The Health bulletin [serial] - University of North Carolina at Chapel Hill

This hooh must notbe taken from theLibrary building.nl'lWf^'m1ff- " "'.-I—— r" t-'s,JUL 1 5 ]% ]LUNC-15M N.36OP-13370

Putlislyed h^ TAZ. N°KJI\ (M9Lm^ 5TATL D°ARD s^AE^LTAThis BulkliAwillbe -serxt free to qu\3 ci"tizer\ of Ihe State up or\ request.!Entered as second-class matter at postoffice at Raleigh, N. C, under Act of July 16,1S94. Published monthly at the office of the Secretary of the Board, Raleigh N. C.VOL. XLV JANUARY, 1930 NO. 1The midwife class of Person County. These women have been taking acourse of instruction provided by the county health department, spo7isored byMiss Ruth McCollum, the county nurse. It is a creditable looking group. Theyare putting into effect the practical idea of improving the status of all midwivesas long as there remains a single woman needing their services.

MEMBERS OF THE NORTH CAROLINA STATE BOARD OP HEALTHA. J. CROWELL, M.D., President r>>,o^i^«.»CTRUS THOMPSON, M.D._THOMAS tV.v^ ^m*E. ANDERSON, M-DTI: «^t^f°°yH 'E. J. TUCKER, D.D.S._. IStatesvilleD. A. STANTON, M.D._r___ ' °£rV u ?.JAMES P. STOWE, Ph.G. • ^^Mu ^^i?*JOHN B. WRIGHT, M.D CharlotteL. E. McDANIEL, M.D. Raleigh__CHARLES C. ORR, M.D. 1 -Asnevillei"^t*^^?,"EXECUTIVE STAFFSecretaryROnIld^ KONALDB. ^V^olEf^a^^^.^^;and}^-^i:State Health Officer.WILSON Assistant to the Secretary.?< V; ^M93^ M.D., Director State Laboratory of HyeieneH E- M?TI'^' ^^' ?i5*?'°^ g^^^*^ «' Health Educatfon.Bureau ofF Engineeringm" REmf^R Mh^^A^^ "t and Inspection.H A TAVTHT?^^ •i*-°/'^^^^°?'.B".^^,^^ °^ V"^l Statistics.t±. A. iAYLOR, M.D., State Epidemiologist.COLLINS M.D Director^^g^QfBureau of Maternity and Infancy.ir;>Tfv^^riSK, M.D., Director of County Health WorkERNEST A. BRANCH, D.D.S., Director of Oral Hygiene.FREE HEALTH LITERATUREwhi-Jw^-lfhl^ ^^^'^ of Health publishes monthly The Health Bulletin,T^LSkT l^i-^r^-^""!? *° ^"7 "^'^^^ requesting it. The Board alsoavailablehasfor distribution without charge special literature on the followingsubjects. Ask for any in which you may be interestedAdenoids and TonsilsCancerCatarrhCare of the BabyConstipationColdsClean-up PlacardsChickenpoxDiphtheriaDon't Spit PlacardsEyesPliesFly PlacardsGerman MeaslesHookworm DiseaseInfantile ParalysisIndigestion. InfluenzaMalariaMeaslesPellagraPublic Health LawsPrenatal CareSanitary PriviesScarlet FeverSmallpoxTeethTuberculosisTuberculosis PlacardsTyphoid FeverTyphoid PlacardsVeneral DiseasesWater SuppliesWhooping CoughSPECIAL LITERATURE ON MATERNITY AND INFANCY.pnt'^f!^!/t"'''^'"^-'.?^"^^^'tf^i"'"^ °" ^^^ subjects listed below will be^^^^ °'' ''^"''*Health, RaleighfNlc.?*° ^^" ^^^^^ ^°^^d °fPrenatal Care (by Mrs. Max West)Infant Care (by Mrs. Max West)Prenatal Letters (series of ninemonthly letters)Minimum Standards of Prenatal CareWhat Builds Babies?Breast FeedingSunlight for BabiesSave Your BabyHints to North Carolina MothersWantWhoBetter BabiesTable of Heights and WelgiitsThe Runabouts in the House of Health(pamphlet for children from 2 to 6years of age)Baby's daily Time Cards: Under 5months; 5 to 6 months; 7, 8, and 9months. 10, 11, and 12 months; 1year to 19 months; 19 months to 2years.Diet Lists: 9 to 12 months; 12 to ISmonths; 15 to 24 months; 2 to 3years; 3 to 6 years.PAGENorth Carolina Health ProspectsFor 1930 ^^____ 3Practical Health Teaching' In WilkinsonSchool 4Recalls Days of Embalmed Beef andTyphoid Fever 6Vitamin Band Pellagra 7Preventing Unnecessary Noises— 1__ 8Heart Disease and the Public Health 9Who Is Educated? 10Practice of Medicine Regarded asPublic Utility11CONTENTSPAGEDriving On Left Side of Road 13Broken Wings 14Vaccination Pacts 21College Blues 23Our Lives Shorter, Not Longer 25Common Sense and the Open Window^26Dosers 28Our Back Cover Cartoon 29How Very Few of Us Die 30An Encouragement 31

The Health Bulletin January, 1930the water is pure, the milk safe andthe food of the right kind, adequateand properly prepared. Two of themost important things to do duringthe first year is to see that the infantis successfully vaccinated againstsmallpox and that it has three adequatedoses of a fresh product oftoxin-antitoxin properly administeredto guarantee against diphtheria.Measles, whooping cough, and scarletfever should be guarded against withall possible care. Six years old andhealthy when school troubles beginmeans power to win if the teacher isThere are so many aids tointelligent.good health now available for theschool children almost all over theState, that no pupil's health should bejeopardized during these years. Neverthelessmany thousands of them havetheir health seriously impaired inmany ways which could be avoided.But we may take heart here for theteachers are learning. It is the solemnduty of every health officer to helpteach them, and none the less the obligationof every practicing physicianto do the same thing. Shorter schoolhours for younger children, all thoseunder twelve, and rigid supervision ofschool cafeterias may be regarded asthe two most imperative demands forbetter health safeguards for schoolchildren. It ought not to be necessaryto say that if any child is so unfortunateas to be admitted to school thisyear before receiving a successful vaccinationagainst smallpox and diphtheriathis important deficiency shouldbe remedied during the first thirtydays of school.In all the foregoing the one responsibleindividual who is paid a salaryfrom public moneys to do these thingsis the local health officer. It makes nodifference whether he is a full timeofficial or a part time one, the obligationis equally binding. It is no useto say the fault is the parents, or thepracticing physician's when failure toinvoke protection is present. Thehealth officer must secure the cooperationof parent and family physician.Details and methods by which thingsmay be done are unimportant. Gettingthem done is the important point.Plans and programs should be madeto fit the local needs. But the principlesare fundamental and State-wide.For the general population attentionshould be given to a more plentifulsupply of fruits and vegetablesand an increase in the consumption ofdairy products, poultry, eggs, meat,and fish, by people who need to guardagainst the deficiency diseases. Purewater, whether it be for village or citydweller or on the farms, should bemade available. Better safeguards toassure clean and safe milk. Adequatescreening of all houses, the extensionof sewage facilities and sanitaryprivies where needed are among someof the things to be looked after in our1930 health prospectus.More humane and sympathetic carefor the aged and the "down and out;"the better safeguarding of the healthof working people in all kinds of industryand agriculture are among ourbiggest needs. For the adult individuala health examination, a really trulyhealth examination, not a pulse feelingand tongue inspecting enterprise,would if included in the year's programadd much to the happiness ofall such wise folk as well as possiblyadding a little something to the spanof life.May your New Year be what youtry to make it.PRACTICAL HEALTH TEACHING IN THEWILKINSON SCHOOL OF ROCKY MOUNTEarly in October the teachers of theWilkinson school of Rocky Mount,North Carolina, wrote to the StateBoard of Health explaining a planthey had for the practical teachingof health matters in the school this

January, 1930The Health Bulletinyear. They informed us that they hadabout three hundred and twenty-fivepupils in this particular school.The plan that they proposed to putinto effect is one that any wide-awakeschool of the State can also utilize.Briefly speaking, they propose to takeup one phase of health teaching eachmonth and study that exhaustively.They selected as their subject for themonth of October the care of the teeth.They asked us to supply them withliterature in the form of a shortpamphlet on the care of the teeth,sufficient to supply each one of thepupils with a copy. It so happenedthat we have been distributing for tenyears all throughout North Carolina acarefully written special pamphlet onthe care of the teeth. This littlepamphlet has two cuts, one a drawingof the temporary teeth and one thatof the permanent teeth. The two areplaced on the same page. Each toothof each set has the proper name andthe approximate date of eruption.The teachers of the Rocky Mountschool proceeded to examine each child,writing his or her name on the pamphletto begin with. Whenever theyfound a child who had a particulartooth corresponding to the tooth onthe plate, either temporary or permanent,which was decayed, they markedthis particular tooth "decayed" or"needed dental attention." Each childwas then asked to take this pamphlethome and to show the parents the situationthat the teacher had found.This is certainly beginning at thebeginning and is one of the most effectivemethods of teaching practicalcare of the teeth we have ever seen.The method assures concentrated intereston the part of the parent at atime when it will probably do moregood than it could ever do again. Theinformation carried in the pamphletis sufficient to explain to the parentthe importance of taking action immediately.No dentist in the world couldcriticise this procedure. The examinationwas not a dental examination, andif a tooth had a decay in it big enoughfor a teacher to see, it is a self-evidentproposition that the dental serviceswere needed; and, after all, the responsibilityof health departments andteachers is to get children who needdental or medical care into the handsof capable dentists and physicians.This procedure on the part of theRocky Mount teachers strikes us asbeing the finest method yet devisedto do that particular thing.To go a little farther along withthe Rocky Mount program, anothermonth, after they settle the teethquestion, is to be devoted to the questionof a study of the prevalence, dangers,and prevention of diphtheria.Here again we are able to providethem with literature which is to thepoint, sufficient for each child and itsparents to have. In this way everyparent who is patronizing the Wilkinsonschool in Rocky Mount will havedirectly called to his attention the factthat diphtheria may be easily preventedthrough the administration oftoxin-antitoxin to any young childrenin their families. If the parents dotheir part and act on the suggestionswhich will be brought directly to them,there should not be a single case ofdiphtheria developing m the Wilkinsonschool of Rocky Mount when the fallsession of 1930 opens. This will giveample time for the immunizationthi'ough the winter and spring of anychildren in homes patronizing thatschool for the immunization to takefull effect before the school opens nextSeptember.And another item of vast importanceto the health of the school childrenis the question of foods. Theteachers propose to take one month forthe study of the particular kind offood, the quantities, and so on thatschool children should have. These areonly items illustrative of the fine andcomprehensive program these teachersare carrying through.We take pleasure in departing fromour usual custom in which we are

The Health Bulletin January, 1930treating all matters these days discussedin the Bulletin in an impersonalmanner, by mentioning the namesof the two teachers who have initiatedthis program. Communication tothe State Board of Health was madeby Miss Charlie Westbrook, one of theteachers in the Wilkinson school, andMiss Bessie McDearman, principal ofthat school. We hope that other teachers,when engaged in their schools, willfollow the example of these wideawaketeachers in this particularRocky Mount school. The field is unlimitedand the need is great for justsuch practical teaching.RECALLS THE DAYS OF EMBALMED BEEF ANDTYPHOID FEVERThirty-two years ago this month thebattleship Maine was blown up in HavannaHarbor, and very soon thereafterthe country was at war withSpain. Some few weeks ago the MonroeJournal published a rather poignantlittle story from a Monroe citizenwho is a veteran of that war. Thestory recalls to mind so graphicallythe conditions in this country, and inthe army where typhoid fever killedmany more soldiers than Spanish bullets,that we herewith publish it infull. To a present-day health officerin North Carolina it will read like astory from some ancient and mustyhistory. However, there are many ofus who can remember only too wellthe conditions that existed in the civilianpopulation in North Carolina justas well as obtained in the army.This man speaks from personalknowledge. He was a victim. The storyhas gone the round many times of apompous major general of one of thecamps walking up and tearing froma polluted well a notice from the medicaldepartment warning the soldiersnot to drink the water from that particularwell. This old incarnation ofpolitical authority, and ignorant ofthings outside of his particular technicaltraining, proceeded to drink ofthe water and to remark that all thismedical palaver was foolishness. Atthe time hundreds of his soldiers weresick from typhoid fever, and many ofthem were dying every day. We havecertainly traveled some distance sincethat day. Read the story that this soldiertells,and take heart that in somethings the world is not as bad as itwas thirty-two years ago."When Mr. John Holloway put onhis uniform of a soldier of the Spanish-AmericanWar, people said, "Hello,Mr. Holloway, I didn't know youwere a Boy Scout.'"That riled John, riled him to thinkthat the war in which he had been asoldier and came very near losing hislife,could be totally forgotten by theolder people and wholly unknown tothe young."But that is about the truth of it.And the government takes the sameattitude, says Mr. Holloway. It doesjust about half as much for a veteranof the Spanish-American War as itdoes for one of the World War forexactly the same disability. Andthough it paid him only fifteen dollarsand sixty cents for soldiering, it musteredhim out without any compensationadjustment at all."Dewey captured the Spanish fleetin Manila bay on May first, 1898, andSchley smacked the Cevera fleet onJuly fourth. At that time the Americansoldiers, every last one of themvolunteers, were being prepared toland in Cuba, but a lot of them nevergot there. They were already dead ordying of typhoid fever or starving onembalmed beef in the concentrationcamps. John Holloway was one whowas laid up with typhoid fever and hisleg was swollen as big as his bodywhen his regiment embarked for Cuba."There are a good many more Spanish-AmericanWar veterans aroundhere and there and no doubt they feel

January, 1930The Health Bulletinabout like John of the hardships ofthat war and the scant attention theynow receive, especially as John says,since what they underwent caused therevolution that swept away the menaceof embalmed beef, cheating contractorsand such like and started thewar against typhoid and made armycamps at last free from such diseases."VITAMIN B AND PELLAGRAIn a letter to the Editor of the Bulletinsometime ago a physician friendremarked that he could not see whypellagra should be regarded as a deficiencydisease in view of the fact thatthe pellagra preventing principle infood known as vitamin B is the mostwidely disti'ibuted vitamin in nature,and so that practically the diet servedon all tables in the homes of the peopleof this State therefore had anabundance of vitamin B, and that theycould not help eating a considerableamount of food containing this vitamin.The fact that vitamin B is presentin the leafy vegetables such as lettuce,cabbage, spinach, turnips, in liver,kidneys, tomatoes, beans, peas, potatoes,eggs, milk, in addition to thelarge amount found inyeast and thebasic foods of every family, cereals,would seem to afford a sufficiency ofthis necessary element. It is, of course,true that an abundance of this vitaminis available, provided we eat it.We have just called cereals the basicfood of every family. This is true, because,in North Carolina at least, cornbread, white store bread, or biscuitmade from white flour, composes thebread diet for ninety-nine per cent ormore of the people.In a thorough-goingstudy of this point the late Dr.Edward J. Wood made a special tripto some of the large flour mills in theCentral West in order to see the processemployed in making flour, a largequantity of which was shipped and isshipped to this State for consumption.He made the same investigationconcerning the manufacture of thecommercial corn meal handled in largequantities by the grocery stores of thissection also. He learned that the germof the wheat, and of the corn, wasremoved in the milling process, becausethis portion of the grain, whichcontains the vitamin B, if retained,then the flour or the corn meal wasmany times more subject to mold andspoilation in shipping, and therefore tocommercial loss.People who eat the native wholewheat bread from wheat made in thissection, or at least milled in this section,and which contains all of theYoungaville girl weighedThis littleonly two pounds when one ivcck old.in a bassinet withShe lay on a pillotvhot water bottles around her for thefirst three months. During this timeshe teas fed lactic acid milk sweetenedivith corn syrup, and administeredwith a medicine dropper. She is a fineexample of what may be done withpatient and intelligent care, includingparental, nurse and medical.

I8 The Health Bulletin January, 1930wheat kei-nel,including the germ, getthe vitamin B in proper proportion.In thesame way the many thousandfamilies in the State who embrace theopportunity of getting their corn meal,from which they make their cornbread, from local grist mills, especiallyfrom local mills in which the NorthCarolina corn is utilized fresh fromthe barns and fields of the local farmers,also get vitamin B in their cornbread, although in smaller proportionsthan in the whole wheat bread. Dr.Wood therefore held that the basiccause which made pellagra possiblewas that the people who had been dependingupon a diet rich in the gei-msof wheat and corn in their bread,when deprived of this through thecommercial products utilized in recentyears, failed to get enough of the pellagrapreventing principles by eatingit in other foods, sufficient to makeup for the deficiency.We reiterate here the doctrine ofGoldberger and Wood, that it is notonly necessary to have an adequatediet on the table containing an abundanceof vitamin B, called by Goldbergerthe pellagra preventing principle,but it is essential that this diet beconsumed by the person who wouldavoid pellagra or other deficiency diseasesof like character.PREVENTING UNNECESSARY NOISESSome of the health departments inthe various cities of the country arevery much concerned over the questionof control of unnecessary noise.The city of London has had variouscommissions at work making surveysin their thorough-going style as a preliminaryto city ordinances drasticallyextending control in order to preventthese nuisances. In this State thecity of Greensboro raises a big fussabout the blowing of train whistlesand the exhaust racket kept up duringthe night by a surplus of motorcycles. In some of the cities of theNorth street cars are blamed for agreat deal of the noise, the city ofDayton, Ohio, in its Health Bulletindeclaring that there had been no improvementfrom a noise standpoint inthe operation of street cars of thatcity in a third of a century.Nearly all the cities and towns inour State find the unnecessary blowingof automobile horns nothing shortof an unmitigated nuisance. The vibrationcaused by heavily loadedtrucks running at rapid speed on thestreets at all hours of the night isanother cause for complaint. For themost part the latter are engaged inthe work necessary to be done for thewelfare of the people, and nothing weknow could be done to prevent it exceptbetter training of the drivers asto how to reduce the racket to a minimum.In the case of blowing automobilehorns, in our opinion about onetoot every six months for the averagecar is sufficient. The fact is that themanufacturers ought to be prohibitedby law from equipping cars withhorns. If this nuisance were drasticallyabated in the foregoing manner,and an ordinance strictly enforced, requiringall drivers to keep well to theright side of the road, there would notbe any possible excuse for a horn onan automobile. Some critic might probablysay that it would still be necessaryto warn pedestrians, but the factis that a few sharp blasts from theautomobile horn when a pedestrian iscrossing the street only tends to confusehim and make bad matters worse.The pedestrian, of course, must betaught to look before he crosses thestreet, just as the automobile drivershould be trained to stay on his sideof the road. The ringing of the trainbells and the blowing of locomotivewhistles day and night in thicklypopulated resident portions of towncertainly should be reduced in volumeand used only as a necessity in thesafe operation of trains. For the rath-|

January, 1930The Health Bulletiner large volume of sound as an incidentof making general "whoopee" inthe residential sections of towns in allhours of the night, that is a matterfor education and regulation by competentauthorities.HEART DISEASE AND THE PUBLIC HEALTHIt was not until about the beginningof the present century that tuberculosiswas definitely recognized as apublic health responsibility. Only recentlycancer has been placed in thecategory of diseases constituting apublic health problem. The fact is thatit is not even so recognized everywherenow. The extremely communicablediseases like smallpox have naturallybeen looked upon as public healthproblems all the time. We are glad tohe able to record the fact that nowheart disease is coming to be lookedupon as just as definitely a publichealth problem as cancer is.Progress tov/ard the control of thespread of tuberculosis is much moresatisfactory now that it is realizedthat the disease is almost always contractedin childhood through exposureof infants and very small children tocontamination with the fresh sputumand other discharges coming from tuberculouspatients living in close contactwith the infants. When it waslearned that this infection was presentin latent form in the children, tobecome manifest in later years, thenit was that the most intelligent effortscould be directed against the eradicationof the disease.It is now realized that about seventy-fiveper cent of all cases of heartdisease develop in children ten yearsof age or under, and that only aboutten or twelve per cent develop in personsover forty years of age. Heartdisease is one of the gi-eat killers ofthis country. More than twice as manypeople die each year from heart diseaseas do from kidney disease or fromcancer or from pneumonia; and thesefour diseases constitute the four chiefcauses of death.Another disturbing element is thatthe rate of death from heart diseaseis increasing about twice as rapidly asthe rate of population increase. Oftenheart disease is congenital; that is, achild is born with the disease present,and in such cases nothing can be doneto prevent its development and theprobable early death of the child. Theonly thing in such possible cases thatcan be done is to pay more practicalattention to the care necessary to safeguardexpectant mothers. The otherform of heart disease; that is, theform that is acquired after the healthybirth of a baby, is nearly always dueto complications resulting from communicabledisease, or to improper habitsof living.The group of diseases known underthe general term as rheumatism isnotably large. Rheumatism is at thistime believed to be a germ disease.For many years the doctors and dentistshave had a great deal to sayabout focal infections.In these conditionsso-called rheumatism infectionis frequently a result of diseased tonsilsor decayed teeth, the germ gainingentrance into the blood streamthrough such conditions in the body.The chief thing to emphasize in thisconnection is that the best method ofprevention of such conditions is to prevent,when possible, decayed teeth,and also to preserve, if possible, normaltonsils, through care for the generalhealth of the child before andafter birth, the prenatal care, ofcourse, directed to proper hygienicliving, proper food, and the freedomfrom disease of the mother.The United States Public HealthService in a recent publication statedthe tabulations of physical records offive thousand school children undertheir supervision showed that of thechildren whose tonsils had been removedfor serious tonsillar infection in

