carolina boys.

The Federal Board calls it Voca-
tional Education and between occupa-
tional therapy and vocational educa-
tion as applied to a sick person, the
dividing line is imaginary, but in ad-
dition to teaching the boys grammar
school work and higher, Mr. Hyde
teaches them mechanical drawing,
raffia work of many and varied kinds,
woodwork, woodwork finishing, shop
work from the simplest drill work to

ARTILLERY REPAIR TRUCK

Loaned by Ordnance Corps, United States
Army, for Use of Student-Patient Soldiers
at State Sanatorium

AT WORK ON TRUCK

Interior of Truck Fully Equipped as Com-
plete Machine Shop for Students

The Health Bulletin

oxy-acetylene and electric welding,
gardening, typewriting, etc., etc., and
makes a study of the mentality of each
soldier boy, collaborating with the
medical staff, including his educational
and hereditary advantages, and when
he has an arrested case the vocational
education is transferred to a college or
other place and his tuition is paid
by the Federal Board and in addition
he is paid $80.00 per month and up
while he is continuing this vocational
education. While at the Sanatorium
he receives his treatment and $30.00
per month (for private) at the hands
of the government.

A case in point was a soldier boy
who was "down in the mouth," had
the "mulligrubs," didn't want anything
done for him, didn't want to get well —
was homesick. A vocational teacher
found after many attempts to ap-
proach him from as many different
angles, that he had always worked
in a dairy until he was drafted into
the service, and that he did this to
support a widowed mother from the
time he was twelve years old and that
his father had been a mechanic. The
teacher then began to talk mechanics
and found out that he had been read-
ing, "Popular Mechanics." A copy
was procured for him, he devoured it
and later a pencil and other drawing
material were brought, and he was a
different man. Hope beamed from his
countenance and six months later

when he left the Sanatorium he was
given a position as draftsman in a
large office at $75.00 per month. That
is Occupational Therapy — that is Vo-
cational Education.

When I told this story to a shrewd
business man, he replied, "It is strange
that a man should have to go to war,
become a casualty from tuberculosis,
and be sent to a Sanatorium for treat-
ment, before there is any one to fit him
into an occupation in which he could
succeed easily and well, and but for
which war and tuberculosis and sana-
torium he would never have found.
How often we try to put square pegs
into round holes when selecting an
occupation or profession for our chil-
dren. Wouldn't it be splendid if the
State would do this thing for all her
children, even while they are well and
strong." We must do it. — L. B. McB.

IN THE CORN FIELD

Agricultural Work by Student-Patient
Soldiers at State Sanatorium

THE SANATORIUM CLINICS

In the furtherance of our purpose
to make the Sanatorium of the most
possible service to the people and to
the profession of the State, we have
established diagnostic clinics to which
patients may come from any part of
the state for free examination and
where physicians may come for spe-
cial instruction in tuberculosis.

That our regular work at the Sana-
torium may not be interfered with
it has been necessary for us to ap-
portion the number of cases coming
each day and to have a regular time
for these examinations, the time being
eight to eleven a.m. So if you wish
to be examined free, write for an
appointment. Otherwise, there will be
a charge of $5.00.

Each patient is examined carefully
and advised according to the peculiari-
ties of his own case. He is also given
printed instructions on how to get
well and how to keep from infecting
others.

We are now making about 1,000 such
examinations a year at the Sanato-
rium. The demand is so great that

The Health Bulletin

we will soon be unable to handle the
problem alone. So we are planning to
establish such a clinic in each of the
ten medical districts of the state and
in addition to encourage their estab-
lishment in all the larger cities. The
greatest problem is to find physicians
who are both capable and willing to
take charge of the work.

To help equip men for such positions
has been one of the motives which
prompted us to offer to the physicians
of the state a special course covering
all phases of tuberculosis. The course
consists both in didactic and practical
work. Lectures are given and assign-
ments for reading and study are made
on the anatomy, histology, and physi-
ology of the lungs; on bacteriology,
prevention, pathology, diagnosis and
treatment of tuberculosis; on the re-
lation of tuberculosis to public health;
on the management of tuberculosis
nurses and on the best methods of
conducting county and municipal clin-
ics.

The practical work of the course
receives the most emphasis and con-
sumes by far the larger part of the
time. With all the outside patients
coming for examination and with our
135 resident patients in all stages of
the disease we have a great wealth
of clinical material.

In teaching diagnosis much empha-
sis is laid on the symptoms of the dis-
ease. One is not only taught the sig-
nificance of the various symptoms, but
is also taught how to obtain and how
to make an accurate record of the
symptoms in each case coming for
diagnosis. He writes histories and
submits them for criticism until he
acquires the art of obtaining them
quickly and accurately.

Several hours each day are spent
in examining chests. First the normal
and then the various abnormal signs
are demonstrated and interpreted in
terms of pathology. After making
several examinations with a member
of the staff, one is given patients to

examine alone and is required to
write the history, chart his findings
and make his diagnosis.

In a short time, no one of course,
can become an expert in diagnosing
tuberculosis, but if he is drilled in and
impressed with the importance of a
thorough and systematic procedure in
making a physical examination, he has
made a long stride in becoming an
expert.

Sufficient time is spent in the labora-
tory to teach one how to find tubercle
bacilli in the sputum and how to ex-
amine urine, stools and other tuber-
culous discharges for tuberculosis.

We have a complete X-ray equip-
ment and we endeavor to demonstrate
its value and its limitations, but we
do not attempt in so short a time to
teach one to become a radiologist.
- It usually requires at least two
weeks working full time during the
day and studying at night for one to
finish the course. We feel that we are
not justified in accepting a candidate
for a shorter period than this.

—P. P. McC.

THE PROPER ORGANIZATION FOR
THE FIGHT AGAINST TUBER-
CULOSIS FOR A TOWN
AND COUNTY

Winston-Salem and Forsyth County
have about completed a real and com-
plete organization for a fight against
tuberculosis, the necessity for which
was apparent to all those familiar
with conditions there. For example,
the city of Winston-Salem has a larger
number of deaths from tuberculosis
than any city in the state.

