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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. 


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." 



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 


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. 





JULY, 1919 

No. 7 


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 

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 

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. 

The Health Bulletin 

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. 


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 

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 


Advantages and Disadvantages of 

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 

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. 


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 

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 

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 

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 

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. 


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. 


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 

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 

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. 


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- 


1. The first cost is comparatively 

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 

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. 


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

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 

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 


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

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 

The Double Compartment Concrete 

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 


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 

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 

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- 


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 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 

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


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- 

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

(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 

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 

(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 


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- 

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 


Similar to Fig. 








2"x 4"xl4' 




2"x 4"xl2' 




l"x 6"xl2' 




l"x 8"xl2' 




l"x 4"xl2' 














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 


Height Projection of 



Length Front Back Front Rear 


For one seat 


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


For two seats 


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


Overall width, 


Width Riser to front Back of hole Back of hole 


front to back 


hole of hole to rear wall to hinge of lid 

of lid 



9" 3" 9" 6" 


Fig. 9. 
a new bu 

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 

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. 




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 

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 

(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 

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


The Health Bulletin 



Min. Width 


Max. Min. 

Bottom Top 



5' 4' 

1' 18" 



5' 4' 

1' 18" 




an 2 seats 

Increase 2' 

for each 

(c) Curbing. 

(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- 




Min. Diameter 






Min. Width 

Min. Length 





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 


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 

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 

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- 


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 

(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 


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. 

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 













^ -* N 


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. 

(c) The tank tube must not be less than 
11 inches outside diameter. 

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. 

(c) All steel tanks are either to be fur- 
nished with sufficient burlap and tar or as- 

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 

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




Sub- SorfarcDrainTile- 
Bedded in-Porou3 


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- 

(c) All joints leading to and from the 
tank are to be made tight. 

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

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- 

(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 


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. 


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 



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 

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 

China 3ow/ 


fla'd Proofed Drop Tube — — f 
Nan Hole 


- 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 

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 

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 

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 



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 

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 

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 

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 

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- 

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 

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 

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- 

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 

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 

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


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 

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. 


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

1. The Secretary of the State Board 
of Health. 

2. Bureau of Engineering and In- 

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


Type of privy 

Earth pit $ 4.50 

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

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

mereial 12.10 

Chemical 28.00 

Double compart- 
ment concrete 
vault 15.20 

First Cost 


Cost 5 




■« in 


CO <a 


o c 

m ca 
o a) 




o a 







o £ 


$ 7.50 

$ 7.50 





$ 22.50 






$ 4.50 




























cant . 











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 

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- 

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 

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 


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 


AUGUST, 1919 

No. 8 




Average Monthly Variation In Number 

of Typhoid Deaths in North 

CaroUna During the 

Last Five Years. 



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 


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 


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 











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


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 





Infant Care 

Child of Pre-School 

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 

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

Please send for only those bulletins for 





AUGUST, 1919 

No. 8 



"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. 



"Now this is the law of the Jungle, 

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

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 

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. 


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

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 




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 

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. 


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 

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. 


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. 



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 

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 

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- 

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 







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- 

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

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- 

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 

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 

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 

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 

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

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 

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 

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 


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 

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 

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 

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. 


Report of the Provost Marshal Gen- 

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 


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 

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. 


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 



No. 9 


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. 


"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. 


"Roll up your sleeves and, 

"GO TO IT!" 


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 


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 


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 










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


German Measles 

Typhoid Fever 





Infant Care 

Child of Pre-School 

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.) 

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 — For Teachers 

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

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

Please send for only those bulletins for 






No. 9 




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. 


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- 

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 

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 
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 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 

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. 


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. 


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 




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- 

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. 


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 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 


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: 

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 will affix to 
the privy a sign bearing the words. 

"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. 

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 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. 
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 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 

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 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 

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- 

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 

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. 



"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- 

"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 

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 

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 

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. 