10 The Health Bulletin January, 19SOwhich had not been removed andwhich were not diseased was muchbetter, not more than one-third asmany having indications of heart disease.A fine pair of Jackson County twins.At present both are underweight, butwe hope that handicap will be removedat an early date.the past, twenty out of every hundredhad attacks of rheumatism, and ofthe children with defective tonsilswhich had not been removed, seventeenout of every hundred had rheumatism.With the former group, fourhad heart disease, and of the lattergroup, three out of each hundred hadheart disease. The showing, however,for children who had normal tonsilsThe use of the word "rheumatism"is somewhat misleading, because ofthe fact that in the past so manypoorly classified conditions have beendiagnosed as rheumatism. This hasbeen done to the point where theaverage intelligent physician feelsthat when the word "rheumatism" isused, it is done so as a general term,and means very nearly nothing. Muchexperimental research work remainsto be done in this group of diseasesbefore an intelligent classification canbe made. It is sufficient for our needsin this discussion, however, to recognizethe fact that heart disease is anincreasing menace, and that it resultsfrom many communicable diseases aswell as from improper habits of living.In conclusion, we would like to emphasizeagain the fact that to do anythingmuch with heart disease requiresan early beginning, and it is one conditionin which prevention is aboutthe only logical procedure towardwhich all efforts at eradication shouldbe directed.WHO ISEDUCATED?September and October this yearhave been disappointing to the StateBoard of Health officials and to thepublic health workers in general inNorth Carolina because of the factthat the presence of diphtheria, judgingfrom cases reported throughoutthe State, has been just as serious,ifnot more so, than in previous years.We have said it several times beforeorally and in print that there istoday in North Carolina no excuse fora parent whose child has diphtheria.The reason for this statement is thattoxin-anti-toxin properly administeredto young children affords such a maximumof protection that it is exceedinglyrare for any child to have diphtheriaafter immunity is securedthrough the administration of toxinantitoxin.A short time ago a close personalfriend of the writer, a university graduateand an important North Carolinaeducator, was detained at his home onaccount of an attack of diphtheria inhis youngest child,a boy of six yearsof age. The child had started to schoolat the opening of schools in September.Naturally being exposed, as somany other thousands of children areevery fall, for the first time to diph-

pJanuary, 1930 The Health Bulletin 11theria and other contagious diseases,not having had the protection affordedby toxin-antitoxin, and being susceptibleto the disease, he promptly contracteddiphtheria. The wife of thisfriend is an educated woman. Both ofthem have had access to the literatureand other channels of informationconcerning every protective deviceavailable for the rearing of theirchildren. Their home is located withinfour blocks of one of the four oldestwhole-time health departments inNorth Carolina. The health officer inthat county has been giving toxinantitoxinat frequent intervals to thechildren of all parents who would takethe trouble to bring them to the officeor arrange the schedule in the differentsections of that particular county.The same thing has been done in manyother counties, and yet there are literallythousands on thousands of childrenin North Carolina today whohave not been given this protection bytheir parents. Our friends in responseto the question as to why they hadneglected to protect their childthrough toxin-antitoxin last springand summer, knowing that their childwould start to school this fall and beexposed to diphtheria, replied thatthey just simply had not done it. Theywere not indifferent to the value. Theywere not in ignorance of its protection,but they simply had not got around toit.A few days later we were in the officeof the health officer of RandolphCounty just preceeding a county-wideteachers' meeting in which the superintendentof Randolph County schoolswas making a particular point to emphasizethe importance of publichealth protection at his very firstcounty-wide teachers meeting held inthe county. While we were sitting inthe office conversing with the healthofficer, a nearby farmer came in withhis two children, a little boy of fourand a baby of fifteen months. Theyhad been there for their first dose aweek previous, and on entering theoffice the little four year old beganpulling up his sleeve, and, with abroad grin on his face, told the healthofficer he was "ready for another one."In less than a half minute the healthofficer had administered the seconddose of toxin-antitoxin to the fine littlechap. There was just about as muchpain as a mosquito bite, and if thereaction is no worse than the average,that was the last that the little fellowwould hear from that dose.Now our question is, so far as publichealth protection goes. Whose educationin these cases proved to be themost practical?PRACTICE OF MEDICINE NOW REGARDED AS APUBLIC UTILITYDoctor Henry G. Longworthy is thetreasurer of an organization knownas the Inter- State Post Graduate MedicalAssociation of North America. Hewrote an article which was publishedin the September issue of the Nation'sBusiness Magazine. He begins his articlewith the astounding statementthat "The practice of medicine todaymay be regarded as a vital public utilityfunction well regulated by law andwell managed by physicians, hospitalsand social agencies."He pictures the physician of thepresent day who practices medicine inthe city as a "bedside medical engineer."He says that as a medical executivesuch a physician "engineers orcalls to his aid at the bedside for thebenefit of the patient, all necessaryconsultations, hospital facilities, nursing,diet, and all the other sciences.In many cases for the diagnosis andtreatment of a single patient, thismedical executive will use the services,directly or indirectly, of a dozen to ahundred persons."The foregoing is true and it is what

12 The Health Bulletin January, 1930making the practice of medicine to-isday one of the most complicated andcostly of professions. It accounts forthe enormous cost of hospital care.The sinister phase of it is that thesuccessful physician can no more hopeor expect to get back to old styleeconomic individualistic methods thanhe can expect or desire to return tohis saddle bags and home-made pills.The danger in the situation lies in thepossibility of the physician (medicalengineer) becoming of necessity a simplecog in a vast machine whose finalsuperior may be a political cabinet officer.That is the spectre of StateMedicine so many thoughtful physiciansfear. In such an arrangement theindividual patient would receive aboutas much personal and individual attentionas one biddie in an incubatorflock of ten thousand.This is the day of big business. Allof us think and talk in terms of billions,whether it be debts or folks.Mergers and combines are in completeand glorious control of everything. Thependulum has simply followed thelaw of averages and swung back fromthe period of thirty years ago whenno corporation or combine was toosmall or too poor to be kicked. Whatmore natural then, in the presentmental state, than to regard the doctoralong with the chain store operatoras a purveyor of a public utilitybecause he has something to sell thatmost people have to have at one timeor another.The writer in the aforementionedarticle quotes Homer Folks in a statementthat the families of this countryhaving illness in the course of a yearpay out in actual cash on account ofsuch illness the astounding total oftwo billion dollars. The same totalamount is spent annually for publiceducation—from kindergarten to postgraduate universities. If cost in lossof time and other economic loss is included,sickness costs the Americanpeople every year about fifteen billiondollars. So, we see that in a way thepractice of medicine and theconductof hospitals for sick people constituteabout the biggest public enterprise inthe country. That being true it is inevitablethat business and medicineshould form a new alliance, and thefoundation stone of the enterprisemust be preventive medicine. The preventionof disease is a public enterprise.To achieve its finest results itmust be organized like an army, andin the struggle for the ideal of longerlife and sounder health, the army mustbe composed of individual physicians.No faculty ever educated a student.What the student gets is the sum totalof efforts made in his behalf by individualinstructors. No medical societyever cured a patient. Some individualmember of the group must assume fullresponsibility and do the job if the patientis to benefit. And that is whatDr. Longworthy meant by calling thephysician a bedside engineer. If themass of the people are to receive thebenefits of this new alliance betweenbusiness and medicine they that arewell must be told how they may keepwell. That is an individual problem.Each must read what some one personwrites for him or he must be toldby some individual. Who is betterqualified than the physician? If theperson who is sick is to benefit hemust have the attention of an individualphysician. In the final analysis thethings that must be done to reach theideal may be summed up about as follows:1. Knowledge concerning the causeof disease and the prevention of itsspread must be placed in the hands ofevery intelligent individual. This is apurely public health responsibility.2. The services of a competent physicianmust be available for every sickperson regardless of where he lives orhow poor he is, for so long a period ashe needs such service. TTiis is obviouslyimpossible at present. Sothe business part of this alliance betweenmedicine and business mustsee that:

January, 1930 The Health Bulletin 133. Hospital facilities are placedwithin the reach of all. The physicianmust practice more and more in connectionwith hospital and medical centers.These hospitals must be placedin the rural sections as well as largertowns. Under this arrangement thephysicians will have available all modernmethods of aid in diagnosis. Sucha system will result in4. Better care for the patient atmuch lower cost than at present. Aphysician will be able to treat manymore patients, and to treat themmore competently. Having his officeand home in such a center, eventhough it be in a small town, the officeor ambulatory patients may receiveassurance of more satisfactorycare, and patients needing bed carecan receive it easily. The cost mustbe many times less than at present,and the physician must receive muchbetter compensation than he doesnow. Business methods can assure allthis and the physician and patient willboth retain forever the fineindividualrelationship that has obtained in thepast,patient.surely to the vast benefit of theDRIVING ON THE LEFT SIDE OF THE ROADHere we are again talking abouttraffic on the highways. However, inview of the fact that mortality duedirectly and indirectly to automobileaccidents constitutes one of the majorcauses of preventable deaths in thisState, we feel justified in continuallywriting something in the Bulletinabout the matter. It has been necessaryin the progress of the scienceof public health in driving away atthe preventable causes of death tokeep continually before the publicthese particular causes and how a differentpublic attitude might result inpreventing death from unnecessarycauses.There are not many rules for safetyon the public highways, but the fewrules that there are constitute somevery important ones, the breach ofwhich causes many deaths and muchsuffering among the people who arethe victims. With the thousands ofautomobiles running along our mainpublic highways every day at highspeed, the least variation from theknown methods of safety may at anytime instantly result in death to oneor more persons.It has been our observation in ourjourneys to and fro around over thehighways that a frequent cause oftraffic trouble, accidents and death, isthe man who persists in driving alongon the left side of the road. Thereseems to be a large percentage ofsuch pests exercising the privilege ofdriving automobiles all the time. Thisparticular insect seems to delight ingetting on a crowded highway andpiddling along at a low rate of speedon the extreme left-hand side of thehighways in the country, and in thecity or town he gets just as far overthe middle of the driveway to the leftas he can possibly get without havinga collision with cars coming from theopposite direction. TTiey seem to thinkthat the roadway is better on thatside, or that the atmosphere is morerarefied and purer, or they may do itfor just pure carelessness. The driverwho wishes to pass, even on an openroad, has to wear his horn out callingattention to his desires before anynotice is taken. By the time he reluctantlyand slowly begins to turn in,one or more cars heave in sight comingfrom the opposite direction, whichmakes it impossible to pass, often fora mile or more.The chief characteristic of the leftside of the road driver seems to be hisdesire to drive along slowly. Whencoming meeting such a driver the legitimate,careful driver of an on-comingcar almost has his hair standingon end before this pest seems to takenotice and grudgingly turns back to-

14 The Health Bulletin January, 1930ward the right, perhaps getting outof the line of traffic just about thetime the driver meeting him has toslam on his brakes or leave the roadwayentirely to avoid hitting him. Sucha habit is dangerous for several reasons.One of the chief dangers, ofcourse, is the impossibility of driversof cars behind him being able to seean on-coming car, perhaps just beforea road intersection, or, in theirefforts to pass him, the on-comingcar is obstructed from view, and accidentsoften result. Another thing,it is bad for the nervous system andtherefore the safety of every driverof a car, and to the people he meets,to have his calmness or his equanimity" "upset from any cause. Such drivingfrequently results in fatal accidentsto pedestrians also.After all, the question of drivingcomes back to the very old one of goodmanners. A polite, considerate, wellbreddriver of an automobile will thinkof the convenience and safety of thedrivers of other cars, as well as hisown, and will therefore govern himselfaccordingly.We would suggest to all personsreading these lines, who are accustomedto driving an automobile thatthey ask themselves the question: "AmI a left-hand side of the road driver ?If the answer is in the affirmative,our advice and request is to quit it.—BROKEN WINGSBySuDiE E. PyattPaul was falling from a couple ofthousand feet above the earth. Hisplane had gone bad, the left wing wasbroken. He was crashing toward theearth at terrific speed with no timeto adjust his parachute.Just before he reached the earththat rose to meet his broke plane,he awoke swearing."D—n!" He could hardly breathe.That left lung, the one the doctor hadpumped gas into that day was paininghim as if a sharp knife had beendriven through it. Pleurisy, and thespot stillneedle that hadsore from the passage of theintroduced the firstshot of air into the pleural space betweenhis lungs and his ribs, causedthe pain. No wonder he had dreamedhe was crashing to earth with abroken airplane xwing.Bird with a broken wing he was,and birds with broken wings nevercould soar so high again.Paul groaned. The night nurse, asilent figure in white, a lantern bobbingby her side like a huge firefly,laid her hand gently on his arm."What is the trouble, Mr. Dunbar?""D d bird with a broken wing!"Paul sighed half asleep, but not forgetfulof the pain in his left side—broken wing. "Never fly again.No more stories from the pilot's seatof my plane—broken wings—Paul's voice trailed off into silenceunder the nurse's ministrations. Whenshe left him he was sleeping again,peacefully this time.Feature writer for one of his state'sbest daily newspapers, and airplanepilot good enough to have a transportlicense, Paul Dunbar had been sentthree months before by physicians whowould hear of no other course to theState Sanatorium suffering from amoderately advanced tuberculosis lesionin his left lung.Paul should have responded to twenty-fourhours a day rest in bed in anumber of weeks, but he did not. The

January, 1930 The Health Bulletin 15lesion began to look as if it might becomeworse, and the physicians in theinstitution decided to administer pneumothorax.Far from being a model patientPaul had objected at first, but hadfinally acquiesced. He had receivedhis first treatment the day before thenight he had had his dream of dashingfrom a great heighth in an airplanewith a broken left wing.Eighteen months of the sanatoriumand Paul was in the superintendent'soffice receiving his final examinationand instructions before leaving the institutionto resume his life back inthe world of men and women outsidethe san's wall.Paul was now what the doctors calleda quiescent case of tuberculosis. Hewould have to have the pneumothoraxtreatments continued, and he couldwork only a few hours a day. He supposedhe should feel thankful that the"bugs" had not gotten him, but inPaul's breast there was a dull, gloweringresentment.— "The bird with thebroken wing never soars so highagain."—And sitting in the superintendent'soffice listening to his final wordsof instruction, Paul was dully awarethat back in the world again he wouldbe a bird with a broken wing, whowould never be able to soar so highagain. For the doctor said emphatically:"No flying for two years."It had been nearly two years nowsince he had flown, strong and wellup there against the sun. Two moreyears, four years before he could flyagain! Was it worth it?As Paul watched an army planeskimming over the hazy blue hillsthat surrounded the sanatorium hefelt for a moment that he had foughtin vain.But the doctor had said he mightreturn to his work on the desk forpart time. Part time on the desk, hewho had been his paper's star reporter,free to go in his plane to the endsof the earth if he could find there astory for his paper, was to be a deskman, writing news that other reportersgathered, and handling copy thatthe fellows who could get out on thestreets were too busy to write. Notyet twenty-five, he had run his gamut,was played out before his time, andall because of that bad lung—d—broken wing!The fellows on The Ashton Newswere nice to Paul. Nice because theywere sorry for him, he thought, asdeaf old Henry Clinard carefullywrote down for him the informationabout that Draketown Street robberythe reporter had brought in before hearrived, to make sure that he wouldunderstand everything connected withit.Watching "Old Henry" Paul wonderedhow it would feel to never beable to hear a sound."Not so bad," Henry had once volunteeredthe information, "if youdon't get cross with people who hollerat you. Deaf folks don't like to beOn the Stump in Guilford.n

16 The Health Bulletin January, 1930—bawled at any more than folks whocan hear do."After that Paul was always verycareful to write out his communicationswith Henry, or to talk in a toneof voice that would make the oldcopy-reader feel that he was not bawlinghim out. Henry appreciated Paul'sthoughtfulness, and there were manytimes when Paul's work would nothave been completed in the few shorthours he was on the desk if it had notbeen for Henry's aid.Gradually there grew up betweenthe deaf copy reader and the youngre-write man with the broken wing theclose bond of sympathy that alwaysunites the incapacitated regardless ofwhat the nature of the trouble is.The first day Paul was back at hisold position he noticed a flower andgift shop that had been opened up inhis absence in the little niche nextdoor to the newspaper office. It wasspring, early spring, and the firstyellow jonquils were blooming. Thelittle shop was filled with the bright,sunny beauty of the yellow flowers,and just behind them stood a girl,whose hair was as sunnily golden aswere the delicate petals of the jonquils,and the smile she gave Paulfrom dewy blue eyes, Paul was willingto swear, was made of pure gold itself."How much are they?" Paul foundhimself vaguely indicating the wholegorgeous display.Again Jonquil smiled, for Jonquilher name must be, she was so muchlike the flowers."Twenty-five cents a dozen, or threedozen for fifty cents," and she had notfinished speaking before Paul decidedthat her voice was as flowerlike as herface and her smile."O, give me all of them," he saidcarelessly."All of them?" A puzzled frowncrossed the sweet, little face, somethinglike a brisk wind blowing acrossa bed of flowers."All of them!" Paul repeated emphaticallyafter her."That will be $10, sir."And Paul thought that her talkingof prices was as if one of her yellowflowers had stepped out of its vase todo business."Where shall I send them, or willyou take them?"Paul looked puzzled for a moment.The jonquils would overflow his oneroom, bath and sleeping porch. "Sendthem out to the Bausman County TuberculosisSanatorium," he said quickly."To anyone in particular?""No, to all of the patients.""What shall I put on the card?""From a 'Broken Wing,' only." Pauldid not realize that his voice was bitter.The girl smiled in quick sympathy,and for a moment Paul's black moodlifted."Say, isn't your name Jonquil?" heasked impulsively."No, it isn't, I'm sorry, but— " shestopped."I'm going to call you Jonquil.""When?""Now, and every time I see youyou see,— " Paul suddenly found hewas floundering helplessly. "I worknext door on the newspaper.""O, you're a reporter?""Yeah, sort of."And with that Paul tipped his hatand went into the office. He had foundsuddenly that he would not like forthis golden, blue-eyed Jonquil tothink of him as a man with a brokenwing.Paul had been back on the desk atThe Ashton News for three monthswhen Lon Dale, the greatest airplanestunt flyer in the United States cameto Ashton. Paul had flown with Dalein the days before he had known thathe had lungs.The stunt flyer's air antics and thereporter's ability at description hadgiven The News many good stories.Dale and Paul, who were very fond

January, 1930 The Health Bulletin 17of each other, were delighted tomeetagain. It had been two and one-halfyears since they had pulled one of thehair raising airplane stunts. They hadnot been together fifteen minutes beforethey were planning one of thosethrilling flights of the old days, Paulforgetting once again that he hadlungs—that he was a bird with abroken wing.They buttonholed Bill Lacates, themanaging editor, as he came in. It didnot take them long to tell him whatthey wanted. A story in The News thatDale was back, and that he and thereporter were going to give again someof the stunts that had given Ashtoncitizens such a thrill three years before.Bill listened, chewing the end of avillainous black cigar."Sounds fine, Dale," he disregardedPaul, "if you can get someone to goup with you to cover the flights, asPaul used to. Paul's not well, youknow. It would never do for him to attemptit."Dale's face fell, and Paul grewpale, his eyes blazed. "Bill, you haveno right to say I'm not well enoughto get that story, any d—n story Iwant to.""Remember, Paul, you're a deskman now, and I'm the only one whocan tell you to go outside, and I'm notgoing to tell you."With that Lacates walked into hisoffice, and Paul was left facing Dale,white and shaken."I'm just a bird with a broken wing.Dale. Ican't even fly now by my doctor'sorders. For a minute I forgot.Bill is right. That was his way of tellingme, 'I'm no good'.""Sorry, old boy," Dale rose andshook Paul's hand. "I was looking forwardto some of our old stunts, but wewon't now."Paul sat at the re-write desk,smouldering resentment in his eyeswhen Dale had gone. The managingeditor had really been kind not to lethim attempt the dangerous physicalstrain the gathering of the materialfor the air stories would entail, butPaul did not want kindness, sympathy.He wanted his old red-blooded strengthback. He didn't want to be a bird witha broken wing.It was the night of the afternoonthat Paul's managing editor had refusedto let him take the air assignmentsthat Paul learned that Jonquilwas crippled, and that her beautiful,white-haired mother was blind.He left the newspaper office, walkingby the little flower shop withdragging footsteps."Hello!" It was Jonquil, whose realname was Marta Sennett, the flowershop girl.Since the day in early spring whenPaul had bought her total availablesupply of jonquils all at one time,the girl had not forgotten Paul, norhad Paul forgotten her.To speak to her every day, and tostop in the shop a few moments totalk to her was almost a ritual withPaul—and with Jonquil, too, if he hadknown.Further than the greetings andflower shop conversations the affairhad never progressed. Whenever Paulthought of knowing her more intimatelyhe immediately became hot,then cold.A fellow with a broken wing had nobusiness being more than the mostcasual of friends to a girl like Jonquil.But tonight things were different.Jonquil had invited him around to herhome, because she told him her motherwas celebrating her fiftieth birthday,and she had been looking for himall day to invite him to the party.Mrs. Sennett was seated by a windowthat looked down on the streetwhen Paul let himself into the littleapartment in response to her invitationto come in when he had knocked.She called cheerily to him to comeacross the room to her chair, tellinghim that she knew who he was.When Paul took the soft hand of

18 The Health Bulletin January, 1930Jonquil's mother, and looked into theeager face raised to meet his, he realizedwith a start that she was blind.Reverently Paul took the whitehand, and bending touched it with hislips. He wondered why Jonquil hadnot told him before that her motherwas blind.Paul's surprises were not at an end.As Jonquil came from the kitchen ofthe little apartment, stripping off herwork apron as she walked, he sawthat she was crippled. Her left footand leg to the knee was horribly deformed.Looking at her Paul thought thathe had never before seen Jonquil outfrom behind her flower counter. Crippledherself, her mother blind, shesupported them both with the littleflower shop. Brave, gallant girl! Nowonder he had thought she was like aflower when he had first seen her. Awave of tenderness swept over him. Hewanted to go to her, to lift her in hisarms, and carry her so she would neverhave to use the hurt limb again.TTien his high mood fell. Bird witha broken wing, he was not even ableto lift her slender body once, muchthe less care for her all of his lifeas he wanted to.Paul touched Jonquil's slim, littlehand softly. The blue eyes on his werequestioning."It has always been that way," shesaid in simple explanation, lookingdown at the deformed foot. "You donot mind that I did not tell you." Sheindicated her leg and foot, her mother'ssightless eyes. "Mother and I don'tlike to talk about it. We play all ofthe time that we are both well andnormal, and it makes everything muchhappier for us."Paul suddenly knew that her warmlittle hand was still in his. He pressedit quick and hard. "You wonderfulgirl. Jonquil."Paul was happy, happier than hehad been in a long time when he leftJonquil and her mother that night.Though happier he left railing mentallyagainst fate, life, whatever force itis,lifethat sends young men out to fightwith broken wings, cripples beautifulyoung girls, makes blind lovelyold women, and deaf good fellows likeHenry Clinard.Passing by Dr. Herndon Benson'shome, Paul saw a light burning in thedoctor's office at the side of thehouse. Doc had been a good friend tohim all along, even when he had insistedon his going down to the sanatorium.He would stop in and talkto the doctor, see if the physician'straining, and the hard philosophy of amedical man could help him to solvesome of his problems.It was late, but Dr. Benson receivedPaul with a smile."My, you're looking fine, young fellow.Weigh more than you did beforegoing to the San, don't you? Not sobad this business of having one lungafter all, is it?"Paul frowned. "Mighty tough, doctor,when you want to do somethingso bad you can taste it, and peopletell you that you can't because of yourlungs."The doctor looked thoughtfullydown at a test tube in his hand. "Paul,to some degree almost every man, womanand child living is physically incapacitated.It may be only a very,very slight trouble, but the physicallyperfect man or woman hardly existsat all, any doctor will tell you.""Guess that's true, doctor, but theydon't have to go dragging around crippledwings like my lung, have deafears, sightless eyes and deformedlimbs," Paul spoke bitterly.Dr. Benson carefully laid down thetest tube. "You are right at that, Paul,but did you ever think of the largenumber of people who fight organictroubles? I myself have a bad heart. Ithas been bad since my high schooldays. My wife suffers from high bloodpressure, and has to stay away frommany social functions she would liketo attend. My oldest son can't playhigh school football because of

January, 1930 The Health Bulletin 19chronic bronchitis. Loretha, my daugher,is underweight and everyday ofher life the food she has to eat is atrial to her.""I know, doctor, but those are alldisorders than can be cured."The doctor shook his head. "Sometimesthey can, sometimes not. We allhave our lives to live, Paul, makingthem as worthwhile as possible, regardlessof whether all of our physicalorgans are in perfect order ornot. Perhaps some day we will breeda perfect race, a race that will nothave to be bound down to earth by theneeds and the disabilities of our physicalbodies today. That time has notcome yet, and those of us who are livingnow have to give our bodies thebest care possible, paying particularattention to the weakest members.Then forget we have a body at all,and live our lives in spite of physicaldisabilities."Paul got slowly to his feet. "There'sa lot in what you say, doctor. I haven'tseen daylight yet, but I'm going tothink things through. I hope 111 beable to see as clearly as you do, whenI have thought them through.""You will, Paul," the doctor laidhis hand fondly on the erect shouldersof the tall young man. "Best of luck!"As Paul walked homeward throughthe night the physician thought whata lucky chap Paul Dunbar was. Twenty-fiveyears ago his disease rapidlyadvancing he would have probablydied. Now, modern medical science hadsaved him, as firte a looking specimenof young manhood as could be seen onthe streets.The broken wing, Paul so bitterlycomplained of, the doctor felt surePaul would find less of a disability astime went on. He would learn to livehis life despite the broken wing.In the gray dawn of the morningafter Paul had been to Jonquil's mother'sbirthday party, and talked to Dr.Benson, he wrote the editorial "BrokenWings" that won for him thatThis distinguished Jackson county couple are 82 and 85 [icars /