Again, there were 3,391 deaths from
tuberculosis in our state in 1918 —
there were more than 100 deaths from
tuberculosis in Winston-Salem in 1918.
Then one out of every 30 deaths from
tuberculosis in North Carolina in 1918
occurred in Winston-Salem, or one
death from tuberculosis occurred in
Winston-Salem to 29 in the remainder
of the state. This in itself should be

The Health Bulletin

enough to awaken the public to a
sense of responsibility to these more
than a 100 citizens who are dying in
their midst every year and the hun-
dreds of other cases who are living to
infect their families, friends and
neighbors. But it takes more than a
mere recital of facts to arouse the
people of Winston-Salem to their duty,
and unfortunately the same is true
for every other town in North Caro-
lina, for while Winston-Salem has the
highest batting average when it comes
to killing people with tuberculosis, yet
the death toll from tuberculosis in
every other town in the state would
be appalling, were it not for the fact
that the public has become so accus-
tomed to it that they give it no heed.

Winston-Salem differs materially
from most of the other towns in the
state in that she has "seen her duty
and is doing it," while practically
every other town in the state is "asleep
at the switch," while their citizens are
dying from tuberculosis.

It would not be possible to speak of
the fight against tuberculosis in Win-
ston-Salem or in North Carolina with-
out mentioning the name of Colonel
J. L. Ludlow, a prominent citizen of
Winston-Salem and member of the
North Carolina State Board of Health
and member of the Board of Directors
of the State Red Cross Seal Commis-
sion since its organization. Several
years ago, about ten we would guess,
Colonel Ludlow organized what he
called "A Committee of One Hundred"
in Winston-Salem, and began a cam-
paign of education in his city on the
prevention of tuberculosis. As the
writer remembers, he, too, began
through this committee the first nurs-
ing service. This was perhaps the
first local organization in the state
unless it might be the organization at
Wilmington, headed by Mrs. Cuthbert
Martin, who has also been a member
of the Board of Directors of the State
Red Cross Seal Commission since its
organization.

We are quite sure that no one re-
joices more over the splendid organi-
zation that has just been completed
than Colonel Ludlow. This organiza-
tion at Winston-Salem and in Forsyth
County is so nearly ideal that we feel
that we owe it to the other towns and
counties in North Carolina to present
the organization to them as an ex-
ample which each of them should en-
deavor to emulate.

1. A City Health Officer with com-
plete Health Department.

2. A County Health Department in
co-operation with the State Board of
Health with a whole-time health offi-
cer at its head.

3. A sufficient number of Public
Health Nurses for city and county in
charge of competent, properly trained
supervising Public Health Nurse.

4. A permanent tuberculosis clinic
in the city open at regular hours, with
physician and nurse in attendance.

5. Tuberculosis clinics held by the
County Health Officer in every town-
ship in the county.

6. Co-operation of the diagnostic
clinic of the State Sanatorium with
the city and county tuberculosis clin-
ics in the diagnosis of doubtful cases.

7. The reporting of known cases of
tuberculosis by physicians and others
to the City and County Health depart-
ments.

8. The County Sanatorium.

9. Sufficient money to "carry on."
The above mentioned organization,

all of which is now in operation in the
city of Winston-Salem and Forsyth
County, is of sufficient importance to
need consideration in greater detail.

1. The City Health Officer and the
properly organized City Health De-
partment is now so well known that a
detailed description is not deemed
necessary. Suffice it to say that the
City Health Department of Winston-
Salem has been continuously progres-
sive since the day the present efficient
health officer, Dr. R. L. Carlton, was
placed at its head, and the permanent

The Health Bulletin

tuberculosis clinic and the well or-
ganized staff of Public Health nurses
is a justification of the statement if
there were not many other things in
this Health Department to justify it
also.

2. A County Health Department in
co-operation with the State Board of
Health with a whole-time Health Offi-
cer at its head:

This co-operative County Health De-
partment is desirable from every
standpoint, but as this article has only
to do with the tuberculosis part of it,
we will limit our discussion to that.
First, the Health Officer, who is to
hold the tuberculosis clinics at stated
intervals in every township in his
county, must have some expert knowl-
edge of the physical examination of
the chest. In the case of Dr. A. C.
Bulla, who is the efficient whole-time
Health Officer for Forsyth County, he
has obtained this by adding to the
ordinary teaching on this subject given
by medical colleges in their regular
course, which is admittedly inadequate,
a course on the physical diagnosis of
the chest, and tuberculosis in general
given by the staff of the State Sana-
torium. This done, the holding of the
clinics with the help of his county
Public Health Nurse only needs time
and energy to make it a complete suc-
cess.

3. The Public Health Nurse has re-
cently been discovered to be the most
important cog in the wheel of the
Health Department, next only to the
Health Officer. The matter of extra
training of the graduate nurse in
public health work, social service ideas
and ideals, record keeping, etc., etc.,
before she is capable of taking up the
duties of a Public Health Nurse is ad-
mitted we believe by all who have
given serious thought to the subject.
There are many schools where courses
are given for this purpose. Teachers'
College, New York; Simmons College,
Boston, Richmond, Cincinnati, Chicago
and other places. There are also many

scholarships provided at this time by
the Red Cross, National Organization
for Public Health Nursing, State Red
Cross Seal Commission of North Caro-
lina, and many other agencies. In a city
a sufficient number of Public Health,
nurses are needed to cover the town,
and each one should be assigned to
a given district and should cover all
the nursing of whatsoever kind needed
in that district — this to prevent over-
lapping, loss of time in travel and
increase in efficiency. To have a prop-
erly co-ordinated nursing service in a
city it is necessary to have a compe-
tent Public Health Nurse as supervis-
or. All and every of which above
outlined plan of Public Health Nursing
is in force in Winston-Salem.