Address _ 

Age Of My Baby _ 

Date of Confinement _ 

The Health Bulletin 




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- 

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 

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- 

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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OCTOBER, 1919 

No. 10 


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






OCTOBER, 1919 

No. 10 



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 

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 

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. 



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. 


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 

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 

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 

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 

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- 

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 

"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- 

(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- 

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 

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 

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- 

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. 


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 

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. 


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. 


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. 


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. 


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

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." 


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: 


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


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- 

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 

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 

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 

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 


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 

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 

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: 

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 

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. 

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. 

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 

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. 


American PuHiQ HeaitK Assn. 
October 27-50 

CJhe Public Health Mecca, 

A twmcan Fix Wir Uca i in Assn. 

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

What the Individual Should Do in 
Protecting Himself from Influenza 



















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

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



No. 11 





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. 



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 


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 


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. 





No. 11 


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 

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. 


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, 



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 

The Health Bulletin 


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.'" 


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 

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) 

"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 

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, 


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 

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 

Thanking you in advance for any in- 

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- 

The Health Bulletin 

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


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- 

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. 


The Health Bulletin 

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. 


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 (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. 


Letters and Reports, Boosts and Bumps; But All More or Less Personal, 

and Interesting 


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. 


The Health Bulletin 

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. 

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. 


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 


would be very interesting to all the 
general practitioners of medicine and 
most of the people in his section. 


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." 


Double Creek School. 
W. L. Brewer, Prin. 


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. 


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. 


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 

The Health Bulletin 


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 


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 




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- 

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. 


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 

"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 

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." 


Topics of Vital Interest to Every Teacher, Parent, and School Child Discussed 
by Thinking Men and Women 



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 

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 

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 

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. 


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 

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 

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 

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. 



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. 


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. 


"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 


"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. 


By Taliaferro Clabk, 
Assistant Surgeon-General, U. S. P. H. S. 


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- 

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 



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. 


"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. 


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 


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 : 

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." 


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 

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. 


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. 


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 



No. 12 




No. 12 


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 

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 

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. 


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 

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 

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 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' 

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- 

The school also has a post-graduate 
course of four months for graduate 


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. 





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 

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 


Miss Connolly, Dr. R. A. McBrayer, 

Miss O'Kelly 


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. 


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 


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- 



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 

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- 

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 


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. 


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 



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 

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- 

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. 


A great number of North Carolin- 
ians are today suffering with tubercu- 


In Center. Mr. C. W. Hyde. Instructor, 
With Students at State Sanatorium 


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 

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. 


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 

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 


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 


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 

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 


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 


Loaned by Ordnance Corps, United States 
Army, for Use of Student-Patient Soldiers 
at State Sanatorium 


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. 


Agricultural Work by Student-Patient 
Soldiers at State Sanatorium 


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 

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- 

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 

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. 


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 

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- 

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 

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- 

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. 

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 

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 

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 

The command now is, Carry On! 

— L. B. McB. 


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 

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 

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 

The Health Bulletin 


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 


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 

(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- 

"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 

(3) That the standardization of the 
plan through supervisory control was 

(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 

(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 

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, 


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^.^'- 


State Director of Health Education and 

Organization Among Negroes 

assuring a more intensive and effective 

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 



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 


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 

Special attention is given to all 



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- 

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 

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 



The 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 


■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 

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, 



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, 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 

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 

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- 

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, 

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, 

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- 

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 

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- 

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 

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. 


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- 

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. 


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 

Don't- pass a Red Cross Christmas Seal 
Booth without buying — encourage those who 
are selling. 


Each Seal Is a Penny's Worth of Cure and Prevention 




This Bulletin will be sent free to any citizen in the State upon request 



No. 12 


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 






This 2d day of December, 1919. 






I— I 













li^l>. tN.X 


0^0^ ^0^ 0^^ 


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, 


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. 



to Go- 


LeDrosy-Smallpox-Yellow Fever-Typhoid 

These in turn have scourged the world, 
but they have been surely conquered by 

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 

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. ■