:20 The Health Bulletin January, 19SOyear's prize for the best editorial writtenin the United States.Donald Heitman, editor of TheNews, found the editorial on his deskand blinked when he saw the name.Dunbar writing editorials? Well, hewould read it, and if it was passablehe would use it, give the boy a bit ofencouragement.Heitman slowly readBroken Wings"The bird with the broken wing neversoars so high again."The airplane up against the sun,a wing broken dives swiftly to destructionfor itself and its occupants.Human beings, blind, deaf, crippled,with bad lungs, hearts and defectivebodily organs, armless, legless, or insome way incapacitated are birdswith broken wings—birds that cannever again soar up against the sun.To some degree all of us are incapacitated.Physical perfection, onehundred per cent is rarely ever found.The wing broken, the machine disabled,shall the incapacitated give up,say life is over? No!Modern medical science has gone along way toward mending the brokenwings of the physically and mentallyincapacitated. The church has alwaysdone its share in binding up spiritualwounds.The broken wing mended one mustgo on, forgetting—if he can—that itwas ever broken.—But it is impossible to forget thebroken wing. Its strength is gone. Itis not the same wing— "The bird withthe broken wing can never soar sohigh again!"True, he can not soar up againstthe sun, but what of the earth ! All ofus are closely bound to earth. The airplanegets only a very small portionof us away for a short time, fromdown there against the earth wherewe live. The broken winged must findinterests upon which he can center histhoughts. Interests close to earth. Hecan not keep his thoughts bottled up,thinking of the wing that Is not workingjust right. He must forget he hasa broken wing in the joy of living,not because, but in spite of somethinggone wrong.Someone to love deeply, a hobby, music,reading, pets, flowers, a gardenwill all aid in throwing thoughts thatmight become morbid off their sinistertrail.You are not a bird with a brokenwing, but a normal, whole, happy individual.Happy with one's work, and in one'shome the morbid thoughts seldom findtime to enter, and when they do theydo not stay long, where the sun i;hatfilters down to earth is allowed tocome in.The broken winged bird may neverfly again, but the memory of the dayswhen soaring up against the blue theearth was green below, the sun goldon his wings can never be taken away.—And who knows, the bird with asoar upbroken wing may be able toagainst the blue with the sun on hiswings, again sometime!There was an offer of a job fromseveral big city papers after Paul'seditorial won the prize. When his hometown paper offered him the place ascity editor with a salary large enoughto support a wife and family on, Paulrefused the big city job, and stayed onin Ashton.Before he accepted the new positionon The News he walked out to talkthings over with Jonquil."Must I take it?" he asked."Take it? Why you know you'll take,Paul!""If I accept the place will you giveup your flower shop and marry me?"The dewy blue eyes had never beenmore flowerlike, as she raised them toPaul. "If you insisted long enough,and hard enough, I might.""Even if I am a bird with a brokenwing?""Hush!" Jonquil placed her fingers

January, 1930 The Health Bulletin 21lightly on his lips. "At our house we'regoing to play we're always well. Iwouldn't marry a man with a brokenwing, even if he were an angel, andI know you wouldn't think of evenlooking at a girl with a crippled foot,"Jonquil teased brightly as Paul silencedher with a kiss.VACCINATION FACTSByFrederick R. Taylor, M. D.Vaccination against smallpox wasthe first great discovery of preventivemedicine. In 1798 Dr. Edward Jenner,an English country doctor, after fifteenyears of painstaking observationand record keeping, published hisepoch-making paper entitled "An Inquiryinto the Causes and Effects ofthe Variolae Vaccinae, a Disease Discoveredin Some of the Western Countiesof England, Particularly Glouchestershire,and Known by the Name ofthe Cow-pox." The modesty of thisgreat benefactor of mankind is shownmost impressively in Jenner's reply toa Mr. Cline of London, who promisedhim the stupendous sum of 10,000pounds a year income if Jenner wouldconsent to settle in London. Jennerreplied to this offer, "Shall I, whoeven in the morning of my days soughtthe lowly and sequestered paths oflife, the valley, and not the mountain;shall I, now my evening is fast approaching,hold myself up as an objectfor fortune and for fame? Admittingit as a certainty that I obtain both,what stock should I add to my littlefund of happiness? My fortune, withwhat flows in from my profession, issufficient to gratify my wishes; indeed,so limited is my ambition, andthat of my nearest connections, thatwere I precluded from future practice,I should be enabled to obtain all Iwant. And as for fame, what is it?a gilded butt, forever pierced with thearrows of malignancy . . .."What has vaccination really accomplished?The following data are copiedfrom the article on Vaccination byProfessor George Dock in the secondedition of Osier and McCrae's "ModernMedicine." He writes:"Coincident with the rapid spreadof vaccination was a marked fall inthe extent and mortality of smallpoxall over the civilized world— . In London,in the years 1761-1800 the mortalityin the successive decades wasrespectively 24,234, 20,923, 17,867,18,477. In the first two decades of the19th century it was 12,534 and 7,856.Toward the end of the second decadeof the 19th century smallpox beganto increase, and in some countries becamealmost as prevalent as it hadbeen before. The causes of the recrudescenceare not difficult to understand.Many people had been vaccinated solong before that they had lost theirimmunity wholly or in pai-t. This wasthe time to settle the question as tothe life-long protection which theearly vaccinators so fondly believed in,but prejudices were still too strong.Many other people were not vaccinatedat all, because smallpox was somuch less frequent that the operationseemed unnecessary, and there was asmaller proportion than before notprotected by smallpox." (One attackof smallpox, when it does not kill,protects against subsequent attacks.)"Looking back, it is clear that certaingreat changes had occurred in thesmallpox situation since Jenner's discovery.The absolute mortality wasless; the disease was not so frequentas before in the years following theusual age of vaccination; and thesefacts were most obvious in countries

:22 The Health Bulletin January, 1930that had the most thorough vaccination.The change in the age-incidenceis interesting. Smallpox was commonlyspoken of in Germany in the prevaccinationdays as "Kinder-pocken'(children's pox). Of 1252 cases ofsmallpox before vaccination 94% werein children less than 10 years of age,and no case above 20. Of 1677 casesafter vaccination, only 18% were under10 years of age, and 42% over 20.Epidemics were smaller, and mildcases, long known, but rarely mentioned,became relatively more frequent"In this period revaccination began.Suggested early in the century,it was long neglected. Certain Germanstates first applied it to their armies"The most striking testof the possibilitiesof vaccination was made inthe war of 1870-71, and dependedlargely upon the far-sighted care ofthe German military authorities.Smallpox became so prevalent inFrance in the pi'eceding winter, thateffoi'ts were begun to combat it, butthe outbreak of the war not only preventedsuch action, but as usual causeda great increase of the diseasewhich rapidly extended over Europe.In Germany, v/here many prisoners ofwar carried the infection, the diseasewas widespread; but it was a strikingfact that the German soldiers were notonly less frequently and less severelyaffected than the French, but that theywere less affected than civilians of militaryage in the same towns. The onlydifference was that all the German soldiersunder arms at the outbreak ofthe war had been revaccinated withintwo years. The following figures showthe mortality of different classes atthat time: revaccinated 5%, once vaccinated14%, unvaccinated 45 7f. Thisobject lesson was not lost on the newlyformed German Empire. In 1874 thefirst law was passed providing for thevaccination of every child before thesecond year, and of all school childrenin the twelfth year. The result of theoperation was to be a matter of record,and failure to produce a satisfactoryvesicle necessitated a repetition. In thecivil population the mortality sankrapidly, so that in 1910 the deathsin the whole empire was only 33 (15being foreigners)."The woi'k from which the above isquoted was published in 1913.Cecil's Text-book of Medicine by 130American authors, published in 1927,has a chapter on vaccination by Prof.D. Murray Cowie. The last two paragraphsof his chapter show how littlesmallpox can be influenced by the bestmethods of sanitation and quarantine,and how completely it can be controlledby vaccination. They read asfollov/s"In no country since the discoveryof vaccination have as rigid sanitarymeasures been carried out as in England—notification,strict quarantine ofpatients and contacts, and careful disinfection.On the other hand, in Germanywhere more attention has beenpaid to vaccination and revaccination,the death rate from smallpox hasbeen much lower. From 1875 to 1905England and Wales had 8,342 deathscompared vv'ith 1,115 in Germany(Schamberg). Vaccination and revaccinationbecame compulsory by lawin Germany in 1874. Since that timesmallpox has ceased to be an epidemicdisease. Unquestionably, vaccinationand revaccination is the most importantmethod of stamping out the disease."General Leonard Wood records theexperience of two battalions (700 U. S.soldiers) in Holguin, Cuba, in 1898:'A large number of American soldiersunder a fair state of disciplinewas sent into a country infected withthe most virulent type of smallpox,where the death rate was heavy andall sanitary conditions were againstthem, and although living for monthsin towns infected with the most malignanttype of smallpox, to whichthey were constantly exposed, not asingle case occurred in the regiment'."

aJanuary, 1930 The Health Bulletin 23Yet, there are still some people whooppose smallpox vaccination! It isvery difficult to see why this shouldbe so. Two arguments are advancedin objecting to vaccination that arethoroughly fallacious. These are:1. That smallpox is now so mildthat vaccination is unnecessary,2. That vaccination itself is occasionallyfatal.Let us consider these supposed objectionsfor a moment.1. Any infectious disease that cannotspread fast usually becomes of amilder type. Smallpox is no exceptionto the rule. However, smallpox is gettingmilder only because vaccinationprevents its rapid spread. Experiencehas shov/n repeatedly that where vaccinationis neglected, smallpox beginsto spread more rapidly again and becomesas deadly as ever. Moreover,even where it is usually mild, somesevere and fatal cases are sure to exist.2. Vaccination is occasionally fatal,as is sewing with a needle, as prickingthe finger may be fatal. The riskis, however, so nearly absolute zeroas to be absolutely negligible—not for01 e moment to be compared with therisk of riding in an automobile. It isnot even to be compared to the risk ofgoing down one's steps at home—performance that kills or cripplessome people every year. Smallpox is aserious risk, on the other hand.If everyone were simultaneouslyvaccinated, smallpox could be literallywiped off the face of the earth,and the germ that causes it would becomeas extinct as the mastodon orthe saber-toothed tiger, and would neveragain plague mankind.Let's all get vaccinated!COLLEGE BLUESByKarl A. Menninger, M. D.Each year thousands of college studentsfall by the wayside. The wiseacreshave many explanations andvery little remedy. Too riiany studentsare going to college. The pace istoo fast. The ideals are wrong. Thefaculties are incompetent. The curriculaare inappropriate. Above all thereistoo much money and too much frivolityand too much social life. Collegestudents have much too good a time.The mental hygienist is somewhatout of sympathy with these explanations.He does not deny that some ofthem may be true but his pragmaticsense is offended by the futility ofgeneralization. His whole point ofview is individualistic. Leaving problemsof curriculum and world politicsaside, he is interested in what has puta particular John Smith and MaryBaker out of the running. The loss ofJohn Smith may mean little to thecollege; the loss of Mai-y Baker maynot greatly distress the world, butsome of these Johns and Marys areworth saving if any one is. The boyor girl who gets to college is one ina hundred. He is engaged in a periodof enormous importance to himself becauseit is his preparation for a specializedcontribution to the world. Forthe same reason it is a period ofenormous importance to the world.For the past ten years psychiatristshave been trying to make people understandthat mental hygiene is not amatter of preventing insanity. Psychiatristsare not particularly interestedin insanity any more. Of coursethe insane are numerous; in fact, theyquite outnumber the college students.But far more numerous are the unhealthyminded. By the unhealthy

24 The Health Bulletin January, 1930minded we mean the unadjusted, theunhappy. One of the Survey's contributorssome time ago wrote under thetitle, "The unhappy are alwayswrong." This is true. At any rate theunhappy are always in need of mentalhygiene, whether their unhappiness isconscious or not. There are lots ofmentally unhealthy people who are notunhappy but who ought to be. Thesetoo are included in the mental hygieneprogram of today.Mental hygiene aims at the prevention,the deflection one might say, ofhuman failure. If it is to be effectiveits efforts must begin months, if notyears, before the student flunks outof college, or has a nervous breakdownor shoots his room-mate or enters anasylum, or arrives at some othershocking and often irrevocable extremity.Consider for a moment what thecollege freshman faces. He leaves thehigh school to enter a college. Frombeing a senior with all that it means,he becomes a freshman with all thatit in turn implies. From town or countryhe may transport himself to acity, and to a very sophisticated andcomplex group within the city. Fromliving at home, with all the protectionand consideration which that includeshe enters a rooming house or fraternityhouse. Meanwhile he (or she) ischanging physically. The average collegefreshman is almost, but not quitean adult physically. This state of almostis very difficult, as every oneknows except those who have neverreached it. Then, too, there are acquaintancesto make of the same andof the opposite sex, and there are certainattitudes to be taken and certaingratifications to be sought and certainnew lines of inhibitions to be set upand certain old ones to be brokendown. There is practically a new spokenlanguage to learn and a new setof taboos and a more or less thoroughgoingrevision of aims and ideals.In addition to these general problemscollege students have a lot ofspecific problems about which the outsideworld knows nothing or which itjudges unsympathetically. There areproblems of athletic ambition and disappointment:the world hears only ofthe successes. There are problems ofGreek letter fraternities, both insideand out, which only one in close contactwith students can fully realize.There are problems of love affairsdealt with in the immature fashion tobe expected at this stage, but also withan intensity which the unsympatheticmay easily underestimate. There areproblems of jealousies and envies insideand outside of the family, conflictswith parents, special antipathiesto subjects and instructors, religiousproblems, curricular problems, physicalproblems real and imaginary, lifeworkproblems, racial problems, economicproblems; in fact all the problemsthe older people confront, plus agreat many more. Think of all thisfaced by a freshman student of onlyaverage intelligence, of average emo-Folks, please meet the New Sisterof oio- two old friends from Greensboro.

——January, 1930 The Health Bulletin 25tional control and average ability,the average American collegeator universityat the average age of eighteen.Surely it is not surprising thatsome of them have "adjustment difficulties"and are sent to the mentalhygiene counsellor or seek his helpvoluntarily. Survey Graphic.OUR LIVES SHORTER, NOT LONGERSo at least concludes C.H. Forsythof the Department of Mathematics atDartmouth College, from recent statisticalstudies, whose results he presentsin Science (New York). Theaverage lives of the young have beenincreased, but the old die earlier. Unlessadults can manage to live moresanely, it will be a losing fight for theelderly, he concludes, at least for sometime to come. Those who feel justifiedin predicting marvelous increases inthe average length of life have failedto appreciate, says Mr. Forsyth, thatpractically all reductions in the deathratehave been in children's diseases,and that little or no attention hasbeen given to ages beyond the primeof life. He finds that conditions in thiscountry at advanced ages have longbeen on the down grade, and that thegreat gains at early ages are alreadymore than offset by the losses at advancedages. In brief, the surprisingconclusion is that the average lengthof life in this country is now actuallydecreasing. Writes Mr. Forsyth:"The main results were obtainedfrom abridged mortality tables constructedfrom the statistics of themales of the ten original registrationStates—the new England States andIndiana, New Jersey, and New York—the only States which have suppliedsatisfactory records since 1900—and even 1890. The results for femalesare not given here, but presentthe same picture—in somewhat lesssmooth form."It will be understood, of course,that there is an average length of lifecorresponding to each age—the averagelength from that age on—althoughit is usually called the expectationof life in that case. In workingwith abridged mortality tables it isnecessary to omit the first few agessay, before the age of ten—for wellknownreasons, but the expectationat age ten is usually a rough approximationof the average length of thewhole of life."During the thirty years from 1890to 1920 the expectation of life at ageten—and therefore approximately theaverage length of life—increasedmarkedly. The results for 1920 proveda little disconcerting for a time, forthat year showed not only unexpectedimprovement at the early ages butalso fairly satisfactory conditions atadvanced ages. The abnormality ofthe year 1920 should have been appreciatedat that time, however, becausewe were just recovering from the'flu' of 1918, and the improvementcould have been easily explained as anatural reaction."Every one has been familiar withthe consistent improvement of conditionsat earlier ages, and some havebeen more or less aware of the situationat advanced ages, but there is noprinted evidence that any one was sufficientlyaware of the seriousness ofthe latter situation to propose thepertinent question of whether thelatter situation would ever develop tothe point where it would dominate. Inany case, the question is no longer pertinent—thedecline at advanced agesalready dominates, and the averagelength of life—or at least the expectationfrom age ten—is already goingdown. The curves for the years 1921to 1927 inclusive tell their own story.The expectation from age forty-fiveor fifty on is the lowest of which wehave any record—far lower than itwas even forty years ago—and it isstill going down, not up.death-rates previ-"The changes in

—26 The Health Bulletin January, 1930ous to thirty are not significant, andalthough it might well be argued thatlittle significant change could be expectedin a short period of only sevenyears, by the same logic the changesin the neighborhood of age seventy aretremendous."It is well to recognize that improvementat the early ages has arather definite limit, and that the declineat advanced ages has no appreciablelimit. It follows naturally thatwith all the improvement in the worldat the early ages the present downwardtrend at the advanced ages, ifunchecked, will continue to dominateand produce a greater and greater netdecline in the average length of life."The great decline at advanced agesis remarkably concentrated about ageseventy, although it extends as farback as age forty. To me, the wholepicture, from our earliest records in1890, to the present time, points consistentlyand inevitably to a future ofa declining average length of life untilthe American adult wakes up to thefact that the odds are at present heavilyagainst his living as long as hisfather or grandfather. Some will say—and no doubt truly—that it is all anatural consequence of the great driftto the cities. Others will go fartherand say life has become too fast andstrenuous, and that we do not knowas yet how to adjust ourselves to sucha life."To the medical authorities thewhole problem will loom as one of relievingthe strain upon the heart. Butlittle will be accomplished until theAmerican adult himself is duly informedand made to realize that he isin the midst of a decidedly losing fight,and that the situation will continueunless he applies himself energeticallyto be superior to his environment.Moreover, each adult must fight hisown individual battle, since he usuallybrooks no interference with his ownindividual mode of living. Medical authoritiesand scentists can be dependedupon to care for the children andtheir diseases, but they have little orno chance to interfere with the livesof adults."It truly looks as if it is going tobe a losing fight for some time tocome, for although some adults aremaking a commendable effort to livesane lives, the vast majority seem veryindifferent, and many give apparentlyno thought whatever to habitswhich they clearly know are bad, andwhich they know they could easilydiscard. There is surely no worse influencethan that wielded by wellmeaningauthorities who go aroundairing their ill-founded beliefs thatall is going fine and that before longeverybody is going to be living seventy-fiveto a hundred years." The LiteraryDigest.COMMON SENSE AND THE OPEN WINDOWByArnold H. Kegel, M. D.Commissioner of Health, ChicagoDo you sleep with your windowopen? Recent discoveries in the scienceof ventilation throw interesting sidelightson the ventilation of sleepingrooms and tend to modify to a considerableextent previous opinions andpractice.Less than a generation ago weheard a great deal about fresh air andfoul air. All outdoor air was labeled"fresh," for want of a better term,and air indoors was supposed to be"foul." These terms are fast disappearingfrom our literature. Flugge

I;dowsjabout. roomJanuary, 1930 The Health Bulletin 27of Breslau, Germany, and LeonardHill, of England, have shown conclusivelythat the bad effects in a poorlyventilated room, the headaches, andgeneral feelings of discomfort, are notdue to some ms^hical substance inthe air that renders it foul, but to anexcessive temperature, a high humidityor a combination of the two. Furthermore,we have learned that the airfrom out-of-doors is not always moredesirable than the air indoors. Thisis particularly true in Chicago andother large cities where the outdoorair is constantly contaminated, particularlyduring the winter months,with smoke, fog and dust from varioussources.Do you sleep better with your windowopen? Analyze and consider thisquestion without prejudice or preconceivedopinion. Suppose you have anorth room provided with an ordinarywooden sash double-hung windowwithout weather strips or a storm window.The weather is cold; Jack Frostflirting with the zero mark on thethermometer, and a moderate wind,say ten miles per hour comes from thenorth. The leakage of air into thebetween the sash and casementand between the upper and lower winwouldbe under these conditions60 cubic feet per minute withthe window closed. Now, an ordinaryadult requires for respiration aboutone-third of a cubic foot of air perminute. So, for the purpose of respiration,the leakage around a closedwindow will supply him with about180 times the amount of air necessary.But to promote circulation of air inthe room, and to ventilate in a satisfactorymanner hygienists have set astandard of from 25 to 30 cubic feetof air per minute for each person.This is a very liberal allowance. Witha leakage of 60 cubic feet per minutearound a closed window under the conditionsmentioned, we still have twicethe amount of air required to ventilatethe room when occupied by oneperson, or an ample supply for twopersons.Let it be clearly understood, however,that we are not advocating as ageneral proposition that Chicago's citizenssleep with the windows closed.We are only pointing out that in coldweather there is no necessity for openingthe windows to any considerableextent under the false impression thatthis practice is necessarily desirableirrespective of weather conditions.This practice does not indicate thebest of judgment on your part. Directdrafts, particularly when one isor healthful.By all means, sleep with the windowopen. Open it wide when theweather permits. But do not make afetish or a fad of open window ventilation.Do not boast to your friendsthat your window is always wide opensleeping,are productive of colds and tendto increase rather than decrease ourdeath rate during the winter seasonfrom influenza and other respiratorydiseases.There is much the medical professiondoes not know about colds, butthere is ample evidence that a simplecold is a local infection of themembrane lining the nose or throat.Quick changes in temperature, uncomfortabledrafts, or chilling of the bodyupset or disturb the control of bloodflow to these parts and favors thespread of infection. In this way asimple cold becomes severe as the infectedarea increases. If the infectioninvades the finer structure of thelungs, pneumonia may be the result.Rest in bed and a comfortable eventemperature are the best ways to treata cold and prevent serious complications.Use common sense in opening yourwindow. Young adults who are strongand robust may profit by the practice.This, however, is not necessarilyso of children, of the aged, and ofmany of all ages who are not particularlyrugged or are susceptible to coldsand drafts. And we strongly suspect