4. A permanent tuberculosis clinic
in the city open at certain specified
hours, with physician and nurses in.
attendance:

The diagnosis of tuberculosis while-
it is yet in the early or incipient stage
is perhaps the greatest need at this-
time in the fight against tuberculosis.
To say that the general practitioner
should be the one to find all these early
cases is to express a woeful lack of
knowledge of his routine work. He
hasn't the time to do it, if the people
would apply to him, and many people
are not willing to pay for a proper
physical examination of the chest and
many others haven't the funds with
which to pay. Hence the necessity
of a clinic. Then the physician who
is in charge of the clinic will take
more interest in the cases as there will
be less danger of them quitting, than
would be the case with a private prac-
titioner. Then, as there is no fian-
ancial reward to the doctor, it is not
embarrassing to have the nurse follow
up the cases, see that they carry out
instructions, and secure their return
at proper times to the clinic. There
is, however, plenty of work to do and
there will always be all the private
tuberculosis work that the general
practitioner will care to do. At the

The Health Bulletin

clinic, too, the doctor and nurses will
have sufficient time to give the pa-
tients proper instructions in the hy-
giene of tuberculosis; the shielding
of the mouth and nose when coughing
or sneezing, the use of sputum
cups, and the proper disposal of the
sputum (by burning). And the nurse
in following up the cases will be able
further to impress these things by
having the patients do them in her
presence. It goes without saying that
all such supplies mentioned above will
be kept in every well regulated clinic
and distributed free to the patients.
The permanent city clinic should co-
operate with the temporary or mov-
able clinic of the County Health De-
partment, by allowing doubtful cases
found in the county to report to them
for further study, and any remaining
doubtful cases should be sent to the
clinic at the State Sanatorium for final
study over a period of days. From the
above you will see that many early
cases of tuberculosis cannot be diag-
nosed by one examination, but must
be studied over a period of days some-
times. But the importance of the
early diagnosis to the patient and to
the community warrants any amount
of study necessary.

5. The tuberculosis clinic held by
the County Health Officer in every
township and in some instances in
subdivisions of a township at stated
periods:

Everything said about the perma-
nent city tuberculosis clinic is true of
the movable county tuberculosis clinic
except as the name implies, to wit: the
county tuberculosis clinic holds one
day in one township and the next day
in another until every township in the
county has had its clinic. When this
round is finished it will probably be
necessary for the Health Officer to
devote his time to other work over a
period of one or two months, when
he will make the rounds of his drives
again, his nurse in the meantime look-
ing after the cases just as the nurse

in town does. Should the county town
be too small to have a Health Depart-
ment, and be included in the work of
the County Health Officer, he should
hold a tuberculosis clinic at his office
at least once a week. As in the case
at Winston-Salem, these cases could
be cared for at the city clinic if satis-
factory arrangements could be made.
In any tuberculosis clinic the work
should not be considered satisfactory
until every person who has been
closely exposed to tuberculosis over a
period of time, such as living in the
same house with a case, is examined.

6. Sufficient has been said as to the
co-operation of the clinic at the State
Sanatorium with the county and city
clinic in four and five to make the
proposition entirely understandable,

7. The doctors of the town and
county owe it to themselves, their pa-
tients and the community to report
promptly every case of tuberculosis
that comes within their knowledge.
To a large extent they serve the same
purpose as pictures taken from an
airplane during the war — locate the
enemy.

8. The County Sanatorium:

No county is serving its people as it
ought unless it builds and maintains
a tuberculosis sanatorium where all
races can be cared for. There is no
place equal to a sanatorium for the
treatment or for the training of pa-
tients with tuberculosis; 90 per cent
or more of the incipient cases can be
cured, if properly treated. We owe
it to every one to give them a chance
to get well. Then there are in every
community cases of tuberculosis that
have nowhere to stay even for shelter.
Common instincts of humanity de-
mand that we provide a place for
these, where they can have humane
care and treatment. No person has
a right to kill his fellow by torpedoing
him with the deadly bacillus of tuber-
culosis, and careless consumptives
should not be allowed to live outside
a sanatorium. Some day we will have

The Health Bulletin

a law covering this — but we must also
have a place to send them and the
County Sanatorium is the place. You
may wonder that we say so little about
the State Sanatorium. It has its
place, a large place too, but every
county in the state should have its own
County Sanatorium. Those who are
able might, also have a building at the
State Sanatorium, as is now provided
for by law. The Forsyth County
Sanatorium is a model for the capacity
intended and is presided over ably by
Miss Ingram as head nurse, who
graduated from the training school for
nurses of the State Sanatorium and
was acting head nurse there during
the war, in the absence of the head
nurse overseas.

9. Sufficient Money:

Winston-Salem and Forsyth County
are fortunate again; fortunate because
their officials are acting with intelli-
gence; The Sanatorium was bvrilt
and is maintained by the county com-
missioners and credit must be given
Mr. E. T. Mickey, who was Chairman
of the Board of County Commis-
sioners, for his leadership in this move-
ment. The city has made appropria-
tions for its clinic and for several
nurses. The county clinic and county
Public Health Nurse is provided for in
the budget for the County Health De-
partment, while the local Red Cross
Chapter provides funds for the salary
of the supervising nurse and perhaps
more, while funds for many other ex-
penses are provided by the sale
of Red Cross Seals and it is intended
to largely increase this fund at the
annual drive December 1-10. So by
this co-operative spirit between many
different agencies, sufficient funds are
provided to operate a completely cor-
related organized drive against the
deadliest foe of our people in the city
of Winston-Salem and the county of
Forsyth.

The command now is, Carry On!

— L. B. McB.

UNIT OF TUBERCULOSIS OF
STATE BOARD OF HEALTH

By Miss Rose M. Ehrenfeld, RN.,
State Director of Public Health Nursing

The Tuberculosis Unit is a plan of
work for a county public health nurse
who is not specializing and who may
be working under a full time county
health department, or in an independ-
ent field. It calls for:

1. "Securing- the names of all per-
sons in the county who are afflicted
with tuberculosis." These are gotten
from cases reported by physicians to
the Bureau of Tuberculosis and from
lists of draft board rejects and dis-
charged tuberculous soldiers.

2. "Recording cases of tuberculosis
in the county and deaths there on a
tack map as prescribed by the North
Carolina State Board of Health."
Cases and deaths, irrespective of race,
are indicated by white and black
tacks.

3. "Visiting homes of persons af-
flicted with tuberculosis as often as
may be necessary to give patient such
nursing attention and household such
instructions as to enable them to util-
ize the best means of treatment and
those sanitary measures of safety
necessary for prevention of spread of
the disease." To the new cases found
the nurse to go sufficiently often to
give bedside care for its teaching
value until reasonably certain of in-
telligent care of the patient and ade-
quate protection of the caretaker and
other members of the family.

4. "Investigating the general health
of members of families where tuber-
culosis exists or has within three
years preceding. The nurse to offer
to members of the family below par
or other contacts, an opportunity for
examination" (discussed later in this
paper).

5. "Visiting every soldier, sailor or
nurse discharged from the army or
navy on account of tuberculosis and
carrying out, in dealing with the
aforesaid persons, the instructions of

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the North Carolina State Board of
Health, especially using influence to
effect proper disposition of such cases
in accordance with provision by the
Federal Government and State.