—j28 The Health Bulletin Janvury, 1980that even the robust sometimes enjoygood health in spite of the wide openwindow in cold weather rather thanbecause of it.Be comfortable with the windowopen. Physical comfort should invariablybe your rule governing sleepingroom ventilation. If you sleep betterand awaken refreshed with the windowopen a fraction of an inch, thatis the best condition for your individualrequirements. If you sleep betterwith the window wide open and thechilling drafts are pleasant ratherthan disagreeable, by all means openyour window wide. But do not throwopen your window in cold and inclementweather and retire with chatteringteeth and sleep with a blue noseand general discomfort under themistaken idea that it is healthful.A person may sleep in cold andwindy weather with the window closedwithout the slightest fear of bad resultsfrom a deficient air supply. Leakageabout and between the sash willsupply sufficient air for breathingpurposes. It is usually desirable, however,to have the window open to someextent; the reason for this is not toobtain more air, but rather to coolthe sleeping room to a comfortabletemperature and promote air circulation.This should be approximately 10°below that of the living rooms.One should understand that the importantconsiderations in maintaininghealthful conditions in the sleepingroom are a comfortable temperatureand clean air. In many parts of thecity, the outside air contains an excessiveamount of soot and dust.It isadvisable to use a cheese cloth screenbeneath the lower sash of the window.An ordinary fly screen can beeasily adapted for this purpose. Thewire screen is left in and covered witha piece of clean cheese cloth. Thisbreaks up the strong currents of airthat produce unwelcome direct drafts,and also filters out the greater portionof the soot and dust. Chicago HealthBulletin.IDOSERSByD. E. Ford, M. D.He poked his head around the edgeof the door and gazed hopefully intothe office. A strange presence pervadedthe room like a thin blue-greenfog."The Welfare Lady says will Dr.Ford cure me.""Working?""The fertilizer man says to keepaway 'till I'se cured."The pain is evident as he limps intothe room."Mah blood's bad," he explains ashe begins to unwind oozy rags fromhis legs.The stenographer has vanished.With the loosening of the drippingbindings slices of side-meat slide tothe floor revealing large and lusciousulcers up and down his shins. Perfectspecimens of ulcers—beautiful examplesfor a medical class.I don't blame the fish factory forcasting him out. But why pick on me!"How long have you been likethat?""Three months—maybe four; butthey want so bad then.""Three months ! You've let your legsrot like that for three months anddone nothing?" Stronger words mayhave slipped out.He straightens up; the worm isturning, indignant at the false chargeof neglect."I've done everything every one told

——January, 1930 The Health Bulletin 29me! I've put on collard leaves andvinegar, bread mash, fish meal, andkerosene oil. I got a black salve at adrug store, I've tried spider webs,turpentine and side meat. I've doneeverything anyone told me!"He leaves the horrid impression that—along with the side meat—someonetold him to come to me.He did everything every one toldhim!While the janitor is called to do theproper things to doors and furniture,the right things are done for the patient.He departs, leaving a specimenof blood and a lingering impressionof a strong personality. He is to letthe bandage alone and to return intwo days—unless someone, meanwhile,tells him different.He did everything everyone toldhim to do! Better men than he—andwomen—do the same. Oh! how weabuse our bodies and those of our children,doing what well-meaning somebodiesadvise!A tired feeling! A pain! Can'tsleep! Sleepy all the time! The babycries! The baby won't cry! Any conditionof body or mind. Free advicegathers around. Friend or strangereach has a sure-fire remedy. Free?Why they beg you to take it ! Read theglowing promises in the newspaperadvertising. Read the wonderful testimonalson the colored wrappers ofthe big bottles—testimonials that areoffered at so many dollars per hundrdfor any medicine manufacturerto buy.Free? The advice only is free. Whopays for the pages of advertising.for the quarts and pints in funnyshapedbottles on the druggist'sshelves and in the parcel post? Thedosers pay. The chronic dosers andhome remedy folks pay more everyyear for useless or harmful stuffthan all the hospitals in the countryreceive.Illness, simple and easily cured inthe beginning, grow by ignorant neglectand harmful dosing to seriousconditions. Finally someone trained tounderstand the body is called—a doctor'sadvice is sought.When you want a dress made doyou patch it together on every neighbor'sfree advice? No, you go to adressmaker, one whose business is toknow dresses. When you want yourhouse painted do you listen to the adviceof the colored delivery boy whosefather used some paint once? No, youget a skilled painter. When you arein jail, you hire a man trained in thelaw.But when you run a fever for daysor have a chronic headache or mostanything — you follow the advice, firstof anyone not trained to know thecauses of illness. If one recommendationdoesn't work another may betried until the sickness gets beyondendurance.Too often it is when strength isgone and pocket-book is flat, aftereverything freely advised—even to"side meat"—has failed, that skilledtrained advice is hired. And too oftenan immediate miraculous cure is expectedfor a condition which, thoughsimple at first, has progressed too farfor help. New Bern Times.OUR BACK COVER CARTOON THIS MONTHWe hear much discussion of thepresent tendency of the younger generationto indulge to excess, or seeminglyso to their parents, in the fastliving incident to the present day. Itis probable that just such apprehensionshave been expressed ever sincecivilization appeared on this earth.Seriously speaking, it does seem tothis writer that many of our finestyoung people are indulging to excessin such pleasures as dancing and cigarettesmoking, to mention no otherexcesses. Excessive smoking indulgedin by boys and girls in their teens isunquestionably detrimental to their

30 The Health Bulletin January, 1930health. Excessive indulgence in thepleasures of dancing, requiring muchloss of sleep,irregularities of varioussorts, to say nothing of the emotionalexcitement, means that young peopleindulging to excess are drawing fromtheir bank of health, resources thatthey will need in later years.The foregoing is merely introductoryto the statement that our cartoonthis month is drawTi by a talentedyoung man who is at present servinga term in the State's Prison. We knownothing of his guilt or innocence, butwe do know that he is in position atpresent to observe some of the disastersthat overtake young people wholose their balance and embark on acourse liable to end in disaster.HOW VERY TEW OF US DIEByWM. BRADY, M. D.Probably many readers know thatwhen I think anybody or anything iswrong I like to say so in print. Notso many know that I apply this policyto myself when I happen to be thewrong one, for now and then I havebeen wrong and I have acknowledgedit fi-eely and just as soon as I could.Met a man connected with the lifeinsurance business, and he seemedsurprised that I oppose a departure ofcertain insurance companies that isvariously called health conservation,longevity service, and the like. I toldhim that primarily I objected, as abuyer of insurance, to paying the additionalcost of such service; and secondarilyI do not believe all of thisadventuring by insurance companiesin other fields of work has any tangibleeffect on the health of theirpolicyholders.My friend came right back there.He assured me that the statistics wereavailable to prove that this health ormedical work by the insurance corporationactually lowers the cost ofinsurance to the public, to the individualbuyer. There he had me, for inall fairness I was compelled to replythat if I were convinced of that Ishould cease opposing these activitiesof insurance companies and become abooster for such practice. Insuranceof all kinds is a great boon and forcomfort and peace of mind while welive and the well being of our lovedones after we've passed along. I saywith all fervor "God bless the life insurancebusiness." In the same spiritI maintain that the use or administrationof funds in the insurance company'skeeping is a matter that is yourbusiness and mine, and up to the present,or until I met this man I refer to,I have felt quite positive that this adventuringin health, in public healthactivities, in what should be privatemedical practice matters, is an unjustifiablediversion of funds, and accordinglyI have opposed this fad ofcertain insurance companies whenevermy views or advice have been sought.Well my good friend saw to it thatthe cold figures were placed in myhands. They were impressive figures,too. The mortality rate, that is, thenumber of deaths, occurring amongeach thousand persons in the year, isgiven in a chart, first that of the populationof the country at large, andalongside it the rate among severalmillion policyholders of this particularcompany. It shows that the death rateamong the people at large was rather|lower than that of the policyholders iin every year from 1911 up to 1925.jIn 1925 the insurance company's rate

January, 1930 The Health Bulletin 31finally got down to that of the wholecountry, and in the past three yearsthe policyholders have been holdingout a little better than the people atlarge.At first glance such figures mightseem to justify the argument that thishealth work by the insurance companylowers the cost of insurance tothe buyer for of course the premiumrate on your insurance is determinedby the death claims the company hasto pay. But the figures must be interpretedwith the fact in mind that thepolicyholders are selected risks, andthe many applicants rejected as poorrisks must figure in the mortality rateof the population at large. These considerations,it seems to me, invalidatethe argument that thishealth adventuringby the insurance corporationlowers the cost of life insurance. Todraw that conclusion it would benecessary to ignore the effect of allpublic health and in fact all other activitiesor work than that done by theinsurance corporation. — EaleighTimes.AN ENCOURAGEMENTThe deathrate for tuberculosis duringthe first half of 1929 was unprecedentlylow for this part of any year.The rate for white policyholders wasonly 73.6 per 100,000. This marks adecline of 3.3 per cent over the recordfor January-June, 1928. There was,also, a 7.8 per cent drop for the coloredinsured. These new declines havetaken place despite the influenza outbreakwhich was responsible, duringthe first quarter, for hastening thedeaths of large numbers of tubercularpatients. It is now assured, almost beyondperadventure, that the end of1929 will see another new minimummortality figure for tuberculosis in theUnited States and Canada; and thatthis figure will be well below the formerlow point established only lastyear.Heart Disease Leads All The RestThe "Degenerative" DiseasesThe combined deathrate for thethree principal "degenerative" conditions(heart disease, chronic nephritisand cerebral hemorrhage) rose slightlyas compared with the first half oflast year. This was due entirely to anincrease for heart disease.Deathrates from Alcoholism, Cirrhosisof the Liver and Acute AlcoholicPoisoning Are All IncreasingAlcoholism, exclusive of acute poisoningby wood or denatured alcohol,was the reported cause of death of321 Metropolitan Industrial policyholdersduring the first six months of1929. This number corresponds to adeathrate of 3.4 per 100,000, andmarks an increase over the correspondingperiod of last year, whenthere were 284 deaths and a deathrateof 3.1.The deathrate from alcoholism continuesto run much higher in the industrialpopulation of the UnitedStates among Canadian wage-earners.This has always held true—both beforeand since National Prohibition.Of the 321 deaths from alcoholism, sofar this year, only six affected Canadianpolicyholders, who number approximatelyone and one-quarter millions.Since January 1, 1922, a periodof seven and one-half years, thereoccurred 3,818 deaths from alcoholismamong Metropolitan Industrial policyholders.Only 43 of these were deathsof Canadians.Six hundred and fifteen deaths werereported from cirrhosis of the liver,which is closely associated with alcoholism.The deathrate was 6.6 per100,000. During the like period of 1928there were 578 deaths, with a rate of6.3. Deaths from acute poisoning bywood or denatured alcohol are of littleimportance numerically, but have latelybeen showing a tendency to increase.—Fro?HStatistical Bulletin,Metropolitan Life Ins. Co. 1929.

ff^HE. YOUNGER GENERATION ARE SWIFTLY SENDING THEMSELVES TOAN EARLY GRAVE BY THEIR RIOTOUS LIVING,'^ SAYS NEWS tTEM.

• ^^'S^^p^sj^abqTnn.^°RmCAR9LI^A SWE.DPARDs^^E^Cm1 This Bunelir\wi];!be 5er\l free to arwj citizen of Ihe 5tcrteupoi\Teque5t. |Entered as second-class matter at postoffice at Raleigh, N. C, under Act of July 16,1894. Published monthly at the office of the Secretary of the Board, Raleigh. N. C.VOL. XLV FEBRUARY, 1930 NO. 2For a number of years we have been proclaiming the desirabilityof utilizing home-made equip^nent for playground exercises.Here at a two teacher school in Columbus county is a fine exampleof the practicability of such devices. This is called a walking ladder.Six year old girls as ivell as boys climb up these poles and wcilk bijtheir hands from one end to the other. As the photograph indicates,there is hardly any limit to the kind of exercises possible ivith sucha device.

DirectorMEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTHA. J. CROWELL, M.D., President CharlotUCYRUS THOMPSON, M.DJacksonvlllaTHOMAS E. ANDERSON, M.DStatesvilleE. J. TUCKER, D.D.S RoxboroD. A. STANTON, M.D High PointJAMES P. STOWE, Ph.G CharlotteJOHN B. WRIGHT, M.D RaleighL. E. McDANIEIj, M.D JacksonCHARLES C. ORR, M.D. AshevilleEXECUTIVE STAFFCHAS. O'H. L.AUGHINGHOUSE, M.D.,RONALD B. WILSON, Assistant to the Secretary.C. A. SHORE, M.D., Director State Laboratory of Hygiene.G. M. COOPER, M.D., Director Bureau of Health Education.H. E. MILLER, .C. E., Chief of Bureau of Engineering and Inspection.F. M. REGISTER, M.D., Director Bureau of Vital Statistics.H. A. TAYLOR, M.D., State Epidemiologist.GEORGE COLLINS, M.D., Director Bureau of Maternity and Infancy.C. N. SISK, M.D., Director of County Health Work.ERNEST A. BRANCH, D.D.S. , of Oral Hygiene.FREE HEALTH LITERATURESecretary and State Health Officer.The State Board of Health publishes monthly The Health Bulletin,which will be sent free to any citizen requesting it. The Board also hasavailable for distribution without charge special literature on the followingsubjects. Ask for any in which you may be interested.Adenoids and TonsilsCancerCatarrhCare of the BabyConstipationColdsClean-up PlacardsChickenpoxDiplithei-iaDon't Spit PlacardsEyesFliesFly PlacardsGerman MeaslesHookworm DiseaseInfantile ParalysisIndigestionInfluenzaMalariaMeaslesPellagraPublic Health LawsPrenatal CareSanitary PriviesScarlet FeverSmallpoxTeethTuberculosisTuberculosis PlacardsTyphoid FeverTyphoid PlacardsVeneral DiseasesWater SuppliesWhooping CoughSPECIAL LITERATURE ON MATERNITY AND INFANCYThe following special literature on the subjects listed below will besent free to any citizen of the State on request to the State Board ofHealth, Raleigh, N. C:Prenatal Care (by Mrs. Max West)Infant Care (by Mrs. Max West)Prenatal Letters (series of ninemonthly letters)Minimum Standards of Prenatal CareWhat Builds Babies?Breast FeedingSunlight for BabiesSave Your BabyHints to North Carolina Mothers WhoWant Better BabiesTable of Heights and WeiglitsThe Runabouts in the House of Health(pamphlet for children from 2 to 6years of age)Baby's daily Time Cards: Under 6months; 5 to 6 months; 7, 8, and 9months. 10, 11, and 12 months; 1year to 19 months; 19 months to 2years.Diet Lists: 9 to 12 months; 12 to 15months; 15 to 24 months; 2 to 3years; 3 to 6 years.Health Calendar 3An Old Story 4A Disappointed Child 6International Congress On MentalHygiene 7Asthma 8Starving In A Land As Fertile Asthe Nile ICCONTENTSPAGEPAGEPulling At Your Heartstrings 16Preventive Medicine As Applied ToThe Individual 21Out Of Date 23The Venereal Menace 24Immunization 28The Cost of Sickness 31How Is This For Milk Drinking.. 31Project About Diphtheria 13 Property Against Human Life. 32

VOL. XLV FEBRUARY, 1930 NO. 2HEALTH CALENDARFEBRUARYAs a rule, during nearly all theyear the climate of North Carolinais seldom too cold in winter to producemuch discomfort or suffering,and it is infrequent that the weatherin summer is too hot for a sufficientlength of time to produce illness asaresult.About the only month in the yearwhich affords any exception to theforegoing statement might be said tobe the month of February. In mostyears, although it is the shortestmonth, it generally has more disagreeableweather than any othermonth. For most of our people, whoenjoy outdoor life, certainly to someextent, during most of the year, thecold, disagreeable days of Februarysometime cause more indoor crowdingthan any other period in the year.This results in an undue prevalenceof the respiratory infeajtions. Peopleare crowded more in the stores,in street cars, and in their homes,and infection therefore is more easilyspread from person to person onaccount of the close contacts necessary.The records always result in arather high death rate from pneumoniaduring this month, and otherdiseases of like character. It is amonth generally fraught with moredanger than usual to old people, especiallythose who suffer to some extentfrom chronic ailments, such asbronchitis and so on. It is literallymid-winter for the children in theschools. Ventilation, and at the sametime a comfortable atmosphere, is alittle harder to maintain during thismonth than other months, thus makingrespiratorj? troubles more commoninthe schools.Another deficiency which everybodysuffers is from the scarcity of freshvegetables and fruits which are availablein more abundance during theother months. For those who arefinancially able to avail themselvesof the abundance of fresh stuff, importedfrom Florida and other placesin the far South, the deficiency isnot so acute, but as about half thepopulation of the State live on thefarms and are dependent on the productsof their own gardens and fieldsfor food, the deficiency is sufficientto result in temporary impairment ofhealth at least.These handicaps may be overcometo a certain extent by concerted efforton the part of every one responsible.A little more care may be directedtoward the heating plants andthe ventilation of school rooms. Thesame thing may be undertaken by thehouseholders in the homes, no matterwhat kind of a heating plant theremay be, whether open fire place orsteam heat; and a satisfactory effortmay be made to procure at least somefi-esh vegetables every day; and forthe old people a little extra care asto food, sleeping and clothing requirementsmay help considerably incoming through the month withoutany impairment of health.We cannot close this subject in

The Health Bulletin February, 1930any more satisfactory manner thanto return to our old slogan, namely,"A Garden for Health" for everyfamily in the State who can affordit.Doctor Henry Albert, State HealthCommissioner of Iowa, sends out thefollowing suggestions which he suggestsmight reduce the liability topneumonia and other respiratory infectionsto a minimum:"1. Avoid persons who have coughsor colds and are sneezing,2. Avoid use of glasses and disheswhich are not properly washed.3. Avoid visits to persons ill withcolds, influenza and pneumonia.4. Wash your hands before eatingand after caring for the sick.5. Dress warmly and avoid unnecessaryexposure.6. Do not use towels or handkerchiefsused by others.not7. Avoid a starvation diet but doover-eat.8. Sleep with the window in yourroom open but be warm.9. Keep the temperature of thehouse and office at not over 70°.10. Cover mouth and nose whencoughing or sneezing."AN OLD STORYIn one of the weekly papers ofNorth Carolina which comes to ourdesk we noticed the following item inone of them in its issue of the weekpreceding Christmas. Naturally weare not giving the name of the paper,nor of the parents of thethe county,child, because such items are constantlyoccurring here and there inevery county in the State. So thereis no good service to be performedby calling out the names of delinquentsof this nature, and it wouldonly serve to hurt the feelings of theparents. We would not mind hurtingthe feelings of the parents if wethought it would protect any of theirremaining children. However, if thephysician attending the sick child wasworthy of the name physician, hehas before now thoroughly impressedupon the parents in this particularinstance the importance of protectingevery remaining child againstdiphtheria. Following is the item:"The many friends of Mr. and Mrs.sympathize with them intheirsad bereavement caused by theGAL TWO—death of , one of their twins,which occurred December 12th atlittletheir home in . Whenwas taken sick they supposedit was a deep cold, but it was discoveredto be diphtheria. For nearlytwo weeks the doctor, the parentsand friends watched and worked withanxiety, but Thursday morning aboutthree o'clock she breathed her last.They dreaded to give up any one oftheir children, but it seemed to bemore sad to part the twins. She wastwo years, four months and fifteendays old."The foregoing is a poignant story,but it is a story that should have amoral for every physician and healthofficer and parent in this State thiscoming year, and that moral is thatevery child under six years of ageshould be protected against diphtheriaby being given three doses, hypodermically,of toxin-antitoxin, whichis the preventive vaccine againstdiphtheria. All children over six yearsshould have the Schick test, andif they are not immune to diphtheria,should receive three doses, whichwould be necessary to confer immunity.There is no longer any excuse forchildren having diphtheria in NorthCarolina. It does seem that the physicians,the health officers, and the parents,with the help of the newspapersin this State, could get this story

Fehruary, 1930The Health Bulletinacross to all the people having smallchildren who need this protection.This is the same old story that hasadorned the pages of weekly newspapersof North Carolina for many,many years. They first thought an attackof diphtheria was a' 'cold," whateverthat meant. They thereforeproceeded to rub on the neck andchest of the helpless little victim somedirty stinking salve, always kept instock in the medicine closet, or on themantelpiece of the poor folks, alwayspurchased at the drug store or grocerystore, and always recommendedfor colds, no matter what a cold mightmean. We have no idea that the practicewill cease until the millenniumis ushered in, and at that time thechildren will not need the assistance.As long as dividends must be forthcoming,and commercial interestsmounting into millions of dollars areconcerned, there will be plenty ofsalves of different kinds for sale forthe treatment of colds. Be it said tothe credit of some of these manufacturersthat they do have at the presenttime conscience enough to recommendon their package, their advertisingmatter, and on the labels ofthe bottle to send for a physician incases of suspected diphtheria orpneumonia. The question is, however.How may an ignorant parent be ableto distinguish the very early signsor dangers of diphtheria and pneumonia?This is especially true in thecountry districts where so many childrenlive a long distance from thenearest physician and where a visitof the physician costs money, and alot of it. To these people it is onlyhuman for them to trust and hopethat the application of the salve willsave the child'slife.Again the physicians have a moreimportant duty to perform in thisregard than any other class of people.The State laboratory and numerouscounty laboratories are availablefor the examination of swarbstaken from the throats in order toset up a definite diagnosis within areasonable length of time, but, evenat that, delay in the administrationof antitoxin is dangerous. The laboratoryreport only serves to confirmthe diagnosis of diphtheria, whichthe doctor may only have reason tosuspect, but the laboratory does furnishalmost totally free of charge afresh reliable product of diphtheriaantitoxin available to every physicianin North Carolina. So thereis no excuse for any delay in the administrationof antitoxin.But far more important to physicianand parent, and certainly to thechildren, is the fact that toxin-antitoxin,which is for practical purposesa preventive vaccine, and not to beconfused with the antitoxin, whichis a serum for the cure of the disease,is available to anybody in theState, free of charge. So it is onlynecessary to have every child immunizedagainst diphtheria in orderto protect from such tragedies as theforegoing item describes as occurringin a North Carolina county early inDecember.A -peanut ranch in the sontheastci-npart of the State. The stacks are peanutvines. It makes fine hay for cattle.

The Health Bulletin February, 1930A DISSAPOINTED CHILDDriving along a country road ineastern North Carolina the other daywe were witness xto a little occurrencewhich may happen any time, anywhere,and which, of course, in away, was trivial but at the same timemeant a great deal to this particularchild.We were driving along some fewhundred yards behind a rural mailcarrier. He had stopped at two orthree boxes and we were slowly approachinghim when he passed anothersmall residence close to the road,but which bore every mark of neatnessand stood out even to the casualpasser-by as an unusual littleroadside home. The carrier, not havingany mail for this particular boxat this house, naturally went on bywithout stopping. Coming along behindwe observed a little girl, somesix or eight years of age, who wasevidently watching with great anticipationfor the approach of themail carrier. After the carrier passedby, the child sorrowfully made herway to the mail box, and just as weapproached, removed a beautifulbunch of fall flowers from the boxwhich she had intended for the carrier.The look of disappointment on thechild's face and her very attitudecaused us to involuntarily stop ourcar and make the acquaintance of thelittle girl. We found that the child'sbaby brother had been ill for quite awhile and the carrier's services hadbeen requisitioned quite a number oftimes to bring medicines and so onfrom town. The family were tenantfarmers, living on a big farm belongingto an absentee landowner. Themother had been ill previously in thesummer, the prospects for a crop returnwere poor, the September stormhad greatly damaged the cotton andruined some of the later tobaccowhich had got wet, and altogether theWhile February may not he a goodmonth to take an outdoor sun-hathlike this Riitherfordton bahy is doing,it is a good time to try to getany hahy to practice this kind of exercise.The pose is most unusual andindicates a hahy of splendid healthand strong vitality.outlook was gloomy for the familythe coming winter. The father'shealth was none too good, and thecrop was fairly heavily mortgagedfor fertilizer and supplies typical ofthe condition of so many tenant farmersthroughout that particular section.The little girl reluctantly confidedthat the mail carrier had beenso good, and that they were unableto repay his kindness, that shethought that as the hollyhocks andthe half dozen or so of late dahlias,that the mother had put out in theyard early in the spring, looked sobeautiful that she just knew the mail

February, 1930The Health Bulletincarrier would appreciate a bouquet tocarry to his own family, which couldbe accepted as part pay for his kindness.Naturally the mail carrier was inblissful ignorance of any such intentionand cheerfully drove on, probablycongratulating himself that he couldpass one box without shifting hisgears and stopping, and thereforegetting back home just that manyseconds earlier. There could havebeen no doubt but that if he hadknown the surprise for him in themail box that morning that he wouldhave been only too glad to have stopped,and there would have been a finevisit all around.To us, or as it would have been toany other observing traveler, it wasonly an incidence of the day's routine;but the lesson it carries may beapplied by any reader to suit his orher own philosophy of lifeas it existsINTERNATIONAL CONGRESS ON MENTAL HYGIENEFirst in the World to Be Held at Washington, May 5 to 10, 1930On the above mentioned date therewill be held in Washington, D. C,one of the most important internationalmeetings to be held in the worldduring 1930. It has only been twentytwoyears since Clifford W. Beers,who is the Secretary-General of thisfirst great International Congress onMental Hygiene, organized at NewHaven, Connecticut, the first MentalHygiene Society in the world. Mr.Beers some months later, early in1909, organized the National Committeefor Mental Hygiene.Many of our readers will recall thatMr. Beers is the author of one ofthe most celebrated books ever published.The title of the book is "AMind That Found Itself." This bookhas been run through more than fifteeneditions in the last twentyyears. It is the most vivid exampleof constructive criticism the worldhas seen since the Sermon on theMount. "During the twenty yearsthat have since passed the peoplesof the world have become increasinglyconscious of the fundamental importanceof mental health and of thefact that mental health, like physicalhealth, may be preserved and enhancedby the giving of attention toknown procedures of prevention, cureand treatment."About twenty countries of the worldwill send delegates to this meeting,including such representative nationsas England, Germany, France,Japan, and others. The range of topicsto be discussed at this significantmeeting are as wide as the field ofhuman relations. The topics willrange all the way from such subjectsas the "magnitude of the mental hygieneproblem as a health problem"to such topics as "possibilities in thefuture of human rerlationships in thelight of an increasing knowledge ofthose factors that help and hinderthe emotional, physical and intellectualdevelopment of the individual."This meeting is sponsored by suchpeople as the President of the UnitedStates, the Surgeon General of theUnited States Public Health Service,the Commissioner of the UnitedStates Bureau of Education, Harvard,Yale, and Johns Hopkins Universities,the United States Departmentof Interior, and many other institutionsand organizations, includinga number of state boards ofhealth.In the preliminary announcementconcerning the meeting the followingsignificant statement to public healthofficers everywhere is made:"Public Health Does, and Must, In.elude Mental Health. The public cannotbe truly healthy unless and until

8 The Health Bulletin February, 1930mental health and its conservationare given deserved attention by publichealth authorities, private healthagencies, medical practitioners andprivate citizens. Man is more than aphysical organism. Good Health includesgood mental and emotionalhabits no less than good digestion,sound teeth and healthy lungs. Thepartly figurative, partly matter-offact,popular slogan: 'Public HealthIs Purchasable,' applies to mentalhealth no less than to physicalhealth."In conclusion, as an additional illustrationof the importance of themeeting, it has been announced thatthe transactions will be published infull in English, French, and German,the official languages of the Congress.Membership in this associationmay be had for five dollars, whichwill entitle the holder to a copy ofthe proceedings. Further informationmay be had by writing Mr. John R.Shillady, Administrative Secretary,370 Seventh Avenue, New York.ASTHMAIt is seldom that a day passes butwhat some person writes to the StateBoard of Health requesting informationon the subject of asthma. Notlong ago a writer in one of the largercities of eastern North Carolinawrote a letter making the usual requestand included some advertisingmatter sent out by a concern in NewYork state, which had free trialmethods and so on, as they put it,for the control of asthma. As thequestions of this writer includedmost of the questions usually askedwith reference to this subject, we areherewith quoting some of them togetherwith the substance of thereply of the Editor of the Bulletin.Following are some of the questions:"Please advise me how I may berelieved, or preferably cured, ofasthma. I have been troubled withit seriously for the past two years.I have been treated by a physician,but I do not get much relief. I seemto be getting worse as time goes on.The attacks are so severe that attimes I have to stay in bed for twoor three days. After the attacks Iam so weak frequently that I cannotget out of bed. Some people tell methat a change of climate will cure itothers tell me that a change of climatewill only give temporary relief.Should a change of climate in yourestimation be advisable, please tellme what place or locality you v/ouldrecommend. Do you think I could expectto be cured or only get temporaryrelief?"The following embraces the substanceof the answer to the foregoingrequest:People generally associate thedisease called asthma with variousconditions which physicians term asasthmatic. The two terms naturallyindicate different conditions. A personmay be asthmatic from manydifferent causes. The term asthmaought to be limited to the specificdisease itself, which is a periodic attackof bronchial spasm. There aresuch variations as cardiac asthma,caused by disease of the heart; renalasthma, relating to kidney diseases;and so on.True asthma is sometimes due toear, nose, or throat troubles, orchronic bronchitis. It frequently occurswith acute irritation of the membranesof the upper respiratory tract.This is the case when it is caused byirritation from pollen or dust particlesor drug irritants. Genuine asthmagives more trouble to the patientsuffering from it at night thanit does any other time. Sometimesthe suffering continues all night, andoccasionally an attack will last sever-

Fehruary, 1930The Health Bulletinal days, giving trouble day and night.Such is the case not infrequently inspite of all efforts at medical treatment.Even though the attack becontrolled with powerful drugs, insuch cases it recurs when the effectof the drug has worn off. Duringthe last few years the opinion hasbeen advanced in scientific circles thatnearly all types of true asthma aredue to some type of hypersensitivenessor anaphylaxis.The best thing for a patient sufferingfrom asthma to do is to havea thoroughly competent physiciancarry through a systematic examination.This should begin, of course,with the nose and throat and teeth.There should be an X-ray examinationin order to determine the conditionat the roots of the teeth as wellas the condition of the pituitaryglands and other such structures.The examination should include allthe structures of the body in order tolocate any source of absorption oftoxicmaterial from any other affectedareas, such as the gall-bladder,appendix, and so on. The dischargesfrom the nose and throat should beexamined, microscopically. The fecesand urine should be examined. Thereare several complete outfits ofmaterial on the market suitable formaking skin tests in order to locateany particular kind of food or bacterialprotein as well as pollens fromdifferent flowers which may causethe attacks. All of these testsshould be carefully applied. Thetruth is, the chronic sufferer fromasthma should receive about as thoroughand exhaustive examination asa patient could possibly be expectedto stand on account of trouble fromany disease or diseased condition.Careful and minute examination intothe diet of the person should be made.Frequently some item of diet is thesole cause of asthmatic attacks. Theexamination for the exciting cause,which may reside in the pollens orfood substances, is for the purpose offinding out what the physicians usedto commonly term the idiosyncrasy ofthe patient toward any of the suspectedcauses. Sometimes the feathersused in a pillow may containthe exciting cause.A story has recently been goingthe rounds in medical circles of ayoung man who lived in Washington,who had a pet parrot. He was devotedto his parrot, but he sufferedsuch agonizing attacks from asthmaat periodic intervals that in one ofthe attacks he was so sick that hisfamily moved him, carrying out anorder for change of climate, and hewas too sick to take the parrot along.Lo and behold, in forty-eight hoursafter he reached his destination, withthe parrot left behind, the attackceased, and he was soon as well as heever was. He remained well and allright until he returned home. Naturallyhe was glad to see the parrotand the parrot was glad to see him,when he got back home. Soonanother violent recurrence of the asthmafollowed. Finally suspicionwas directed at the parrot, with theresult that on permanent separationof the patient from his parrot nomore attacks of asthma occurred.Such occurrences are very common.Particles such as dandruff fromhorses sometimes cause violent attacks,and so on.It is probably true of no otherdisease as much so as asthma thatthe important thing of all things' todo is to locate the cause of the attack.When the cause is known it is genei"-ally easy to effect a cure; but unlessthe cause is definitely established anytreatment instituted is a haphazardproposition. If the cause is found toreside in chronic disease of the upperair passages, naturally it may bevery hard to eliminate the cause.In such cases only palliative treatment,tiding the patient over the peri-

10 The Health Bulletin February, 1930odic attacks, is about all that can beaccomplished.Hay fever and asthma are generallyregarded as being due to the samecause when the asthmatic attacks occuronly at certain periods of theyear, just as in the case of periodichay fever. The preventive treatmentunder such cases of both conditionsis the same—find the cause and removeit, or get away from it.For patients who cannot be curedpermanently physicians are preparedtoprescribe the best treatment possible,which, however, can only obtainthrough a careful study of each individualpatient by a competent doctor.We will leave it, however, to the physicianwho is called on to treat suchpatients to utilize his own treatmentafter he makes his own examination,because if we were to recommend atreatment as specific for one patientit might not work in the oppositedirection for another patient.STARVING IN A LAND AS FERTILE AS THE NILEAs a boy the Editor of the HealthBulletin spent many years on aNorth Carolina farm. Before he wastwelve years of age he had becomethoroughly impressed with the slipshodmethods prevailing in his communityamong the people, a majorityof whom failed to provide themselveswith the necessary food and feedstufffor their families and what little livestock they had. In those days NorthCarolina had what was known asopen range territory. The farmershad, as a rule, a few hogs, and a fewcattle—an exceptional one now andthen having some sheep, but that wasrare—and a few goats. The wholescrub outfit roamed the ranges forfood, especially in summer. In thespring the pigs were caught and amark put in their ears, so each farmerwould know his stock in the fall.The yearling cattle was treated inthe same way, and then when frostoccurred and the grazing becamelean, the hogs that the cholera hadnot killed and the cows that the tickshad not eaten up would straggle backto some of the farms. After someconfusion each farmer could locatehis own property, if such measly animalscould be called property. Thestock was then turned in the littlefields and fattened up, and thehogs utilized as meat for two oror three winter months. In the summerthe whole dependence would goback to western sow belly, shipped inby freight from Minnesota or Iowa.In addition to the little cotton, and insome instances tobacco, production,the farmers largely depended on tar,pitch, and turpentine for what littlemoney they had. The turpentine wasexchanged for flour, also from Minnesota;more western meat, and molassesfrom Louisiana, shipped in viaWilmington. The one saving featureof the whole enterprise was that gamewas rather plentiful, partridges,squirrels, and rabbits being availableany time in the year, and this affordeda little variation in the ordinarymonotonous diets. It is hardlynecessary to say that this regime wasnot depended on by the betterclass,or at least the financially better offclass, of farmers, but a large majorityof the small landowners and allof the tenants depended on such aschedule. In many of the plantationhomes year-round gardens, orchards,milk and butter, and the best of foodwas available, but such families wererather the exception.Our observation has been in recentyears that the situation along thisline has grown worse with time. TheState Board of Health, through itsvarious health department affiliationsin the different counties, andthrough the literature that it has been

—February, 19SO The Health Bulletin 11sending out for more than twentyyears, has constantly agitated forhealth reasons, if for no other, thenecessity of a garden and diversifiedfood for every family. Early in Decemberappeals were going out in differentsections of the State, especiallythe eastern part of North Carolina,literally begging for help for hundredsand even thousands of peoplemen, women, and children — facedwith literal starvation before anothercrop can rescue them. Thiswhole section from which these criesare arising in increasing volume isas fertile as the Valley of the Nilein its palmiest times. As much gardenand truck produce could be raisedin any one county in that sectionas the people of all the whole State ofNorth Carolina could consume annually,if only the efforts could bemade. It is a section where a yearroundgarden is possible, as provedby individuals here and there all overthe territory. It is one of the finestcountries in the United States forstock raising, especially for hogs. Theagriculture departments of the Stateand Federal Government have madepossible the raising of tick-free cattle.Hog cholera is no longer a menace,thanks to the activities of theanimal industry department of theState Government, and yet, owing toa fool policy of raising only so-calledmoney crops, these people face starvationyear after year when there isa failure of crops due to adverseweather or market conditions. Thiswriter regards the chief trouble asbeing a dog-eat-dog policy on thepart of the landlord and tenant alike,in which the landlord exacts the lastdrop of blood in the way of tobaccoand cotton acreage, and in which thetenant reciprocates by demanding allthe credit at the time store that hecan possibly get, each one gamblingat the expense of the other. If thelandlord would demand that his tenanthave chickens, hogs, and cattle,'i'.Bird houses made by the childrenin a two teacher school. The tree is"The Birds Christynas Tree." It haspop corn and suet on it. The childrenput it up just before Xmas, and doeach year. Sunken in the ground, atthe foot of the poles holding the birdhouses, is an old stove bottom forthe Birds Bath. All thesebird housesare occupied this year. It is a veryinteresting place. If you happen tobe traveling on Route 20 m the southeasternpart of the State, you maysee it from the highway in the groveof pines beside the schoolhouse.and a garden before a singleacre oftobacco or cotton should be planted,and then if he should demand in hiscontract with the tenant that thisgarden must be kept up the yearround, that the hogs and the cattlemust be cared for properly, and allthe supplies grown at home, therewould be fewer and fewer cries goingout to the general public forhelp.It is nothing short of a suicidal policywhich the Agricultural Depart-

12 The Health Bulletin February, 1930ment and the Health Departmenthave failed so far to prevent. Twentyyears ago we excused ourselves forthese delinquencies largely on theground that our population had beenso greatly infected with hookwormand malaria, especially our farmingand tenant population, that they wereunable physically to do the work necessaryto raise their food supplies andotherwise arrange an intelligent livingschedule for themselves. Beforethat period, and very properly, weattributed a large part of our delinquenciesto the devastating effectsof the Civil War. This was undoubtedlytrue. The best blood in the Statewas left on the battle field, and thewidows and orphans of these fightingmen were not only left to procurefood under the most adverse circumstances,but the whole section hadto fight an economic policy, saddledupon us by the victorious North,which it took fully a generation toovercome. This writer would be thelast to blame the acute sufferers ofthe Civil War for apparent shortcomingsin anything. He would alsobe slow to blame the poorer class ofthe population afflicted with hookwormand malaria for so many years,but there is no excuse now-a-daysfor any human being having hookwormor malaria. Safeguards areprovided for every individual, freeof charge, who cares toavail himselfof the protection offered by healthagencies in North Carolina. So itseems to us that it comes down nowto a matter of sheer laziness and selfishnessand indifference to the needsof our own families, and our owncommunities.If we are ever to shake off thesituation as now exists it is time webegin. The month of February hasalways been the period in this Statefor starting a garden. There is no bettertime than right now to go out andstake off and plow up a garden platsufficient to afford all the vegetablesThis particular bird hoitse has fourrooms. It was made by a small boyivhose father told him he tvould givehim five dollars for every bird whobuilt a nest in it. When the schoolnurse was there the teacher told hereach room was occupied; but thefather had not paid. He had no ideathe birds would use it when he saidthis.necessary for the whole family fromnow to the thirty-first day of December.There is no better time thannow to procure a good milk cow andto feed and care for that cow,and toproduce enough milk and butter forthe entire family to the end of theyear. There is also no better timethan now to start a bunch of pigs onthe road to pork for the Decembersmokehouse. When these things aredone, it will be ample time to lay offthe acreage perhaps for tobacco andcotton. Then if the Agricultural Departmentwarnings are listened to,and if the acreage in either is notexcessive, and if the protection whichmodern science affords against the

February, 1930 The Health Bulletin 13boll weevil is practiced, regardless ofweather, rains, or doughts, a faircrop may be expected, and if livingsupplies are produced, and not boughtat a credit store, there may be somemoney for the family next December.However, if there is little or no moneyforthcoming, if the family has milk,butter, eggs, chickens, and pork, togetherwith all kind of vegetablesraised in the garden, there will beno appeals to the public to feed thestarving people in the garden spot ofthe United States next December,PROJECT ABOUT DIPHTHERIA AT THE NORTHCAROLINA COLLEGE FOR WOMENDivision of Hygiene Puts on Interesting Study About DiphtheriaPreventionThe Division of Hj^giene in theNorth Carolina College for Womenat Greensboro, headed by Dr. AnnieO'Donnell, several months ago decidedto cooperate with the State Boardof Health in its efforts to spread theknowledge about diphtheria controlto as many people in the State aspossible. In order to help in a practicalway. Dr. O'Donnell decided tocarry on some special studies in herclasses in the Division of Hygienewith especial reference to the preventionof diphtheria among the familiesand friends of the students inher classes. As these students comefrom practically every county of theState, it may be readily seen that theidea is a practical one.Doctor O'Donnell has submitted tous four of the best letters receivedduring this project and we are gladto publish them below. All of the lettersare very interesting. All of themhave some nice stories to tell theirlittle friends to whom they are writing,and all of them are short andto the point. Such efforts as this willaid greatly in the dissemination ofknowledge about the prevention ofdiphtheria, and hasten the time whenthe disease will be a matter of historyin this State. We are first publishinga short descriptive sketch of Dr. O'-Donnell describing the methods adoptedin undertaking the study in herclass. Following is the statement byDr. O'Donnell describing the project:"As the North Carolina StateBoard of Health is putting on a campaignto have all pre-school childrenin the state immunized against diphtheriabefore the end of the year itwas decided to have the students inthe Hygiene II classes at N. C. C. W.help by a project which will be described."Each student was asked to writea letter to some child in her familyor to a friend between the ages ofone and five years explaining whatthe toxin-antitoxin meant in such away that it would appeal to the child.Also, to give the parents the informationneeded, and the incentive tohave their children given the inoculationsrequired for immunization.These letters were carefully read bythe members of the department, andthose which follow were the ones selectedas the best of their particulartype of the more than four hundredwritten and mailed to that number ofchildren in the state. In each letterthere was enclosed a TRAIN TICKETTO NO-DIPHTHERIA-TOWN whichhad been generously supplied to usby the Metropolitan Life InsuranceCompany."Before the end of the college yearreplies to several letters had been receivedstating that the children hadalready taken their first inoculation.Some of these tickets when completed

to—14 The Health Bulletin February, 1930will be delivered to the local Parent-Teachers organization."Following are the letters written bythe four members of the class, publishedexactly as they wrote them:"Dear Welbon:"I'm sending you something. It's aticket for you to take a trip on. I'mgoing to tell you about that trip, butfirst I want to tell you somethingelse."Once when I was a little girlabout five years old, I was sick. O!very sick. The doctor came and lookedat me and looked at my throat,and said I had diphtheria. When youhave diphtheria it's because a germ,a little thing not as big as the tiniestlittle black speck you ever saw getsinto your nose or your throat andmakes it sore. Then it hurts, and itgets worse and worse. It's all becauseof that little germ. Mother saidI had to get the germ from somebodyelse, and that she knew I hadn'tbeen near anybody that had diphtheria.The funny thing is thatthough you can get a germ fromsome people that don't even have thedisease, and are not even sick. Theyjust carry germs around in theirthroats and give them to little boysand girls by sneezing or coughing oranything like that. I s'pose I got mygerm from somebody like that. Aboutthree days after I got sick, my twinsister, you know, she is just as oldas I am, got sick too, and the doctorsaid she had diphtheria. Nobody elsein our house took the diphtheria, butmy sister and I were very sick for along time. When we got well shecouldn't talk. Honest, she couldn't sayone word. We were all so sorry, butwe didn't know what to do. But notlong after that Daddy took us to Augustato a big doctor, and he madeLily talk, and O! how glad we were."The best thing is that now thedoctors have found something thatthey call toxin-antitoxin. They giveit to little boys and girls three times,and thenthen, they won't ever havediphtheria, if that old germ does getin their throat! Isn't that fine? That'sjust what I want you to do with thisticket I'm sending you. Get yourmother to read you about what is onthe ticket, and take this trip andthen you won't ever, ever have olddiphtheria. Up here at school 'we'resending a ticket to lots of boys andgirls everywhere so they can take atrip, and afterwards never have diphtheria.Don't you want to go? Hooray,for the big trip!Best wishes.Cliff Dolvin.""Dear Margaret Rae:"Aren't yo-j surprised to hear fromme? You sec, I have some special newsto toll "'c that . I thought I should•wr you right now, and not waitto ! you this summer."Dj you remember the times I usedto tell you and Jack and Johnnie andWalter Bright about Brer Rabbit andthe Tar Baby? Well, I have justlearned a new story, but this one isno fairy story. It is about a littlebug, called a germ, which gets in littlechildren's throats and makes themsick. The other day in Hygiene classI studied about this bad little bug,and my teacher gave me a ticket toNo-Diphtheria-Land and told me tosend it to some little boy or girlwhom I knew. Of course, I wantedto send mine to you, and that is whatI am doing right now."This ticket to No-Diphtheria-Landwill take you on a nice trip, and willkeep this bad little bug away fromyou. You should take this ticket to adoctor and he will just put sometoxin-antitoxin in your arm. That isan awfully big word, but it isn't halfas bad as it sounds. You go to thedoctor three times, and then afterabout six months you have a littletest, called the Schick test; and nofooling, Margaret Rae, you will neverrun into that bad little bug."I think this is a good plan, and I

February, 1930 The Health Bulletin 15know that you will think it is, too.When I come home this summer Iwant you to tell me if you have usedthis ticket. And you will have to hurrybecause I'll soon be home. Will yoube glad to see me? I'll be glad tosee you."Here's hoping you have a grandtime on your trip to No-Diphtheria-Land.Lovingly,"Dear BettyFrances:Florence.""As a project of the Hygiene class,each girl is writing a letter to somelittle child between the age of oneand six about the disease, diphtheria.I thought I would send my letter tothe little girl I like best."We are trying to keep little girlsand boys of your and Dickie's agefrom having diphtheria. This diseaseis dangerous at your age, and thatis when most people have it. I wantyou to be able to say that you arehelping the N. C. College Hygieneclass to fight against it. If you havenot already taken the toxin-antitoxin,I want you to take it, for it keepspeople from taking the disease. Tellyour little friends about this awfuldisease and perhaps they will followyour example, and take the treatment.If every little girl and boy were totake the toxin-antitoxin there wouldnotbe any more diphtheria."I am sending you a ticket whichenables you to get the toxin-antitoxin.Don't let it go to waste. Ifyou have already had the treatmentgive it to Dickie or to one of yourlittle playmates for it may keep someone from having diphtheria. Now, Iam expecting you to help fightagainst this disease.Yours sincerely,Elizabeth.""Dear Tommy:"How would you like to go on anice trip? I believe you'd like it so Iam sending you a ticket for one. Youcan get mother to read it to you, andyou can start just as soon as she'lltake you to the starting place. Youmust tell her how much you want togo and then I'm sure she'll let you.This trip is to No-Diphtheria-Town,and you travel to it by the road ofToxin-Antitoxin. Some of these wordsare pretty long for a five year oldboy, so I'll try to explain them."First of all diphtheria is somethingthat makes you sick. I knowyou don't like that because whenyou're sick you can't play or do anythingbut stay in bed and hurt. So,of course, you don't want diphtheria.It's caused by germs and they're sosmall that you could put a thousandof them on one of your freckles, andthey wouldn't even cover it. Of course,if they're that tiny, you can see thatyou can't just swat them like youwould a fly or a mosquito. You haveto fight them some other way, andthat's what Toxin-Antitoxin is for."You remember sticking one ofmother's needles in your finger 'once,don't you? You were very brave anddidn't even cry. You tried to tell usthat it didn't hurt much—remember?Well, when you take the Toxin-Antitoxinit's a lot like that. It only hurtsa little and that's over so quickly thatyou don'teven mind. The Schick testis like that too. It's just to see ifyou're liable to have diphtheria atall, and maybe after you take it, youwon't even have to take the other. Buteven if you do, I know you won'tmind because you are such a braveboy. It will be an adventure likemother reads you in your story books,and you will be the hero on a voyageto No-Diphtheria-Town! Doesn't itsound nice? You must get mother towrite and tell me when you start onyour trip. I shall be waiting for newsof you!Your friend,Louise."