6. "Making such other investiga-
tions regarding presence of tubercu-
losis in the county as may be neces-
sary, not inconsistent with the sym-
metrical development of county plan
of work." The geography, roads,
population, etc., regulate the extent
of one nurse's ability to emphasize the
different units of work.

7. "A campaign of education
through public schools by means of
lantern slides, lectures, moving pic-
tures and distribution of suitable
literature; publication of newspaper
articles (submitted or approved by the
Bureau of Tuberculosis) and offering-
suitable prizes to school children for
essays on subject of tuberculosis."
This provision explains itself.

8. "Arrangements for clinics for ex-
amination of persons with suspicious
evidence of tuberculous infection (the
medical examiner furnished by the
Bureau of Tuberculosis of the State
Board of Health). This effected by
the nurse conferring with persons sus-
pected of tuberculous infection and
submitting information regarding
their condition to the State Sanato-
rium and later arranging for groups
of such as suggested by the Sanato-
rium, to receive a thorough examina-
tion by a specialist therefrom." (The

NURSES' HOME

MISS ROSE M. EHRENFELD
State Director of Public Health Nursing

initial clinic according to this plan
discussed later in this paper.)

9. "Secure treatment for all persons
found to be tuberculous, by family
physician, in State Sanatorium or
private sanatoria, at clinics or by
County Health Officer or county phy-
sician." The following indicate the
need of county clinics:

(1) Large number of previously
unknown cases discovered by exemp-
tion boards, military camps or naval
schools.

(2) Belief that the strain of war
creates conditions favorable to the de-
velopment of the disease among civil-
ian population.

(3) As a practical way of eco-
nomically carrying education to a com-
munity and acquainting the people
with the extent of the disease.

(4) To serve the counties too small
to have a local dispensary and offer

The Health Bulletin

clinic physician who knows tubercu-
losis in all stages, to communities
where the need is great and facilities
for examination of the lungs limited.
The ultimate aim is to create an or-
ganization for constructive work and
secure the supervision of all consump-
tives.

"Report of first clinic showed 120
examinations with definite appoint-
ment for 30 others at later date. Of
the 120, 72 were negative, 25 posi-
tive and 23 probable. Of these 6 were
teachers advised to stop teaching for
a period of rest; 7 were advised to
lighten work and rest or to stop work
entirely; 8 were ordered to Sana-
torium for treatment and to bed pend-
ing admission thereto; 16 were advised
to have X-ray and 9 others placed un-
der observation and to record daily
temperature and have further exami-
nation; 2 advised to wean babies and
5 referred to family physicians for
other than chest findings. (Medical
supervision by family physician
recommended for all.)"

The clinic demonstrated:

(1) As practical the unit of tuber-
culosis work.

(2) Unlimited educational value of
same.

(3) That the standardization of the
plan through supervisory control was
possible.

(4) With an active supervising tu-
berculosis agency, a modest amount
of money, a clinic physician who
knows tuberculosis in all stages, and
a nursing staff trained in public
health aspect of tuberculosis, all the
essentials for conducting a clinic were
available.

(5) That this type of clinic is prac-
tical, inexpensive and satisfactory
and has come to stay.

The response to the clinic showed:
1. That rural North Carolina is in-
clined to accept as authority repre-
sentatives of the Bureau of Tubercu-
losis of the State Board of Health.
Our word was never questioned that

we know of; but one occasion it was
not accepted by a member of the medi-
cal profession as being worth as much
as that of a veterinarian who spoke
on the same occasion.

2. The need of the Modern Health
Crusade, not alone in schools but to
extend its influence back to the homes.
One family coming for examination
(a man, wife, two boys and a girl)
gave evidence of neglected health
chores and, on being questioned by
the examining physician as to their
bathing facilities at home, he was in-
formed that the boys went swimming.
"What about the girl?" The reply
was, "She ain't bathed since she was
a baby." And what a contrast to this
is the case of a recently reported adult
crusade enthusiast who claimed, "I
just can't take any more baths than
I do but I rub harder and enjoy them
more."

3. To what extent the county public
health nurse has the confidence and
support of the people. I believe this
was secured:

(1) By making known her work in
advance of her coming and stimulat-
ing intelligent interest therein.

(2) By having back of the nurse
a board of representative people, typi-
cal of the county's interests.

(3) By her own ability to teach and
organize groups of class work
throughout the county.

(4) Through her ability to co-oper-
ate with existing agencies, thus creat-
ing a demand for her service.

(5) By making herself known to
mixed audiences and "making good"
in every opportunity afforded her.

(6) As a very gratifying reduction
in tuberculosis mortality is due to
ordinary public health activities, such
as control of milk supply, child wel-
fare work, the prevention of com-
municable diseases, etc. (which have
perhaps been quite as instrumental as
the warfare against specific tubercu-
losis infection) we believe that county
public health nurses are the most im-

The Health Bulletin

portant single factor in placing a new
slant on the tuberculosis problem.

(Read before the meeting of the
Southern Conference on Tuberculosis,
Asheville, N. C, October the 24th,
1919.)

HEALTH WORK IN NORTH CARO-
LINA FOR NEGROES

By Florence Chapman Williams

State Director of Health Education and
Organization Among Negroes

Because of his large interest in the
health of the people of this State,
particularly as it pertains to tubercu-
losis, and with a vision to realize that
the health of one race cannot be
properly conserved unless the health
of the other is in like manner con-
served, on account of the close re-
lationship of the races, health work
among negroes was actively and sys-
tematically begun in the year 1917, by
Dr. L. B. McBrayer, Chief of the
Bureau of Tuberculosis, at Sanato-
rium, N. C.

Conferring with Mr. N. C. Newbold,
State Agent for the Jeanes Fund,
"which, co-operating with the counties,
supports what is known as Industrial
Supervisor in each of forty-four coun-
ties in this State, it was decided that
the plan could best be carried out
through these supervisors, making the
county the unit of operation thereby

-•X* t.J^.^'-

MRS. FLORENCE C. WILLIAMS

State Director of Health Education and

Organization Among Negroes

assuring a more intensive and effective
program.

These supervisors, together with the
Superintendents, have full charge of
the rural schools, and going into every
section of the counties offer a fine me-
dium for the furtherance of the health

MEMBERS MILLER'S CHAPEL COMMUNITY LEAGUE

The Health Bulletin

program. They find it a pleasing part
of their usual duties because of a
natural interest, and receive an added
stimulus through an addition to their
salaries by Dr. McBrayer's bureau.