16 The Health Bulletin February, 1930PULLING

suspicious.February, 1930 The Health Bulletin 17ded her head in agreement, lookingat Mary fondly over the top of herglasses:"You, big old girl, Mary, you'renot trying to say I didn't give youthe proper chance?""No," Mary laughed. "I've alwaysbeen healthy enough, and so haveyou, Mother. Even Louise has hadgood health all through six pregnanciesand childbirths in thirteenyears. It's the health of the thirdgeneration in this family I'm worryingabout. If Louise and Walter don'ttake better care of those youngstersof theirs there won't be one of themthat will be able to do the work thegrown-up members of the family aredoing now, if they live to be grownupmen and women.""I'm worried about the children,too, Mary," Mrs. Parker said slowly."I offered to bring Bud and Lorisout here for awhile until the babystops causing Louise so much trouble,but she wouldn't hear of it. SaidWalter wouldn't like the children tobe out here."Mary's eyes fell down to the headlinesof the evening paper:"CHILDREN'S HEALTH CLINICSCONDUCTED BY HEALTH DEPT.ARE WELL ATTENDED IN CITY"She read slowly; then the smallerdeck:"News Reporter Visits HealthDepartment Clinic ThisMorning; Secures InterestingStoryTHREE CLINICS IN THE CITY"From the article Mary learned thatthe clinics were for children fromthe age of birth to twelve years. Theywere conducted from 9 until 12 threedays a week, Monday, Wednesday andFriday at three centers in the city.Mary made a note of the days, thehours, and the clinic that was nearesther home. If she could not getLouise to take the children to theclinic she was going to take them herself.The city was trying to do its shareto give its youngsters a square healthdeal. It was most certainly up to thefathers and mothers, and if not thefathers and mothers, old maid auntsto see that the children had an opportunityto get all that was comingto them from the city.The next morning at the printeryWalter was very sweet to Mary. Sosweet that she grew . Beforethe day was done her suspicionswere justified. Walter asked her toloan him $150 to have the childrenexamined, and their tonsils taken out,he explained.Mary was more suspicious nowthan she had been before. Walter explainedwhat he wished the moneyfor. He was not accustomed to thinkingof his children's health conditions.He must be planning to usethe money for some other purpose,covering his real motive in trying toborrow the money with the children."What doctor are you going tohave make the examinations?" Maryqueried."Uh-ah-er, —Doctor—!" Walterfloundered."Walter, you don't want to takethe children to the doctor. You wantthe money for something else. Maryfaced her brother-in-law squarely.""Nice aunt, you are, not to helpyour own little nieces and nephews!"Walter sneered."I'm willing to help all that isneeded, but I'm not satisfied to giveyou money to spend for everythingbut the children. Have what medicalattention for the children is needed,and when the doctor presents the billI'll help you pay it, but I won't giveyou a cent, Walter.""That's all I want to know aboutyou," Walter sulked.Before the day was over Maryfound that Walter wanted the money

18 The Health Bulletin February, 1930to make a first payment on a car,and not for the children at all. Louisewas as anxious for the car as hewas. They were more interested in anew car than they were their children'shealth."Mother, we'll have to fix up thechildren and take them to one of thehealth clinics I was reading aboutlast night," Mary said, when theirnext-door neighbor stopped tellingof Walter's and Louise's visit to hisautomobile agency for a car that day."Tomorrow is the day for the nextclinic, 9 to 11, at the Wylie school,"Mrs. Parker consulted the day-oldpaper."All right, mother, I'll telephonethe manager in the morning that I'llbe out for half a day. The childrenwon't be in school, because Louise andWalter have not entered them yet.We'll take the car, go down, bundlethem all in, and take them along.We'll carry Louise if she'll go. Ifshe won't we'll take the children withouther."The nurse at the Wylie school, cityhealth clinic, next morning lookeddown a row of five youngsters and ababy in arms, that were brought toher desk by a determined looking,youngish woman, who might or mightnot be their mother, and an olderwoman who must be their grandmother.They had never been to the clinicbefore the nurse was sure. She tookout the registry cards, and began takingthe children's histories immediately.The youngish looking womanwas not the children's mother shesoon learned.In the children's histories she securedtheir names, fathers and mother'sname; date of birth, weight atbirth, whether or not the child hadcome to normal birth at nine months,who the physician was that attendedthe mother and each of the six children;the pre-nantal care of the children'smother before each child wasborn. Then there were questions asto how the baby got along after arrival,and others covering their schoolrecords.What Mrs. Parker did not knowabout her daughter's children, Maryapparently did, and the questionswere all answered satisfactorily.After the children had been carefullyregistered, given a numberand a card upon which progress wasto be noted at future clinics, theywere all weighed and measured. Thenwrapped in sheets they waited thecoming of the doctor for a physicalexamination.The physician in charge of theclinic. Dr. Harold George, examinedwith hisstethoscope each of the children'slungs, heart and general interior.He examined each child's tummy,and satisfied with the young per-A honieiimde trapeze and a littlenative acrobat perforfuing in a southeasternNorth Carolina rural school.

Febrv-ary, 1930 The Health Bulletin 19son's interior, he turned it over tosee how things were progressing inthe posterior regions of the futurecitizen by the name of Winton.With the aid of a flashlight eachchild's mouth, throat, and the conditionof hair, scalp and ears werecarefully looked in to.Mary and her mother stood by interestedonlookers as the doctor wentabout the examining of the six children."The mother of these childrenshould be here," he said when theexaminations of the six were completed."I can tell you two womenwhat is wrong with the children,and what should be done, but themother will be responsible for carryingout my instructions.""Tell Mother and I what shouldbe done," Mary spoke quickly. "Weare going to see that these childrenhave the right kind of health chance.""You mean you are going to takecare of the children yourselves?" thedoctor asked."Yes, until Walter and Louiselearn that children aren't to be treatedlike little pigs, but as young humans,future citizens.""Well, I'd like to see more auntsand grandmothers of children whoaren't getting the proper healthbreaks take the stand you and yourmother are," the doctor said, as herescued his stethoscope from Bud,who was finding it a most interestingplaything.The report the nurse gave Maryand her mother as they were preparingto leave the clinic showed thatBlanche, 11, was underweight, pronouncedlyso. She should be watched,the nurse said, for any possiblesymptoms of childhood tuberculosis.Junior, 10, had bad tonsils. Hisweight was not noi'mal, but he wasnot as much underweight as Blanchewas. He needed a tonsil operation atonce, as he had recently had an abscesson the left tonsil.Lucile, 8, had definite symptomsof a bad heart. Her weight was alsonot what it should be. She neededrest, quiet, cleanliness and good food.The teeth of Loris, 7, were herworst trouble. They needed the attentionof a good dentist, badly, andLoris should be introduced to a toothbrushand taught how to use itwithout delay. Loris was not the onlyonly of the children whose mouthneeded the services of a toothbrushand a good dentrifice, but she wasthe one of the children whose teethhad suffered most from a lack ofdental care and mouth cleanliness.More nourishing food, bath andclean, comfortable clothes were Bud'sneeds.Marian, the baby, 9 months, neededspinach, orange juice, and lacticacid milk fed in clean vessels at regularhours.The proper care of children wassimple, the nurse and doctor bothstated. The main thing was to knowthe simple fundamental principles forthe proper care of children, and thencarry these principles out every hourof every day from the birth of thechild until it became an adult manor woman, no longer under the careof the father and mother.A typewritten sheet with five simple,but indispensable rules for thehealth and happiness of children wasgiven Mary and Mrs. Parker beforethey left the clinic.These were the five rules:1. Cleanliness, plenty of soap, water,baths, and thrice daily brushingsforteeth.2. Fresh air, sunshine, clean, airysurroundings in the home and atplay.3. Warm, comfortable clothes forwinter.4. Cleanliness, and not too manyclothes for summer.5. Nourishing food at regularhours, cereals, vegetables, milk, fruit."Freedom from preventable dis-

20 The Health Bulletin February, 1930eases, medical care, and the remedyingof defects are due every child"was printed beneath the five rules inbig black letters.And immediately under that:"Every child has a right to asquare health deal from its parents.If its parents won't give it to himit is up to the state or the municipalityto see that it has it."Six, clean, happy, well-fed youngsterswent to bed in the two sparerooms at the Parker home that night.Walter had not been at work inthe afternoon when Mary reportedfor duty at the printery, and callsat the Winton apartment until thechildren were all put to bed at ninewere met with central's 'Sorry," but42-J does not answer."Finally Mary and Mrs. Parkerstopped worrying about whether Walterand Louise knew where the childrenwere. The children did not worryat all. It was one of the few timeswhen they had all been at theirgrandmother's, and the excitement ofthe visit and the good things shegave them to eat, would either ofthem have banished all worry fromtheir childish heads."Gee!" Junior said, as he ate hissecond piece of apple pie, "I'll soonbe big enough to beat Himmie Jonesif I eat this much every night."The Winton children were beginningto get a fair break—a realchance, and they did not pull Mary'sheart strings in quite the way theyhad.Saturday morning Walter was atwork. He did not mind at all thatthe children had spent the night withMary and his mother-in-law. Indeed,he said that he and Louise had expectedthat, and had gone off to adance in a car a friend had loanedthem, because they did not have tobother with the children."Wish you'd keep them over Sunday,"Walter suggested casually."Louise and I want to go to themovies tonight, and it's no fun todrag a bunch of kids along.""How would you like Mother and Ito keep the children?" Mary lookedat her brother-in-law, questioningly."Keep them? Why you can't dothat? They're my children, mine andLouise's.""Yes, they're your children, allright," Mary admitted Walter'spoint, "but you and Louise are darnedpoor parents. Mother and I have decidedto keep the children until youand Louise get a more suitable placefor them than that four-room flat,and until you learn what it reallymeans to be the parents of six children.""Parents of six children!" Walterlooked at Mary in disdain. "Whatdo you know of being a father ormother. If you feel that way aboutit I'll bring the children home today."Walter strode angrily to the door.Mary stepped determinedly in frontof him. "Those children are going tostay with mother and myself untilyou and Louise turn over a new leafin the book of being parents.""We'll see about that!" Walterthrust Mary aside, and strode on outof the printery.The Winton children did stay willitheir grandmother Parker and theirAunt Mary until their father andmother had made better preparationsfor their care.At the dance Louise attended thefirst Friday night the children spentaway from home she developed acold that soon became a serious caseof pneumonia, and Mary had to hirea private nurse to care for her, becauseshe could not leave her workto care for her sister, herself.During Louise's illness and convalescenceshe had time—for the firsttime since Blanche had been borneleven and one-half years before tomiss her children, and to realize whatthey meant to her and to Walter.Allowed up and around the apart-

February, 1930 The Health Bulletin 21ment Louise missed the children morethan she had while ill in bed. Thethirdday she was up she had a longtalk with Walter, one of the mostserious talks they had had in theirthirteen years of married life, andthe next day, with the doctor's permission,Louise and Walter wentlooking for a house. A house thatwas not too close in town, withsunny, airy rooms, a garden wherevegetables could be raised, and chickenskept to help supplement Walter'spay envelope in providing food forthe six young mouths, and enoughplayground for the children, so itwould not be necessary for them toplay on the sidewalks, and in thestreet.The house was found, at a figurenot much higher than that they werepaying for the four-rom apartment.The furniture from the apartmentmoved in to the new house, and somegood, substantial pieces bought second-handfurnished the new homecomfortably.Mary and Mrs. Parker were askedout to inspect the new house, and thenext day the six children went reluctantlyback to their parents."You've taught me a lesson, Mary,"Louise said as her sister kissedBlanche and Loris goodbye. "I'm goingto take such good care of thechildren now, be such a good motherto them, they will never want to leaveme again to see anyone, not even youand mother."PREVENTIVE MEDICINE AS APPPLIED TO THEINDIVIDUALByThomas A. Mann, M. D.kPresent knowledge of medicalscience and its application to the bodypolitic are not coextensive. The averagelength of human life is nowabout fifty-six years. If all the peoplecould receive the benefits of modernmedical knowledge it is safe tosay the average length of life wouldbe at least seventy years. To addfourteen years to the average lifelimit would mean an economic savingof so many billion dollars thatit is hard to estimate. Changes inthe application of medical science areslow and are marked by the oppositionof those who like to follow thebeaten paths. Knowledge of diseaseprevention, however, is bound to beone of the biggest factors in leadingto a more economic application ofmedicine.We may classify medicine thus:1st Research medicine; 2nd Curativemedicine; 3rd Preventive medicine.The first two we shall not discuss.Preventive medicine can be dividedinto two distinct fields. The firstdeals with community measures andis controlled by our health departments,national, state and local.These departments are efficient inproportion to public financial supportand to the standard of the personnels.The second field deals with the individualand the medical professionand at the present time must be appliedprincipally on the same financialplan as curative medicine. Its valuedepends on the efficiency of the specialistin preventive measures andcooperation on the part of the public.Medicine is gradually evolvinginto a system whereby the individualwill be advised before he becomes incapacitatedby sickness. The wise

22 The Health Bulletin February, 1930father and mother will soon carrytheir children to the specialist whowill not only immunize them againstsuch diseases as typhoid fever, diphtheria,whooping cough, and scarletfever, but who will through periodicexaminations and frequent inspectionskeep tab on their physical conditionand have teeth, tonsils and adenoidsor any physical defect remediedbefore serious damage is done. Thespecialist will be a nutrition expertand will advise concerning the children'sdiet and exercise.While the physical mechanismseems to be very adaptable in extractingand assimulating its food requisites,there is no doubt that thenearer one approaches the scientificallybalanced diet the more vigorouswill be his state of health. Theexcretory organs are spared unduelabor, resistance to disease isincreasedand the outcome is a longer,healthierlife.Not only will parents seek adviceto prevent sickness among their childrenand try to furnish condition underwhich they may develop and leadto a vigorous state of health. Theworking man and woman will bechecked periodically to see if the kidneys,heart, arteries and lungs arefunctioning properly.Many serious conditions affectingthe human organism are in their incipiencyso trivial and seemingly sounimportant that consulting a physicianwould not be deemed necessary.Progress of the disease, however,is slow but sure and where aidis finally sought it is too late to save.Cancer is at present such a conditionand in dealing with it we are remindedof the old quotation, "The millsof the gods grind slowly but theygrind exceedingly fine."Of course we can not dream of theday when the clinician will not beneeded, and our medical colleges willcontinue to turn out medical doctors,but there will be more and more at-A close up of a baby long leaf pinem southeastern North Carolina.tention paid to preventive measuresand among the specialists we willsoon find the practitioner of preventivemedicine.So much is now known about thevalue of prenatal care and the valueof proper diet and regulation of lifefor the prospective mother that womenin all walks of life will soon putthemselves in the hands of the professionaladviser so their offspringwill have the best chance to be bornin the most vigorous state of physicalperfection. After birth the lifeof both mother and child will becarefully supervised to prevent sickness.A word of caution in regard to theconsultant may be advisable here.Not every person with a "doctor"attached to his name is well qualifiedto advise concerning the preventionof disease. Special study is requiredto be able to advise as to

February, 1930 The Health Bulletin 23energy value and quantitj^ of foodto be taken. Skill in detecting dangersignals in physical defects and abilityto supervise muscular exerciseare all necessary. "While many medicalmen are prepared to give excellentadvice both in clinical and preventivemedicine there are some whoThe mistrial in the Gastonia casecaused by the mental breakdown ofone of the jurors is a glaring exampleof the dismal inadequacy of the Americansystem of criminal justice andthe failure of the law to keep up withsocial progress. It goes far to bearout Dean Roscoe Pound's theory regardingthe anachronistic characterof the American law structure as afactor in explanation of this inadequacy.He said cogently at a recentconvention of psychiatrists, "Manythings in law depend on the way thosewho framed the laws and those forwhom they were framed were raised.When those for whom they wereframed were raised in one way andthose to whom in the later generationsthey must be applied were raisedin another, we are on the way toone of the crises which mark thecourse of legal history."The Charlotte episode, reflectingon our methods of selecting juries, illustratespointedly the truth of thisstatement. The jury system in itspresent form may have answered thepurpose of justice in the early daysOUT OF DATEof American life, but it is patentlyunequal to the needs of the presenttime. Under the simpler conditions ofa century ago we had juries thatwere perforce more intelligent becausethey were composed of men ofsimilar mental calibre to those involvedin the litigation before them.Today there is usually a wide gapbetween the mental make-up of thelitigants and their "peers," the jury.It is precisely the complexity of pre-\have confined their study almost entirelyto curative methods and arehandicapped when called upon togive reliable advice to keep well. Itis better to select an adviser whospecializes in preventive measuresrather than to call without discriminationany doctor.sent day living which, in DeanPound's opinion, calls for a differentlaw system, that is responsible forthe progressive deterioration in qualityof our juries. The lawyer haskept up with modern progress, butthe lav/ has not; a condition the lawyerhas been quick to take advantageof, at the expense of justice and thecommonweal.The issues growing out of our economic,political and social life that arerequired to be settled in courts of lawtoday are no longer so simple as thoseour forefathers were confronted within an earlier era. Human behaviorhas itself become more complex becauseof these changed conditions.Violations of the law are not so easilydetermined in our present intricateindustrial life as they were in theagricultural community of a hundredyears ago. As a result, our courtsneed not only a more adequate organiclaw and more modern legal andjudicial machinery to administer thislaw, but they need every help theycan get from other fields of knowledgethan their own that have abearing upon the problems beforethem.Not the least of these helps cancome from the growing body of knowledgepossessed by psychiatry and thenew psychology, the disciples concernedparticularly with problemsthat are among the most difficultthe courts have to deal with, namely,problems in human behavior. Thisis not to suggest that juries be composedof psychiatrists, psychologists,

24 The Health Bulletin February, 1930or other experts,nor even that everyjuror be examined by such expertsbefore he is impaneled. It is merelypoint out the greatest usefulness ofa service that psychiatry and psychologycan render in helping judges tobetter understand problems in whichhuman elements are determining factorsand to more finely balance thescales of justice. Human conduct isa pivotal factor in every case thatcomes before them and unless theybe as wise as Solomon they must lookto others to supplement their knowledgein various particulars. Psychiatryis called upon to determinethe mental condition of persons accusedof crime concerning whom thequestion of sanity is raised. It iscoming to be employed more and morein the disposition and treatment ofconvicted offenders. It has beenused to determine the veracity ofwitnesses as to facts.It can certainlyhelp in selecting better juries. Itcan do a great deal, even with itspresent knowledge, to help makeAmerican justice more efficient—NationalMental Hygiene Bulletin.THE VENEREAL MENACEByW. W. Craven, M. D.(Read at the 1929 Annual Meeting of the Medical Society of the State ofNorth Carolina)One after another of the agenciesthat have retarded the fuller andmore satisfactory development ofsociety have come under the condemnationof the masses, and effortsmore or less successful have beenaimed at their suppression or eradication.After centuries of uncurbedrampage the rum demon became intolerableand society has taken astand, rather feeble though it be,against it.Then the fight against opium andits derivatives and its path acrosstime isbeing made much more difficultthan it once was. Today an effortis being made to cause a recessionof the automobile speed menace,perpetuated by the reckless speeddemon loaded with "fire water" orperhaps only with the spirit of the"killer." Finally it is becoming noticeablethat public attention is becomingmore or less directed towardsthe so-called social disease, gonorrheaand syphilis. Today America asnever before is faced with the momentousquestion of how best to controlthese two diseases to say nothingof the swath being cut by the bacillusof Ducre. Unless there is a slackeningof the inroads made by thesediseases on the human economy therewill be results far more disastrousin the future to all races than hasbeen the case in the past. The exactorigin of these social diseases as totime and place is not definitelyknown, but it is probable that thepeople of the early dawn of historywere familiar with them. ChapterXV in Chronicles of our Bible refersto an ailment whose symptomatologyas recorded in very suggestive ofgonorrhea. In the present era withso many means of rapid transportationthe matter of limiting prostitutionis a greater problem then ever.The isolation and cure of those infectedseems to be an ideal well nighunattainable. In times past whenpopulation was not shifting anddrifting as it is today there was farless chance for rapid and widespreaddissemination of venereal disease.Before the Civil War and for manyyears thereafter, notably in the caseof the colored race, there was little

—February, 1930 The Health Bulletin 25change of residence and these diseaseswere rarely encountered. In Africaamong the native blacks we are toldby medical missionaries the socialdiseases were unknown prior to theadvent of the white man and his advancedcivilization.Today in proportion to the increaserpropensity of the colored peopleto go to the big centers of populationin like manner has the venereal menacethreatened his ranks. The wellknown song that the colored manchants, "He rambled, he rambled, herambled till the butcher man cut himdown" is pathetically true in moreways than one. The venereal butcherman lays him low by the tens ofthousands annually. On the returnof the prodigal son from his travelsthere is a noteworthy increase in thenumbers of darkies applying to theapothecary for medicines purportedto cure "stains," "running rage,"etc., nor is this peculiar state of affairslimited to those of "dusky hue"for there are other prodigal sons ofdifferent color that are prolificsources of trouble. Probably everynation under the sun is infected withthis particular breed. Heretoforesociety has had no way of knowingof the countless number of humanderelicts strewn along the highwayof licentiousness. The public shouldknow of the thousands of children inthe world whose eyes have been forevercurtained by the gonococcus andwhose minds have been clouded bythe treponema palida. Dwarfed anddeformed bodies harboring minds ofimbeciles are encountered every dayin every part of the woi'ld resultingno doubt more often than is suspectedto this course of the human race.The public should know of thethousands of unsexed and sterilewomen made so in toll to the inexorabledepredations of the gonococcus,and it should be told that the largerper cent of major gynecology is dueto the ravages of this same organism.One of the saddest pictures that thedoctor has ever known is that of theignorant and trusting bride who marrieswhat she thinks to be her ideal,a man's man, and a ladies' man, onewho prides himself on being a regularfellow, and looks forward to a happymarried life and with what is herheritage—children; all to soon comesthe discharge that knowingly or unknowinglythe family physician assuresher is a result of marital relationsand will soon adjust itselfwithout treatment. Then follows theslight pain in the pelvic region accompaniedby a noticeable tenderness.At first it seems that there is littlereason for apprehension, so uncomplaininglyshe travels her road ofpain, not knowing the cause of hersuffering, believing it to be a woman'spoi'tion. In the meantime, theerrant husband, light-hearted libertinethat he is, goes on his way likethe proverbial lion, seeking whom hemay distroy. Finally there comes aday when the wife finds herself abed-ridden invalid and it dawns onher that she is seriously ill. Nextcomes the trip to the hospital withits attendant dangers and mutilationfor something that she is both ignorantof and innocent of. In due timeshe leaves the hospital, if indeed thisis to be her good fortune, unsexedand with her most cherished hopethat of motherhood—gone forever.Surely something should be done toavert this appalling misfortune thatis befalling so many of our womenday after day. Sympathy on thepart of the guilty party will neverbring relief or satisfy the demandsof justice. The guilty must paysomewhere, sometime. To attempt togive even approximate statistics onthe prevalence of gonorrhea andspyhilis is manifestly impossible forthousands of these patients never goto physicians and a knowledge oftheir presence never reaches the collectorof statistics. The vei-y nature

26 The Health Bulletin February, 1930of these diseases insure their existencebeing scrupulously safeguarded.Many of the sufferers never confidetheir secret to anyone, simply buyingpatent medicines said to cure suchdisease as they think they have. Itis safe to say that not less than 60per cent of males at one time oranother have had gonorrhea or syphilis,or perhaps both simultaneously.As to their prevalence among femalesit is far more difficult to arrive ata conclusion. Some fifteen yearsago, Dr. Keyes, the urologist, thoughtthat there were perhaps sixteen casesamong males to each found amongthe opposite sex. Were he living todayno doubt he would revise hisfigures. Owing to inborn modestythe female is slow to consult a physician,and when she does he is oftenleft in doubt as to the present or absenceof the gonococcus. Numerousmistakes in diagnosis are made inthis realm of medical science. Fortunatelynature unaided often bringsthese cases to a safe conclusion .Itis a curious fact states Dr. Keyesthat gonorrhea is either much moremild or much more severe in the femalethan the male. Many femalesare unaware that anything is wrongwhile other are quickly overwhelmedby salpingitis, pelvic abscess, and attimes complicating peritonitis. Inthe male one encounters an inflammatorycondition of the prostate glandin practically all cases where theposturethea has been invaded. Hereit is frequently most intractable andis a source of many grave lesionswithin the gland itself, and here toowe find the port of entry of systemicgonorrhea. When there is a cessationof discharge from the external meatusthe patient experiences a feelingof false security not being consciousof the fact that the deep urethra invery many instances is still an excretingsurface that is unloading puswell laden with the infectious organisms.This very condition constitutesthe greatest menace on the part ofthe male. He ignorantly in mostcases transmits the infection to thewife or prostitute. He is misledthrough the circumstance of the pusbeing prevented from appearing atthe external meatus by the actionthe compressor urethra or "cut off"muscle. The last count in the indictmentagainst gonorrhea is systemicgonorrhea or gonorrhea rheumatism.A condition comparatively rare andfairly controllable. This condition israther grave in that at times it isresponsible for iritis and endocarditis.About one-half of one per centof gonorrheal cases are supposed tohave systemic gonorrhea. Its courseis one of slow progress to a cure thatis usually permanent. As to a manor woman being permanently andhopelessly disabled by the social diseases,authorities differ widely.There are' some of large experienceswho believe or at least profess tobelieve that no one is ever thoroughlycured of gonorrhea. Any statisticsat all and in any sphere of humanendeavor where the collector of sameis both judge and jury should becarefully considered before acceptance.No man's opinion is infallibleand on one has a monopoly on wisdom.Certainly there is a reasonableexpectation of cure in 75 per cent ofallofcases that take a thorough courseof retinal treatment.We vainly search for a remedy forthe present deplorable status of thesocial disease menace. We ask ourselvesthe question whether or notlegal measures will be effacacious.This is extremely doubtful. A standardizedexamination of the applicantfor marriage made in a correctand impartial manner by a board appointedby the state medical authoritieswould be a step in advance ofthe present slip shod method wherethe family physician is the arbiter asto eligibility for marriage. The questionof marital unfaithfulness and

February, 1930 The Health Bulletin 27The young long leaf pine emergingfrom the infant stage resembles acandelabrum . It is an aristocrat oftrees.clandestine living is well night unsurmountableand is obviously beyondthe pale of the law. Women mustlearn, if indeed they do not know,that man and woman hold entirelydifferent positions as to infractionsof moral law both as to physical consequencesto themselves and of publicopinion. No such appalling misfortuneawaits the male who has contractedgonorrhea as that whichthreatens the life and character ofthe female. The guilty man belongs tothat class inthe majority, but not soin woman's case. In the eyes of societyman is hurt little while underthe same count the woman is rated anoutcast, and often has to suffer inaddition to social ostracism ravagesof disease that are irreparable. Thusto some extent we see that the wagesof sin are less inexorable in the caseof the male. This unfairness is apparentto all, yet it must be facedby society in general. Women are ofteninnocently and accidentally infectedby using unclean syringe nozzles,unclean linen, etc. All physiciansnow-a-days encounter valvitis inyoung females due to criminal carelessnesson the part of those responsiblefor their care. It is highly probablethat the number of venereal casesis on the increase and that the socialdiseases are penetrating strata of societyhitherto immune. It is becomingnoticeable that colored people are nolonger prolific. The majority of unionsbeing productive of no increasein population. The gynecologist knowsbetter than anyone else of the enormousnumber of cases of uterine adnexaremoved from the women of' bothraces on account of the inroads of venerealdisease. Females generally andnot a few males know practicallynothing of the nature of syphilis andgonorrhea.In the case of the young femalemany times when the moral issueinvolved is not sufficient to restrainher from a plunge into the realmand young woman should beof venery the fear of physical sufferingwill disuade her. Every growinggirlinformed in some way as to the prevalenceand the nature of gonorrhealand syphilitic infection. The youngmale is better informed on such mattersthan is the female.Every living thing seeks to evadeanything that will entail bodily suffering.If the public could follow thedoctor through the wards of sufferingever present in all hospitals, andafter a manner this is possiblethrough the press, and there see thecountless victims doomed to the operatingtable through the agency ofvenereal disease, it would take thisproblem of the social disease far moreseriously than it does under presentconditions. Society in general wouldconsider well before taking any step

28 The Health Bulletin February, 1930that would lead into this road at theend of which is only broken bodies,heartaches and blighted lives. Numerousindeed are the sacrifices madeeach year at the shrine of Venusthrough ignorance as well as throughwilful waywardness. An improvementin the moral tone of society offersthe best solution of the venereal problem.Our ministers and welfare workersmight be more effective if theyspoke more plainly, using terms thatcould not be misunderstood. The properdissemination of literature bearingon this subject would undoubtedlyhave a far reaching effect. Punishmentfor the guilty parties would beeffacacious could they always be appi'ehended.Small cash fines and suspendedsentences do little good towardsrestraining the hygienic lawbreaker as will those who break otherlaws. Punishment regardless ofthe offense aimed at are practicallyworthless unless they hurt. The prospectof real punishment would makethe infectious libertine consider wellhis step before advancing furtheralong his road of conquest. Our presentlaws regarding venereal diseaseare broken with the same impunityand abandon that traffic laws arebroken.As to individual prevention there isno infallible method. A better methodof dealing with prostitutes would bea big advance. Putting them to somekind of hard work and seeing thatthey did it would help some. The ideaof work is odious to this class of ourpopulation and only an iron handcan ever make them do it.Bringing venereal disease and sexualmatters into the light of dayand into public understanding seemsplausible. The prostitute like the poorwe have with us always still it is tobe hoped that in the future it willbe in ever decreasing rather than increasingnumbers. Whether or not thesocial diseases are undermining thephysical and moral standing of thisnation is a question worth deliberating.WillUncle Sam, today the mightyof earth, fall as did Sampson of old,to the lusts of the flesh? The questionisa reasonable one.IMMUNIZATIONByDon M. Griswold, M. D.Immunization is one of the morerecent methods to be used to preventthe spi'ead of communicable diseases.Not only is it one of the newestmethods, but it is by far the mosteffective of all the measures employedin the control of preventable diseases.Reporting of communicable diseaseshas been in use throughout thecenturies. The first step necessary inthe control of any communicable diseaseis to know where, when, andunder what circumstances cases areoccurring.Placarding of individuals or thedwelling places of individuals havinga communicable disease was begun inearly Egyptian history. Its purposewas to announce the location of asource of danger to health.Quarantining was first used by theVenetians who noticed that after thevisit of ships from certain ports,sickness developed among the citizens.It was found that if the shipswere detained in the harbor for fortydays before the men or goods wereallowed to come ashore, the cases alloccurred on the boat and none ofthem among the inhabitants of thecity. It was from "quaranta," theforty day delay, that the name quarantinewas derived.Isolation came into practice whenit was realized that there was a groupof diseases, such as measles, whoop-

February, 1930 The Health Bulletin 29ing-cough, mumps, chickenpox, andGerman measles that did not warrantthe stringency of quarantine.Immunization is the last of the protectivemeasures to come into use.The era of immunization can be saidto have been ushered in by the announcementof Jenner that personswho had had cowpox would not contractsmallpox. This observation wasmade in 1796. Surely the mind ofman works slowly, when 130 yearslater we still find unvaccinated people.Ample proof of Jenner's assertionwas soon supplied by epidemiologicalstudy of the history of cases ofsmallpox. This brought about thepractice of artificially inoculatingwith cowpox virus in order to producethis rather harmless diseases forthe benefit of the resulting immunityagainst smallpox. Modern laboratoryprocedures have so purified and standardizedthe cowpox virus that theproduct of the biological laboratoriesis now just sufficient to cause onesmall lesion at the site of inoculation.Even with this small lesion theresulting immunity is complete for aperiod of seven years. Many people,especially babies and preschool children,carry this immunity for theirwhole life.Typhoid fever was the next greatscourge to have its terrors removedby immunization. The work of Dr.Almroth Wright who made the firstvaccine has undoubtedly saved thousandsof lives. During the Spanish-American War, 22,000 American soldierscontracted this one disease, alarger number than ever fired amusket at the enemy. As a result ofthis great sacrifice of human life,studies were made that have broughtthis disease under control in all wellsanitated communities. The studies ofVaughn, Shakespear and Reed begunin 1898 have borne fruit and havesaved more lives than were lost duringthe entire Spanish-American War.Typhoid vaccine has been used underthe conditions of military and civillife for thirty years and has provedeminently satisfactory.Diphtheria prevention by immunizationwith antitoxin was begun soonafter announcement of the antitoxinby Roux and Von Behring in 1894.This immunization is complete, butis of short duration, seldom lastingThis is a grove of North Carolinayoung long leaf pines. The earlieryears of this writer were spent amida virgin forest of full grotvn longleaf pities. He has no fonder memoriesof childhood than the many happydays aniong those wonderful pines.The individual who has never silentlyand reverently listened to thesoughing music of the wind passingthrough the green pine bows in winter,has missed something no radiovoice can supply. Let us all hope thatthrough proper conservation the peo-])le of this State 50 to 100 years hencemay again have such privileges as fellto the poorest of us a half centuryago.

—30 The Health Bulletin Februarij, 1930longer than from three to six weeks.The need of a more permanent andlasting immunizing agent led manyAmerican scientists to research inthis field. Theobold Smith, Park,Houghton, and many other biologicallaboratory workers noted that whenthe animals used in experiments weregiven an overdose of diphtheria toxinand were saved by the subsequent administrationof diphtheria antitoxin,these animals invariably developed ahigher degree of immunity and it lastedfor a longer time than otherwise.This research led to discovery of amixture of toxin and antitoxin thatwould bring about a lasting immunityin a large number of persons towhom three inoculation were administered.This immunity develops infrom six to twelve weeks and remainsfor at least seven years, and somepeople retain it for their entire lifetime.In general, the younger the personreceiving the treatments, the higherthe degree of immunity and the morelasting its quality. Babies under sixmonths of age are naturally immune.Children from six months to six yearsof age are highly susceptible. Allchildren should be immunized againstdiphtheria. This method has been usedsince 1815 and millions of peoplehave been protected by it.Scarlet fever is the latest one ofthe acute communicable diseases tobe met with an adequate method ofprevention by immunization. The researchesof the Doctors Dick gave usa much needed protection againstthis disease. Since 1920 many thousanddoses of scarlet fever streptococcustoxin have been administered, andimmunization by this method is nowan accomplished fact.Many parents are deciding thatthey have not fulfilled their entireresponsibility to their children untilthey have given them the benefits ofthese immunizing procedures. This isthe personal responsibility of the parent.Health officials as well as otherpublic authorities are becoming moreconvinced as experience in the use ofimmunizing procedures increases,that more disease can be prevented byimmunization than by all other meanscombined. It is much cheaper inmoftey, not to mention the sicknessand suffering, to immunize and preventacute communicable diseasesthan to allow them to take their tolland try to clear up the wreckage.To be of its greatest usefulness,immunization against any diseaseshould be carried out between epidemicswhen there are no cases in\the community. This requires an understandingof the facts that fortunatelyis becoming increasinglycommon among modern parents.Michigan Public Health Bulletin.A NEW BOOK ABOUT MILKDoctor Samuel J.Crumbine, generalexecutive of the American ChildHealth Association, and Dr. James A.Tobey, of New York City, have writtena new book about milk. Thetitle of the book is, "The Most NearlyPerfect Food; The Story of Milk."It is published by the Williams andWilkins Company, Baltimore, andsells for $2.50. Dr. Charles Bolduan,director of Health Education of theNew York City Department of Healthin a review of this book, has thefollowing to say:"This is one of the best presentationsof the interesting phases ofwhat is probably the most importantsingle food of man. Excellently plannedand well told, the material holdsthe reader's attention throughout.Scientifically accurate, the text canbe relied upon by teachers and studentsof home economics, dietetics,agriculture and dairy science, medi-

1February, 1930 The Health Bulletin 31cin, public health and particularlychild hygiene and school hygiene."We would like to add that this bookwould make a very convenient referencefor health officers. It is conservative,and does not pretend to saythat milk is a perfect food, and thereforewhat they do have to say aboutthe value of milk is much more dependablethan it would otherwise be.The book would make a splendid referencereading for high schools andcolleges when studying about milk.THE COST OF SICKNESSThere is not an adult responsiblehuman being livin gbut what is concernedeither directly or indirectlyabout the question of ""^Tiat it coststo be sick." Up to this time therehas not ben available any exact datasetting forth all the facts of thevery much involved question of thecost of sickness. Realizing thesethings the American Medical Associationacting with several largefoundations has created a committeefor the purpose of making an extensivestudy of all phases of the subject.This group of people composingthe committee, and known as"The Committee On the Cost ofMedical Care," represent the public,the medical profession, public health,institutions, and many other specialinterests. They are working on a fiveyears program of exhaustive study.Dr. Ray Lyman "Wilbur is the chairman,and Dr. Harry H. Moore is directorof esearch study. Dr. W. S.Rankin of the Duke Foundation is amember of the committee, representing"Institutions and Special Interests."The editor of the Health Bulletinis pleased to say that judging fromsome of the preliminary reports receivedfrom Dr. Moore that he believesthe study will be of greatvalue to the doctors, hospitals, thesick and to the general public.HOW'S THIS FOR MILK DRINKINGA local paragraph in the Dayton,Ohio, Health Bulletin describes thehabits of a native daughter of Daytonwho is married and living inSeattle, Washington. The formerDaytonian and her husband havenine children, composing a family ofeleven persons. They are all milkdrinkers, and the milk man leavesseventeen quarts of milk at the houseeach morning. This quantity of milkis somewhat in excess of the recognizednormal requirements of theaverage person, but it is a habit thatis much better to carry to excess thanto fail to come up to the requiredstandards.This Seattle family ought to be ahealthy family. Just imagine for amoment that the per capita consumptionof milk in the State of NorthCarolina was placed on such abasisfor one year. It requires little effortto imagine what a transformationsuch a habit would mean to thehealth and prosperity of all the peoplein the State. In the first place,think of the hundreds and even thousandsof children who are getting aninsufficient quantity of milk at present,who would be so greatly benefitted,and whose health would sogreatly improve following such a diet.Then imagine, if you will, what theeffect would be on the dairymen andlocal producers of milk throughoutthe whole State. It would literallytransform eastern North Carolinafrom a tobacco raising, cotton growingtenant ridden section, to a landof stock raising, home owning,healthy, satisfied population.

32 The Health Bulletin February, 1930PROPERTY AGAINST HUMAN LIFE. ByRev. Stanley C. HarrellThe news of the day carries anannouncement that China is rushing100,000 troops to the border to resistadvances of the Russians, and thatdaily conflicts are taking plase. Thecontroversy between the two powershas risen over the possession and controlof a railway system. The nationsof the world have been engaged in aserious attempt to outlaw war. Everyeffort in that direction is to be mosthighly commended, but there is aquestion as to whether the abolition ofwar can ever be accomplished untilmore has been done than the mereoutlawing of armed conflicts.What the world most urgently needsis a complete revision of its standardsof values. It has long been the customto place a higher value upon propertythan upon human life.Especiallyhave nations been guilty of thisatrocity of judgment. There was atime when an effort was made to coverup the effort to secure national possessionsby the term "national honor."But in recent years even that has beenabandoned, and national officials talkopenly of protecting material possessionsand securing economic advantages.And always there is back ofthis talk the idea of using armies toprotect property and to secure tradeadvantages. This is not to questionthe right of nations to protect theirpossessions; but we raise the questionas to whether or not there should beat least some consideration of thelivesof the men who are to be calledupon to defend national possessionsby the offering up of their lives.should not be forgotten that thenations which did not hesitate toItengagein a war which involved almostthe entire world, did not hesitate totalk of human beings as cannon fodder.Somehow, the two ideas of wagingv/ar and the wanton destruction ofhuman life have always gone hand inhand. Many of the world's most successfulgenerals have spilled blood asif it were no more than water. Thefact that they did not hesitate tosacrifice the lives of thousands oftheir men was the very factor thatmade them successful.The oustanding teaching of theChrist isthe supreme value which isplaced upon human life. But todayhuman life is about the cheapest commoditywhich the world knows.Thereis not a single social problem of theday that would be very difficult tosolve if we had the Master's conceptionof the infinite worth of humanlife. What agency or institution is sowell qualified to proclaim this messageas the Church, which calls herHead the Lord of Life.—The ChristianSun

u})]i5\edbijTA£./^°RmCAR9LIi^A STATE. DPARD s^AmUTA£)ul]etir\ will be ^gr\t free to qa\j citizeA cf "the State upor\reqije5t. |Entered as second-class matter at postoffice at Raleigh, N. C, under Act of July 16,1894. Published monthly at the office of the Secretarj- of the Board, Raleigh, N. C.VOL. XLV. MARCH, 1930 NO. 3ST. AGNES HOSPITAL FOR NEGROES, RALEIGHHere is a photograph of St. Agnes Hospital for Negroes at Raleigh. It isa modern hospital with a capacity of 100 beds. It is a first class institution inevery particular. It was founded in 1896, and so has a third of a century ofhumanitarian service to its credit. Its graduate nurses have carried comfortto the s k throughout middle atid eastern North Carolina mnd the physicianson its staff have saved many lives.

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTHA. J. CROWELL, M.D., President CharlotteCTRUS THOMPSON, M.D Jacksonv «THOMAS E. ANDERSON, M.DbtatesvlUeE. J. TUCKER, D.D.S^rV. ?°?J"?'"?D. A. STANTON, M.D High PointJAMES P. STOWE, Ph.G ^^^^,^°."^JOHN B. WRIGHT, M.D Ralei«hL. E. McDANIEL, M.D-."^t'^^1?,"CHARLES C. ORR, M.D. AshevlUaEXECUTIVE STAFFCHAS. O'H. LAUGHINGHOUSE, M.D.,RONALD B. WILSON, Assistant to the Secretary.C A SHORE, M.D., Director State Laboratory of Hygiene.G M. COOPER, M.D., Director Bureau of Health Education.H E. MILLER, C. B., Chief of Bureau of Engineering and Inspection.F M. REGISTER, M.D., Director Bureau of Vital Statistics.H. A. TATLOR, M.D., State Epidemiologist.GEORGE COLLINS, M.D., Director Bureau of Maternity and Infancy.ERNEST A. BRANCH. D.D.S. , Director of Oral Hygiene.FREE HEALTH LITERATURESecretary and State Health Officer.The State Board of Health publishes monthly The Health Bulletin,which will be sent free to any citizen requesting it. The Board also hasavailable for distribution without charge special literature on the followingsubjects. Ask for any in which you may be interested.Adenoids and TonsilsCancerCare of the BabyColdsClean-up PlacardsChickenpoxDiphtheriaDon't Spit PlacardsEj"esFliesFly PlacardsGerman MeaslesHookworm DiseaseInfantile ParalysisInfluenzaMalariaMeaslesPellagraPublic Health LawsPrenatal CareSanitary PriviesScarlet FeverSmallpoxTeethTuberculosisTuberculosis PlacardsTyphoid FeverTyphoid PlacardsVeneral DiseasesWater SuppliesWhooping CoughSPECIAL LITERATURE ON MATERNITY AND INFANCYThe following special literature on the subjects listed below will besent free to any citizen of the State on request to the State Board ofHealth, Raleigh, N. C:Prenatal Care (by Mrs. Max West)Infant Care (by Mrs. Max West)Prenatal Letters (series of ninemonthly letters)Minimum Standards of Prenatal CareWhat Builds Babies?Breast FeedingSunlight for BabiesSave Tour BabyHints to North Carolina Mothers WhoWant Better BabiesTable of Heights and WeiglitsPAGEOne First in Which We May TakeJustifiable Pride 3Some Observations about Pneumonia8A Health Project of Local Concern 10The Nurses' Page 11Betty Blackie 13Death Rate from Appendicitis Increasing14CONTENTSThe Runabouts in the House of Health(pamphlet for children from 2 to 6years of age)Baby's dally Time Cards: Under 6months; 5 to 6 months; 7, 8, and 9months. 10, 11, and 12 months; 1year to 19 months; 19 months to 2years.Diet Lists: 9 to 12 months; 12 to 15months; 15 to 24 months; 2 to 3years; 3 to 6 years.PAGERelationship betv^een the StateBoard of Health and CountyHealth Departments 16Science and CUltism 19Farm Relief, Better Food, BetterHealth 20Interesting Letter from DoctorWashburn Now in Europe 23"Beautiful Day" 25''Rich Man, Poor Man" 31

VOL. XLV. MARCH, 1930 NO. 3ONE FIRST IN WHICH WE MAY TAKEJUSTIFIABLE PRIDEAt the present time the subject ofmedical care and the provision ofhospital facilities for the people ofall classes everywhere is receivingmore attention in the press of thecountry than any other subject. Theweekly papers, the secular press, themagazines having national circulation,as well as the medical journalsof the country, are printing everyweek, and every day in the daily papers,material on this subject.It is well known that the Stateof North Carolina has been doingwith a minimum bed capacity forhospital treatment for both whiteand colored people for a long time.With the aid of the funds provided bythe late J. B. Duke, a great impetushas been given to the building andequipment of modern hospitals in theState during the last two or threeyears. The aid given by the DukeFoundation is extended to both whiteand colored people.The colored people in many of thecities and towns of North Carolina,as well as some of the country sections,have a death rate, especiallyamong the infant population, sometimesapproximating twice that ofthe white people in the same locality.An essayist at the meeting of theNorth Carolina State Medical Societyin 1929, from Winston-Salem, statedthat the death rate among coloredinfants one year old or younger wasmore than twice as high the previousyear in that city as the death rateamong the white infants. There areother places in the State where thesame story could be told. This handicapis undoubtedly being graduallyremoved. It will take a long time, becausethe standards of living and othereconomic influences must be takeninto consideration.Farther along in t'uis article wewant to discuss intimately, and withpride, the hospital facilities for Negroesin North Carolina, but beforegoing into the discussion of that featurewe want to say something aboutthe National Negro Health Weekmovement.The Surgeon General of the UnitedStates Public Health Service, atthe request of Dr. R. R. Moton, presidentof the Tuskegee Institute, thegreat Southern institution for Negroes,founded by Booker Washington,convened a conference in Washingtonlast October to consider waysand means for the sixteenth annualobservance of National Negro HealthWeek. It was decided to designate theweek beginning March 30 and endingApril 6, 1930, as the week in whichall the public health agencies of theUnited States will be asked to concentratetheir interest in the health ofthe Negro race.At the aforementioned conferencesome dozen or more great nationalagencies especially interested in theadvancement of public health amongthe Negroes were represented. Someof the topics that will be intimatelydiscussed this year have been summarizedby the report from the Sur-