This work in each of forty-four
counties is directly under a Jeanes
supervisor and is handled by organiz-
ing in every community, where there
is a school, a Negro Community
League consisting of a President, Sec-
retary, Treasurer and Executive Com-
mittee for officers, and it is the desire
to enlist every person in the com-
munity as a member.

In every Community League there is
organized three committees: One on
education, one on health and one on
agriculture. The scheme is to get as
many people into the league as pos-
sible and there work as many as pos-
sible. Miller's Chapel, Rowan County,
is a small community, but nearly
everybody in the community is a mem-
ber of the League. This is a thriving
little community and everything for
community uplift is done through this
League. The County Supervisor
works through it; the Farm Demon-
stration Agent works through it and
the minister works through it.

The Committee on Education does
everything possible to improve the
school along all lines. Picture No.
1 was the school at Miller's Chapel
known as Thompson's school, before
it was rebuilt. Picture No. 9 is the
present new building after rebuilding.
The material was purchased, the house
built and finished without aid from

LEADERS AT LANDIS

Officers of Community League at Thriving
Rowan County Town

anybody but the patrons themselves.
It is a model rural school, furnished
in Hyla blackboards and patent desks.

The Agriculture Committee handles
all phases of club work among the
girls and boys, such as pig, corn, and
poultry clubs and gardening and can-
ning among both the girls and women.
In some counties these canning clubs
have saved from thirty to fifty thou-
sand quarts of fruits and vegetables
every year, and from the corn and
pigs and poultry the girls and boys
in many instances send themselves
to boarding school.

The Health Committee looks after
all phases of health in the community:
sanitation around home, school and
church; visits the sick in the com-
munity and raises money by various
means to improve better living con-
ditions where families are not able
to make better conditions for their
sick.

Special attention is given to all

BEFORE

AFTER

The Health Bulletin

cases of tuberculosis. Literature on
this dreaded disease is carried to the
homes and read and discussed. Pic-
tures are shown at the Community
League meetings on tuberculosis and
also much literature is used. In some
Community Leagues the Health Com-
mittee buys fruit, eggs and milk and
ice for tuberculosis patients. They
have also screened the bedrooms and
made sleeping porches for these pa-
tients.

The county people as a whole are
doing much in the way of screening
their homes and back porches. There
is a very decided improvement in the
life of the average rural family.

Landis people have one of the clean-
est communities seen anywhere, with
quite a number of the homes well
screened. The work in Rowan County
is under the direction of Mrs. Rosa
Hargrave, County Supervisor. There
are also in Rowan County two men who
lend wonderful co-operation to the
work of their community. These men
are Prof. J. E. Aggrey, of Livingstone
College, Salisbury, N. C, and Mr.
Thomas B. Patterson, the efficient
Farm Demonstrator of same county.
Nothing is ever too much trouble or
too big a task for these men to put
over if it is for the betterment of
Rowan County. They have given un-
limited aid to the State Health Direc-
tor and their County Supervisor in all
phases of Rowan County Community
work.

There are a number of counties do-

ing very good work along the lines of
health as well as education and agri-
culture. Of these Vance County is
doing her part. In Vance the work is
under the supervision of Mrs. Lelia
B. Yancey, County Supervior. In every
community in Vance County there is a
good school with good toilets. Picture
No. 8 shows the Community League at
Middleburg, Vance County, one of the
largest and most progressive leagues
in the state. Every member in this
League wears the double Red Cross
button and is a crusader in the fight
against tuberculosis. The supervisor
of this county did quite a bit last year
to promote the Crusaders Health cam-
paign in her schools as did the Super-
visor of Beaufort County, Miss Eliza-
beth J. Jones and a few others.

There is at Henderson, N. C. the
Henderson Normal School, of which
Dr. J. A. Cotton is President.
There is no school man in North
Carolina who has done more
than Dr. Cotton towards rural com-
munity co-operation. When the work
first started in Vance County, he
helped pay part of the supervisor's
salary. He gives of his time, the use
of his car and horse and buggy. What-
ever interests Dr. Cotton in this rural
work also interests Mrs. Cotton. She
has contributed just as freely to the
development of this work as he has.
In fact there seems to be throughout
the Henderson Normal School that
spirit of good will and co-operation.
Everybody connected with the school

MIDDLEBURG COMMUNITY LEAGUE OFFICERS

The Htcat.tk Bulletin

seems eager and ready to help in any
phase of rural work for Vance county
wherever there is an opportunity.
President Edwards of Kittrell College
is also identifying himself largely
with county work and stands ready
with the use of his school and in many
ways to push forward the work of
Vance County. There is shown
throughout the state a wonderful
spirit of co-operation from the various
heads of all departments, the Educa-
tion, Health and Agriculture depart-
ments co-operating.

This work was started in 1917, with
the Department of Education under
Mr. N. C. Newbold and the Bureau of
Tuberculosis under Dr. L. B. Mc-
Brayer, working jointly. To date
there are nearly five hundred com-
munity leagues organized with nearly
fifteen thousand members. The Edu-
cational Rural Community work is
under Mrs. Annie W. Holland, Jeanes
Fund State Supervisor, who is doing a
great work along educational lines and
gives unlimited support to all com-
munity work. The Health work is
under Mrs. Florence Chapman Wil-
liams, State Director, Bureau of Tu-
berculosis. This Bureau is anxious to
handle all kinds of health work, and as
all phases of health work bear on tu-
berculosis, stresses at all times and
under all conditions the fight against
this dreaded disease.

There is to be a big drive on in each
of the forty-four counties for the sale
of Red Cross Seals, taking place De-
cember 1st to 10th. An allotment has
been made to every county and the su-
pervisor is responsible for this amount.

There is no question but that every
county will put this drive over the
top, when by so doing it will be made
possible to put into these counties a
Health Educational* Car, carrying a
moving picture outfit. This car will
give one week of afternoon and even-
ing programs, as desired, in each of
the forty-four counties. In this drive
every Community League is placed

DR. J. A. COTTON

■President Normal School for Negroes
Henderson, N. C.

on its mettle, being the first time they
have been asked to raise money to
help in any way further the health
work. For that reason alone, each
league seems anxious and delighted
to do a great big job.

This is a year for plenty of real
hard work for schools and communi-
ties. Just after the Red Cross Seal
drive comes the Crusaders Health
Campaign in all the schools. The
work was crippled to some extent last
year by war drives and influenza. But
with a big Peace Program ahead of all
the world and with the restlessness
of educational, industrial and social
conditions facing us as they must for
the next five years, we all must be-
come interested and cq-operate, not as
colored people or as white people for
the narrow benefit of any group alone,
but together, as citizens for the com-
mon good of our common community,
our common country.

One year ago last summer this
health work was a part of every in-
stitute and summer school in North
Carolina, and at Hampton, Va. The
Presidents of each of our State Schools

The Health Bulletin

and the conductors of every institute
were anxious, kind, courteous and en-
thusiastic in their co-operation of this
work, in that the State Health Direc-
tor was given daily periods for lecture
work and community organization and
nights for lantern slides with the
teachers. In nearly every institute
and summer school all student teach-
ers responded as one. The spirit of
co-operation was really wonderful.

The work thus far planned and car-
ried out has clearly indicated the wis-
dom of Dr. McBrayer in conceiving
this idea and justified the expense in-
cident thereto. We need help, we need
sympathy, we need co-operation, we
need money to extend this work which
means so much to the people of our
state, and I am persuaded to believe
that money spent in this health work
is destined to yield large dividends,
for has the state any better asset
than a healthy, intelligent citizenship ?
Good health must be promoted for
how can a sound mind exist other
than in a sound body?

The co-operation from all educa-
tional departments at Raleigh, espe-
cially education and agriculture, have
gone way beyond our expectation. At a
meeting in the Hall of Representatives
at the Capitol in Raleigh, September
the 26th, with State Superintendent
of Public Instruction, Dr. Brooks, and
State Agent for Negro Schools, Mr.

N. C. Newbold, and about fifty of the
State's leading educational negro men
and women, a declaration of principles
was unanimously adopted by these
people.

The State Superintendent declared
that in attempting to inaugurate a
broad educational policy for both races
he was confronted with serious diffi-
culties. Therefore, it seemed desirable
that the negroes of this state should
adopt a platform of principles upon
which they will stand, one convincing
to all that doubts may be vanished;
that strife may cease and that good
will may prevail between the races.
Moreover, all school officials of both
races should at all times seek to
make right and justice prevail among
all classes of people.

If this is done, we shall have an
unprecedented era of good feeling. Ed-
ucational progress vnW be promoted,
great economic prosperity will result,
and there will be no strife in North
Carolina. This meeting not only tends
to prove the wonderful co-operation
between all educational forces in
North Carolina, but also the co-opera-
tion and relationship between the
races of the state.

As State Director of this work
among my people, I have been in
nearly all the forty-four counties re-
ferred to above and in some two and
three times, working day and night,

SPENCER CANNING AND PIG CLUB

The Health Bulletin

often under hard conditions, talking
to my people about health, showing
them pictures, and they have respond-
ed with readiness, sympathy and
co-operation that have commanded my
profound admiration and respect.

That the vi^ork has been effective
can be clearly seen as one travels
through the rural communities of the
state. Great progress is indicated in
better, cleaner, screened homes,
greater use of paint, sanitary closets,
pumps, drainage, and greater care in
handling the sick and promoting good
health. In Northampton County under
Mrs. Sarah Randolph a vi^onderfully
successful drive w^as made for sanitary
closets with Dr. F. M. Register, at
that time the county's whole-time
health officer, co-operating.

I cannot close this article without
a word of thanks for all who have
interested themselves in this work, for
their sympathy, help and co-opera-
tion, without which we could not have
carried out our plans. Moreover, I
here make acknowledgment of the
help, advice, sympathy and personal
direction of Dr. McBrayer and Mr.
Newbold, without which the work
could not have reached its present
state of efficiency, and I congratulate
them on the conception of the idea
of this work, which, under God, must
stir the people from one end of this
state to the other.

THE RED CROSS CHRISTMAS
SEAL

The Red Cross Christmas Seal, as
millions of Americans know today, is
an agent of happiness and health.

It was originated in 1907 by Miss
Emily Bissel of Wilmington, Delaware,
who had learned through Jacob Riis
of somewhat similar seals that were
sold in Norway for the purpose of
raising funds with which to fight
disease.

Miss Bissel persuaded the American
Red Cross to take up the idea with the
result that the seals were sold in a

limited number of communities in
1908. The sale yielded a revenue of
approximately $3,000.

The Red Cross then decided to issue
the Seal each year and to turn the
proceeds over to the National Tuber-
culosis Association and its affiliated
societies for the purpose of financing
the campaign against tuberculosis.

The number of Seals sold in Ameri-
ca has risen by leaps and bounds until
in 1917 the total reached 180,000,-
000. In 1918 as a war measure the
Seals were not sold, but through an
agreement between the American Red
Cross and the National Tuberculosis
Association were awarded in limited
quantities to each member of the Red
Cross.

This year the Seals are again "on
sale," beginning December first. More
than half a billion Seals have been
printed for distribution to state and
local agents. In addition to the Seals
this year there vdll be "Health Bonds"
in denominations ranging from $5 to
$100 to be sold in lieu of Seals to
large contributors who do not send out
a sufficient quantity of mail in De-
cember to make use of all the Seals
they would like to purchase.

The national campaign against tu-
berculosis, in which North Carolina
has come to play an important part,
is directed by the National Tubercu-
losis Association. Under the guidance
of this organization the forces en-
gaged in the fight against tubercu-
losis have grown rapidly year by year
since 1895. In that year there was
only one organized tuberculosis so-
ciety, and one tuberculosis sanatorium.
Today there are more than one thou-
sand state and local societies in every
section of the country. More im-
portant still, there are today over six
hundred sanatoria for the treatment
of tuberculosis, thousands of visiting
nurses, hundreds of open-air schools,
and thousands of free clinics and dis-
pensaries. Measured in human lives,
the result of this work might be

The Health Bulletin

summed in the statement that in 1895
the death rate from tuberculosis was
200 per 100,000 of population. Today
the ratio is 140 per 100,000. A SAV-
ING OF 60,000 LIVES ANNUALLY.

The work of the National Associa-
tion, and of the affiliated state associa-
tions, is financed through a small per-
centage of the proceeds from the sale
of Red Cross Christmas Seals by local
agencies throughout the Nation.

In North Carolina the fight against
tuberculosis is led by the North Caro-
lina State Board of Health, acting
through its Bureau of Tuberculosis
with Dr. L. B. McBrayer as director.
Supplementing most effectively this
department of the state work is the
State Red Cross Seal Commission of
North Carolina, acting in co-operation
with the American Red Cross and the
National Tuberculosis Association. The
Commission handles the sale of the
Seals each year, and directs the pri-
vate and quasi-public activities in the
state against tuberculosis. The direc-
tors of the Commission are: Mrs. C. C.
Hook of Charlotte, Mr, Hamilton C.
Jones of Charlotte, Dr. Otho B. Ross
of Charlotte, Mrs. Gordon M. Finger
of Charlotte, Mrs. Cuthbert Martin of
"Wilmington, Mrs. W. N. Hutt of Can-
dor, Mrs. Thomas D. Jones of Durham,
Dr. William L. Dunn of Asheville, Col.
J. L. Ludlow of Winston-Salem, Mrs.
Mark Quinerly of Greenville, Mrs. S.
H. Brown of Oxford, Mrs. J. L. Wet-
more of Arden, Mrs. Charles R. Whita-
ker of Hendersonville, Mrs. R. C. War-
ren of Gastonia, Mrs. C. C. Hook of
Charlotte is chairman, and Dr. L. B.
McBrayer of Sanatorium is executive
secretary and treasurer.

The sale of the Seals was begun un-
der the auspices of the Commission
in 1913, when 525,307 Seals were sold.
Since then the increase has been
marked: In 1914, 674,522, in 1915,
803,386, in 1916, 1,207,874, in 1917,
1,754,102. There was no sale in 1918.
In the last sale Greensboro led the
State with a total of 160,956 Seals

sold, more than doubling the next
largest sale. Grouped closely together
for honors for second place were four
cities, their total sales being as fol-
lows: Asheville, 78,160, Raleigh, 75,-
112, Charlotte, 70,724, Wilmington,
69,028.

It has been the custom since the sale
of Seals was begun by the Commission
to leave seventy-five per cent of the
total receipts from sales in the hands
of local committees for local expendi-
ture for the eradication of tubercu-
losis. The remaining twenty-five per
cent is divided between the American
Red Cross, the National Association
and the State Commission for the pur-
pose of financing their work.

Indicative of the work for the pres-
ent year are the following appropria-
tions made by the Commission at the
annual meeting of the directors in
April: (1) for public health nursing,
$1,000; (2) for furnishing dairyman's
cottage at State Sanatorium, $508.35;
(3) for the care of tuberculous sol-
diers, $3,500; (4) scholarships for
public health nurses, $1,000; (5) fur-
nishing bottling plant at dairy of
State Sanatorium $2,500; (6) for Red
Cross Seal campaign, $1,000; (7) for
public health nursing in local com-
munities, $1,000; (8) for establishing
tuberculosis clinics, $2,000; (9) for
tuberculosis work among the negroes,
$2,000.

Accomplishments in the past year
are shown from a few excerpts from
the report of the executive secretary
for the year ending March 31, 1919.
With regard to the treatment of dis-
charged tuberculous soldiers at the
State Sanatorium: "After a visit to
Washington and consultation with Col.
Banks, medical advisor of the War
Risk Insurance Bureau, he agreed to
pay us $2 per day, which was just
about the actual cost for the treatment
of soldiers who had been discharged
on account of tuberculosis. On ac-
count of the crowded condition of the
office force of the War Risk Insurance

The Health Bulletin

Bureau, it takes several months to
get them to rule on a tuberculous sol-
dier; so we decided to use this ap-
propriation as a revolving fund, and
we have been admitting soldiers dis-
charged on account of tuberculosis
without delay so far as we could, and
have been carrying about forty all
the while for the past several months.
The Sanatorium could not continue
to run and pay its expenses without
the $1 per day charge for patients,
so this fund was advanced to the
Sanatorium for the payment of this
$1 per day for the discharged sol-
diers whom the Government had not
yet passed on. It is intended as soon
as the Government pays the Sana-
torium the $2 per day for these sol-
diers, the Sanatorium will return the
amount paid by the State Red Cross
Seal Commission and the money can
be used over again. This is work-
ing very well, and the Home Service
Committee in every county has been
notified of this arrangement. Like-
wise we have received from the War
Department the names of the men who
have been discharged from the army
on account of tuberculosis, in North
Carolina to the number of about 500.
We have written them personal let-
ters advising them that free treat-
ment could be had from the Govern-
ment. In addition to that the Federal
Board for Vocational Education has
promised to send us at their expense
a teacher to teach these soldiers vo-
cationally and avocationally, and vo-
cational therapy, so with all it seems
to be a very splendid arrangement
made possible by this appropriation by
the State Red Cross Seal Commission."
An appropriation of $3,420 was made
for the purchase of an X-ray equip-
ment for the State Sanatorium. Speak-
ing of this the executive secretary
says: "The Sanatorium has expressed
itself as being very grateful for this
contribution from the State Red Cross
Seal Commission, and it has, perhaps,
the most complete X-ray equipment in

the state, and it is of wonderful help
in the work that is being done. Due
credit is given in the annual report
for this splendid donation, and in ad-
dition the matter was mentioned be-
fore the Appropriations Committee of
the last General Assembly, and the
Legislature's attention was called to
the fact that it had not properly pro-
vided for the Sanatorium, and but for
the kindness of the State Red Cross
Seal Commission, we still would not
have this equipment. This, no doubt,
had something to do with the more
generous attitude of the General As-
sembly."

Additional outstanding features of
the state work is that of Miss Rose
M. Ehrenfeld, State Director of Public
Health Nursing, whose salary is paid
jointly by the Red Cross Seal Com-
mission and the Metropolitan Life In-
surance Co. She has and is doing a
remarkably effective piece of work in
the state that has met with great ap-
proval and success. Florence C.
Williams, colored, has been employed
as State Director of work among the
negroes, her work being done in co-
operation with the office of the State
Superintendent of Public Instruction.
Through her efforts Community
Leagues have been organized in forty-
four counties of the State, with mem-
bership of approximately twenty thou-
sand. It has been characterized as the
most efficiently serviceable health
work attempted on a large scale
among the negroes in the Southern
States.

The bulk of the work accomplished
from funds received through the sale
of Red Cross Christmas Seals, how-
ever, has of course been in the local
communities where the sales) were
made. By the use of such funds pub-
lic health nurses have been employed,
special school work among the children
done, patients sent to and maintained
at sanatoria for tuberculosis, sana-
toria assisted financially through the
furnishing of rooms and the purchase

The Health Bulletin

of necessary equipment, and the par-
tial maintenance of one local sana-
torium.

This year the National Tuberculosis
Association is offering to the people
of the United States 650,000,000 Red
Cross Christmas Seals, of a total value
of $6,500,000. Of this amount North
Carolina is asked to take $90,000
worth, virtually all of which is for the
promotion of local work against tu-
berculosis. It is a small amount when
the enormous loss from tuberculosis
in the state each year is considered.
While there has been a gratifying
decrease of about twelve per cent in
the number of deaths from this disease
during the past four years, yet last
year in North Carolina 3,391 people
died, and about 27,000 people were
suffering because of tuberculosis. The
economic loss to the state is in excess
of $15,000,000 each year from this one
source alone. To reduce this loss, and
to save the suffering and sorrow
caused by tuberculosis, the people of
the State are asked to purchase during
the ten days between December first
and tenth these little messengers of
hope and cheer to provide the funds
for a bigger, more intensive and more
efficient fight against the common
enemy.

Red Cross Christmas Seals will
be on sale through local committees in
practically every community in North
Carolina this year. Where there is
no local committee handling the sale
the seals may be obtained in any
quantity desired by writing direct to
the executive secretary of the State
Commission, Dr. L. B. McBrayer,
Sanatorium, N. C. The price of the
seals is one cent each. — R. B. W.

MODERN HEALTH CRUSADE

Good health is dependent upon the
observance of certain simple rules

or right living. To make these rules
easy and attractive to children is the
purpose of the Modern Health Cru-
sade.

The Modern Health Crusade is an
organized movement that has enlisted
more than three million American
children. It is adding strength to com-
ing workers and protecting them from
the increased disease and neglect
which the war has brought to the chil-
dren of Europe. It is a system of
health education that grips the child's
interest until health practices become
habitual. Through the children it is
educatin parents and promoting com-
munity health.

The Modern Health Crusade supplies
the child with a motive for patient
work in acquiring health habits when
the abstract advantages of health and
and the usual teaching of physiology
do not call the child to action. Ma-
terial is educational just in so far
as it creates an interest. With adults
the direct motive for the faithful ob-
servance of the laws of health is usu-
ally insufficient until sickness creates
a desire for health through its ab-
sence. With children it is all the more
essential to supply an indirect motive.
The Crusade accomplished this by in-
troducing the play element into the
study and practice of hygiene. It
transfers some of the romance of the
medieval crusades to a vital quest of
present-day children. It holds up to
them the chivalry of health, the high
ideals of strength, right living and the
protection of the weak. It makes an
instant appeal to the child through its
titles and badges as well as by giving
him something to do and honors to
earn; but throughout it adheres to the
laws of habit-formation. It applies
the approved pedagogical principle of
learning health habits by doing them.

TUBERCULOSIS!

eprosy — Smallpox — Yellow Fever — Typho

These in turn have scourged the world, but
they have been surely conquered by science.

Now Tuberculosis goes to the block. There
must be no reprieve, no pardon.

Tuberculosis can be PREVENTED and
can be CURED. But you must do your part in
this national fight against the WHITE
PLAGUE.

Don't- pass a Red Cross Christmas Seal
Booth without buying — encourage those who
are selling.

JSE RED CROSS CHRISTMAS SEAL

Each Seal Is a Penny's Worth of Cure and Prevention

EXTRA

IrDeaji

I PUBLI5AE.D BYTAC hPR-TA CAgCLIhA 5TATL. BQAIgD s>^MEALTm1|I-£

This Bulletin will be sent free to any citizen in the State upon request

Vol. XXXIV

DECEMBER, 1919

No. 12

PROCLAMATION BY GOVERNOR BICKETT

The annual sale of
the Red Cross Christmas
Seals is now on. No more
beautiful expression of
the Christmas spirit
can be made than for
every letter, card and
package to bear the seal
of the Red Cross. The
seal adorns the package,
is a recognition of the
blessings of the Red
Cross, and the money
will be used to stamp
out the Great White Plague. We are enjoying an
era of unrivaled prosperity. Let every one have the
,grace to show forth gratitude by buying Red Cross

Seals.

(/.

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Governor,

This 2d day of December, 1919.

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AN APPEAL FOR HELP

Dear Reader:

We believe that a great number of the readers of The Health Bulle-
tin are interested enough to want to aid in the work of stamping out
tuberculosis in North Carolina, which means better security for the
loved ones of each, as well as aid for those who are suffering.

This every one can do by buying Red Cross Christmas Seals, which
are sold for one penny each. Use the seals for decorations for your
Christmas letters and packages, and let your dollars bring Christmas
cheer to many.

In many communities of the State the Red Cross Christmas Seals
have been on sale since December 1. If they are not available in your
community order as many as you can afford AT ONCE, using the
form below.

For those who are suffering or may hereafter be stricken with tuber-
culosis, we thank you; and wish you a merry Christmas, health, and
a happy, prosperous New Year.

Sincerely yours,

STATE RED CROSS SEAL COMMISSION,

By L. B. McBrayer, M.D.,
Executive Secretary.

December 1919.

Dr. L. B. McBrayer,

Executive Secretary,

Sanatorium, N. C.

Enclosed find $ for which please send to me

Red Cross Christmas Seals.

(name)

(address)

to Go-

TUBERCULOSIS!

LeDrosy-Smallpox-Yellow Fever-Typhoid

These in turn have scourged the world,
but they have been surely conquered by
science.

Now Tuberculosis goes to the block.
There must be no reprieve, no pardon.
Tuberculosis can be PREVENTED
and can be CURED. But you must do
your part in this national fight against
the WHITE PLAGUE.

Tuberculosis last year cost North

Carolina in excess of $15,000,000 in

money, over 27,000 persons needlessly

ill, and more than 3,300 persons who

uselessly laid down their lives, a wasted sacrifice upon the altar of this greatesi

scourge of mankind.

In the determined efforts being made to reduce this appalling yearly loss tc
the State each citizen may take an active part by buying now Red Cross Christ
m«s Seals. All the fv.nd? ^o secu cd aic used for the prevention and cure o1
tuberculosis. ■