The Health Bulletin March, 1930geon General's office and include suchitems as "Finding Ways and Meansfor Carrying on Health Educationand Other Activities throughout theEntire Year." In this attempt the importanceof keeping alive the local organizationsfostering communityhealth among the Negroes will beespecially stressed, in order that itmay function throughout the year.The United States Public HealthService will issue, as it has in thepast, a special health week bulletinand poster which will be available ata cost of between twelve and fifteendollars per thousand to any organizationespecially desiring to cooperatein this work and to help themovement along. The North CarolinaState Board of Health, as in the past,will supply literature on various subjectsin limited quantity, suitable foryear round study as well as emphasizingthe problems during the specialweek of study.This National Week is especiallypromoted by the Tuskegee NegroConference and the National NegroBusiness League. It is hoped thatthis year all of the larger towns andcities of North Carolina which haveconsiderable colored population mayplan their observance of this week atas early date as possible and utilizenot only the printed material, orradio when possible, but the pulpits,the schools, and every other agencyin which people may be reached withthe message on how to prevent communicabledisease and improve thegeneral health of the race.Negro Hospitals in North CarolinaAs we remarked in the beginningof this article, any discussion of publichealth and medical care is invariablytied up with hospitalization forall those who are in need of hospitalcare. Very little progress was achievedin the battle against tuberculosisuntil a specialty of hospitalizationfor all who needed it was promoted.Consistent efforts were startedalongthis line about twenty-five years ago.It is therefore more than significantthat in 1928 the general death rateof nearly every state in the Unionincreased over the preceding year,but the death rate from tuberculosisdeclined to the lowest point in thehistory of reporting in the UnitedStates. Any one who can read oughtto be able to understand why suchis the case.In the conduct of hospitals forboth white people and colored peoplemany difficult technical questionshave to be dealt with, for example,as to whether a hospital shall havea closed or open staff, and so on. Inthe provision for hospitalization forNegroes such difficulties have beenenhanced by such questions as towhether or not the staff shall be composedof white physicians or coloredphysicians or a mixture of both.Sometime ago we received a reportwritten by Dr. H. M. Green, presidentof the National Hospital Association,which is composed of the Negro hospitalsof the country. This associationis an associate member of the AmericanHospital Association, and it is devotedto the program of improvingthe hospital situation among Negroes.The subject of the pamphletwritten by Dr. Green is, "A More orless Critical Review of the HospitalSituation Among Negroes in theUnited States."Doctor Green's report is a dispassionate,conservative statement of thesituation which should receive, and wehave no doubt will, the respect it isdue in all medical circles in this country.In a description of the very fewhospitals run exclusively for the Negrorace Dr. Green in his report hasthe following to say which is of muchinterest to our people: "The Duke interestand the Richardson familyhave aided the Negroes of North Carolinato erect two splendid hospitalswhich give the Negroes of that State

March, 1930The Health Bulletinadded reason to be proud of theirState."Doctor Green had just mentionedthe fact that there are only five schoolhospitals in the South exclusively forcolored people, which include thesplendid Saint Agnes Hospital in Raleigh.Dr. Green points out that "theNegro race is and must continue fora long time a poor race, working forsmall wages with little opportunityfor investment or for advancement inthe economic scale, therefore, theymust remain for a time a race of commonlaborers. They cannot hope tobuild or maintain large and wellequipped hospitals, and unless someway is found to help them they maycontinue to suffer from discrimination."In the foregoing paragraph Dr.Green is discussing the difficulty oftreating colored people and whitepeople in the same hospital, and oneofthe discriminations he mentions isthat in a hospital, especially in theSouth, conducted for white and coloredpatients under the same roof thestaff is always composed of whitephysicians. He very reasonably agreesthat in most instances this is necessary.I Now for the justification of thetitle to this article. The Negroes ofNorth Carolina todaj^- have availablethree of the most modern and wellequipped hospitals specifically for Negroes,situated in towns of one hundredthousand people or under, existinganywhere in the country for anyrace. These three hospitals are SaintAgnes in Raleigh, the Lincoln in Durham,and the Richardson Memorialin Greensboro.Saint Agnes Hospital, RaleighSaint Agnes Hospital in Raleighwas founded in 1926 by Mrs. SarahB. Hunter, wife of the then presidentof the Saint Augustine School.It is therefore known today as a"School Hospital." In the beginningthere were twelve beds for womenand children. The first class of nurses,which numbered two, was graduatedin 1898. The present building waserected in 1906 and comprised a bedcapacity of seventy-five. Through anaddition to this building in 1924 thenumber of beds in this hospital wasincreased to one hundred. They haveat present five graduate nurses ontheir staff and thirty-two pupilnurses in training. It may be said,without fear of contradiction fromany quarter, that the nurses whohave been graduated from this hospitalduring the last thirty yearshave done as much to ameliorate sufferingamong the Negro race as anyother agency in the State. This hospitalhas the approval of the AmericanMedical Association for interntraining. It is fully accredited by theAmerican College of Surgeons asmeeting minimum requirements, andhas been placed in Class A by theNorth Carolina Board of Nurse Examiners.The Duke Endowment andthe Julius Rosenwald Fund have recentlyassisted this hospital. This hospitalhas a medical staff composed ofboth white and colored physiciansand surgeons who practice their professionin Raleigh.Lincoln Hospital,DurhamThis splendid new hospital has acapacity of one hundred and eightbeds. The history of the origin anddevelopment of this hospital is one ofthe most interesting connected withthe whole subject. The Editor of theBulletin wrote to Dr. C. H. Shepard,medical superintendent of the LincolnHospital, requesting some informationabout the development of that institution.Dr. Shepard replied in aletter so interesting and so packedwith information that we take pleasurein publishing it in full. His descriptionfollows:"Lincoln Hospital was organized in1901 and opened in the same year.

The Health Bulletin March, 1930The hospital at that time was a framestructure of a thirty-nine bed capacity.It is a general hospital seekingto meet the needs of the coloredpeople of Dui'ham and vicinity."The first Lincoln Hospital wasgiven to the colored people of Durhamby Messrs. Washington Duke, J. B.Duke, B. N. Duke and B. L. Duke, asan appreciation for the loyalty of theold Negroes to the white people ofthis vicinity during the War Betweenthe States, and for their part in theindustrial development of the City ofDurham. It is interesting to recallthat for sometime Mr. WashingtonDuke had it in his mind to erect tothem a monument on the campus ofTrinity College, now Duke University,and made public statement of same.Dr. A. M. Moore, the first coloredphysician to practice in Durham, andJohn Merrick, a recognized friend ofthe Dukes, asked that they build ahospital instead of erecting a monument.The wisdom of their solicitationwas so obvious as to meet with theinstant approval of the Messrs. Duke,and the first Lincoln Hospital waserected on the corner of Proctor Streetand Cozart Avenue. TTie entire costof the first plant was $8,551.00."The present hospital was erectedin1924 under an amended charter of1923. The Dukes gave $75,000.00 tothe erection of the new building, while$25,000.00 was given jointly by theCounty and City, $25,000.00 by hewhite and $25,000.00 by the coloredpeople of Durham."The Board of Trustees is bi-racialand consists of the following: S. L.Warren, M. D., President of theBoard, W. G. Pearson, Vice-Presidentof the Board, W. C. Strudwick, M.D., Secretary, J. M. Avery, Treasurer,W. F. Carr, H. L. Carver, ClydeDonnell, M. D., R. L. Flowers, J. L.Pearson, M. E. Newsome, Foy Roberson,M. D., T. C. Graham, C. C.Spaulding, J. E. Shepard, C. H. Shepard,M. D. The superintendent ofthe hospital is C. H. Shepard, M. D."Lincoln Hospital is controlled by aTHE LINCOLN HOSPITAL FOR NEGROES AT DURHAMThe above is a picture of the quarter million dollar hospital for coloredpeople at Durham, which has a history of twenty-nine years service to itscredit. Please read Dr. Shepard's letter in this issue about the history ofthe Lincoln Hospital.

March, 1930The Health BulletinBoard of Trustees, elected every twoyears by sources hereafter to be named.It is wisely provided in the charterthat in the event the authorizedsources of election fail to function,then the Board automatically becomesself-perpetuating. The sources ofelection are as follows: The DukeFamily or their representatives (2)Aldermen of the City of Durham (1)Academy of Medicine (white) 1Commissioners of the County of Durham(1) ; Academy of Medicine (colored)3; North Carolina Mutual InsuranceCo. (2) ; Royal Knights ofKing David (2) ; Colored MinisterialAssociation (1) ; North Carolina Collegefor Negroes (1) ; Principals ofthe City Colored Schools (1),"The value of building, plant andequipment is $234,851.11. There is atotal of 108 beds divided as follows:Six private room beds, ten semi-privateroom beds, seventy-nine wardbeds, nine bassinets three baby cribsand one bed, Superintendent ofNurses."The Nurses' Training School wasestablished in 1902 and has been inoperation ever since. It has a grade"A" classification. The hospital alsois recognized as a class "A" institutionby the American College of Physiciansand has at the present fiveregistered nurses, three interns, thirty-fivestudent nurses, one orderly,two janitors, fireman and three cooks.The requirement for entrance to theSchool of Nursing is a high schooldiploma and three years are requiredfor graduation. There is a Nurses'Home, the gift of Mr. B. N. Duke,which cost $25,000, containing theclass room and DieteticDepartment."During 1929 our new X-ray machinewas installed at a cost of $6,-000.00. During the same year therewere fifty-three physicians treatingpatients in the hospital."L. Richardson Memorial Hospital,GreensboroThe Richardson Memorial Hospitalof Greensboro, North Carolina, openedits doors on the 18th of May, 1927.We find the following interesting historyreported in their hospital bulletin,kindly sent to the writer by themedical superintendent.In January, 1923, some colored citizensof Greensboro, realizing thegreat need for a hospital for coloredpeople in that city, met together andorganized the Greensboro Negro HospitalAssociation. Out of this organizationgrew the activeplans for thehospital. The family of the late L.Richardson of Greensboro were inducedto become interested and theycontributed fifty thousand dollars tohelp in the erection of the hospital.Mrs. Emanuel Sternberger contributedten thousand for the equipment ofan operating room and an X-ray department.The institution was namedthe L. Richardson Memorial Hospitalin honor of the late L. Richardson"not only because the gift from thisfamily was the largest, but becauseof his well known kindness and sacrificesfor the poor unfortunate coloredpeople in the city."This hospital has a bed capacityof fifty-six with an addition of sevenbeds for infants. It has a splendidnurse training school, and a nursesbuilding has been recently completed,providing rooms for thirty-twonurses. The Duke Foundation and theRosenwald Fund assisted in the constructionof the nurses home, andthey also assist in the maintenanceof the hospital. The hospital has amixed staff of white and colored physicianswho work in harmony.This hospital is one of the mostmodern anywhere, and it has recentlybecome affiliated with theAgricultural and Technical Collegefor Negroes, the great State institutionfor Negroes which is located atGreensboro. The A. and T. College

8 The Health Bulletin March, 1930has been recognized by the AmericanMedical Association as one of thetwenty-five Negro colleges in the morethan one hundred Negro colleges ofAmerica in which two years creditin pre-medical work is allowed. Thehospital has a corps of nineteennurses in training as well as a staffof five registered nurses. It has beenrecognized by the American College ofSurgeons and approved by the AmericanMedical Association. It is accordedan "A" grade by the AmericanCollege of Surgeons, one of the fewNegro hospitals in America to be sorecognized. Dr. S. P. Sebastian, themedical superintendent, has been apracticing physician in Greensborosince 1912 and has devoted his lifeto the task of getting a hospital forcolored people built in that city. Thenurses training school has been fullyrecognized by the North CarolinaBoard of Nurse Examiners.These three hospitals for Negroes,in three of the largest towns in NorthCarolina, emphasize what is beingdone to promote the health of coloredpeople in this State. It is interestingto record that plans are under wayfor the erection of several other largehospitals for Negroes in other sectionsof the State. .These things, however,may be told in another story.SOME OBSERVATIONS ABOUT PNEUMONIAPneumonia in all its varied formsstill ranges very near the top of thelist as the cause of death in theUnited States. In many great citiesof the country it is either first orsecond as a cause of death everyyear.There seems as yet to be no specificmeans of preventing pneumonia.Like so many other diseases, there isa great deal that no one understandsconcerning the distribution and occurrenceof pneumonia. There are afew things that seem to be definitelysettled. One is that pneumonia seldomoccurs except as a sequence tosome communicable disease, acute respiratoryinfection, or wounds in accidentsof various kind. Anotherthing, as every physician practicingin rural districts knows, pneumoniafrequently occurs in very virulentform, causing two or more deaths inthe same family sometimes, amongthe farm population. This seems toindicate that people living close togetherin the cities may develop akind of contact immunity which protectsthem often from the virulentattacks of pneumonia and which thefarm family living in an isolated section,having little intimate contactwith other people, do not seem tohave.Pneumonia organisms, that is thegerms which cause acute outbreaks ofpneumonia, are very common andmay be found following a microscopicalexamination of the secretion inthe mouths of many people, at frequentintervals, who seldom if everdevelop an acute attack of pneumonia.some ag-This indicates that there isency acting in a way which lessensthe immunity of individuals at certaintimes, which causes them to succumbto attacks of pneumonia.Pneumonia most frequently followsattacks of a condition whichhighly technical people have designatedas acute respiratory infection andsuch, and what the man in the streetcalls the common cold. If colds andother communicable disease, especiallysuch diseases as measles andwhooping cough in children, could bedefinitely prevented, it is easy to understandthat the death rate frompneumonia could be greatly lowered.We have recently seen in severalstate health publications, and in differenttechnical journals, publishedreports giving the result of investigationsmade by two representatives of

March, 1930The Health Bulletinthe Rockefeller Foundation in thestate of Alabama. We are herewithquoting from one of these reports forthe information of our readers. Wequote without comment as follows:"These men went to a sparsely settledcommunity in Alabama and madethe cases of pneu-observations on allmonia occurring in an area of approximatelya thousand square miles,having a population of about 35,000."The disease has certain peculiaritiesin a warm climate and it wasthought that a study of these mightbe of value in helping to formulatemeasures directed toward saving someof the 100,000 lives lost annually bythedisease."This particular community wascomparatively free from the commoncold until directly following a weekof cold weather beginning January 1.At this time the mean weekly temperaturereached 24 degrees F. and awide-spread epidemic of colds occurred.From these colds most of thecases of pneumonia developed withintwo or three weeks. It was establishedthat following a period of coldweather, with attendant sufferingand" exposure, pneumonia became prevalent.The sequence was, first, coldweather, second, an epidemic ofcolds, third, pneumonia."In individual cases the acute coldsdeveloped into pneumonia often followingexposure while riding severalhours in a v,'ind, or getting rainsoakedand thoroughly chilled whenreturning from school. Most of thecases occurred in children under 15years of age and the relation of chillingto the development of a cold andthen pneumonia was quite definite.There would have been fewer casesof pneumonia had these children withcolds not been sent to school duringthe inclement weather, and of courseexposure and chilling incident to the"cold snaps" on January 1 contributedtothe acute upper respiratory infectionwhich preceded the pneumonia."The writers could not but be impressedwith the conditions in thiscommunity as comparable with thoseof the pioneer days of our forefathers.A lack of frequent contactwith each other produced a communityof people with relatively low resistanceto pneumonia of the formstudied. Under crowded conditions ofEnjoying Raleigh's January sunshine on an economy screened sunporch(8x7 ft.) that cost but $12.00 for materials plus "daddy's" labor.

10 The Health Bulletin March, 1930city life there occurs a kind of communityresistance to the same typesof germs which in isolated areascaused serious illness. However, thesame factors—namely, exposure andchilling—often are responsible forcolds and pneumonia in a Northernclimate, and these are due to organismsto which we have not become accustomed."The suggestions which it is perhapsworth while for us to pass along ina discussion of pneumonia is to recommendthat people suffering fromrespiratory infections, coughing, andsneezing, and so on, should avoid contactwith their fellows. They shouldstay at home inbed during the acutestages of these conditions in orderto protect other people. We would alsolike to urge upon people whose dutiesand pleasures take them frequentlyamong other folks that they try toavoid crowding in stores, theaters,churches, and street cars, or in automobiles,especiallj^ where they mightbe thrown in direct contact with someindividual who happens to be a carrierat that particular time. In conclusion,it is hardly necessary to saythat close attention to personal hygienewould seem to help in wardingoff such diseases.A HEALTH PROJECT OF LOCAL CONCERNUnder the above heading theStatesville Landmark recently publishedan excellent editorial discussinga proposed big drainage projectof interest to the people of Statesvilleand a large part of Iredell County.The preliminary remarks of theeditor, before entering into the discussionof the drainage project, areso very much to the point,and so interesting,that we herewith quote thatpart of his editorial in the hope thatit may be read by all the readers ofthe Health Bulletin to their profit."Good health is of first importancein the scheme of things. In any considerationof public betterment, sanitarymeasures, anything tending toState Board of Health School Dentist in action at Asheboro.

March, 1930 The Health Bulletin 11guard general health conditions,^'hich means guarding the individualhealth, should have first place.These things are banal, so much sothat it seems hardly necessary to mentionthem. But as a matter of fact thegeneral public is so much inclined tobe indifferent to this primary requisiteof its welfare that very oftennothing is done to remedy the mostobvious need until conditions becomeso bad that it is a matter of survival.^Meantime the health of manyindividuals has been wrecked, in somecases permanently; many lives havebeen lost and the economic damageTHE NURSES' PAGEfar surpasses that suffered from fireand storm and flood which attractgeneral attention and arouse the citizenryto prompt action for relief. Weare curious that way, but notwithstandingsome improvement under theurge of modern methods we are stillvery much indifferent. It is the heritageof the older day when sicknesswas accepted as a visitation of God.We now know better than to chargeGod with responsibility for resultsour own negligence, the failure toofdothe things we can do for ourselves.But we are not yet living up to theinformation."Time Now for the Examination of Children Who Expectto Enter Scnool This FallIn the counties of North Carolinahaving whole time health departmentstheir organization work is alreadywell under way and their programformulated for the examinationof small children of five and onehalfyears old, who are expected toenter school for the first time thisfall. Last year this work was verysuccessful in a number of counties inwhich the health officers cooperatedwith the parent-teacher organizationsand in which the work was performedin a thorough-going manner duringthe months of April and May, and insome counties even earlier.The parent-teacher organization,which by this time, is organized inevery county of the State to a moreor less extent, has carried out to increasingsatisfaction for the pastthree or four years the policy of carefulexamination by competent physiciansand dentists, of children whohave been found to have handicaps,such as decayed teeth or other physicaldefects, which may be remediedduring the spring and summer previousto entering school and at the beginningof the session in the autumn.The strong point in the parent-teacherorganization is that they havecarefully systematized the work, andcertain members of the association,who represent the mothers of eachgrade, assume the responsibility forfollowing up the examination in orderto see that the children found needingtreatment have such treatment available.During 1929 the nurses of the StateBoard of Health assisted in the workcarried on in thirty-five differentcounties. This work was done for themost part by nurses employed by theBureau of Maternity and Infancy.The nurses in that bureau alone wereinsti-umental in securing the examinationof more than seven thousandof these small children. The directorof the Bureau of Maternity and Infancystated in his report to the AmericanChild Health Association thatthis work was carried out to a greatextent last year in connection withthe celebration of May Day. He reportsthat in one county where theclinics were conducted on a countywidescale more than sixty per cent ofthe defects discovered had been correctedbefore the end of the summer.He stated further that in most of

12 The Health Bulletin March, 1930the counties where the bureau nursesassisted in the conduct of the clinicsthat they were assured that this workwould be an annual occurrence andwould be extended to include practicallyall the children in other regionsof these counties which had not heretoforebeen reached.Lack of space makes it impossiblefor us to go into detail in describingthe classification of defects found inthe more than seven thousand childrenwhom the nurses of the Bureauof Maternity and Infancy were instrumentalin having examined byphysicians. It is to be hoped that thisyear the work will be extended to includeevery county in the State. Theparent-teacher organization may restassured that the physicians and dentistsin the respective counties will bewilling to assist them in any reasonablemanner in carrying out thiswork for the benefit of the handicappedchildren.The educational department still reportsevery year a large percentageof children who are grade repeaters.For the most part these children repeatthe grades because of physicalailments, sickness resulting in lossof time, and many other causes whichare often brought out and remediedwhen taken in time. Therefore theconception of the pre-school roundupis a sensible idea. In the firstplace, it takes care of the children atan earlier age than would be the caseif no efforts were made along thisline until after the school session,even though the first session for thesechildren was well under way. Anotherreason is that the children who canenter school in good shape physicallywill stand a much better chance ofdoing successful school work, makingthe average attendance, and in successfullypassing the grade requirementsfor the first two or threeyears.The nurses from the State Boardof Health are engaged in this workat present and will lend all aid withintheir power to assist again this yearin making the work successful. Asthese lines are written, early in February,the work is well under wayand most of the nurses whom it ispossible to provide for this workhave programs already arranged andpromises made to about the limit oftheir capacity for this year. This,however, need not deter the parentteacherorganizations and the localhealth departments and the medicalsocieties about over the State fromcarrying out the work to a successfulconclusion in every county in NorthCarolina.Doctor George Collins, Director ofthe Bureau of Maternity and Infancyof the State Board of Health,who is the official representative ofThis little Fayetteville lady is thehealthy young daughter of a trainednurse and she is named for one ofthe State Board of Health nurses.The report is that she has been"raised" to her present state of perfectionby State Board of Health literature,with Frank Richardson'sbook as the consultant.

:March, 1930 The Health Bulletin 13the Board cooperating with the StateDepartment of Education and theParent-Teacher Association, has issuedrecent!}^ the following letter tointerested organizations"The State Congress of Parentsand Teachers, State Board of Educationand State Board of Health areagain sponsoring and promoting cooperativelythe organization and conductof clinics for the physical examinationand immunization againstcommunicable diseases of the childrento enter school next fall for the firsttime. The problem of reaching thechild that is about ready to enterschool for the first time is a difficultone and the observation of the methodsused by others is of particular interest.The most effective of the methodsthat are being used is herewithbriefly summarized."First, by arrangement with theboard of education, superintendent ofschools and principals, a registrationof the children that are to enterschool next fall for the first time isobtained, including the names and addressesof parents. This preschoolregistration can be very effectivelysecured through the children alreadyin school. Of course, by such a method,not all of the preschool populationis reached but a greater numberis reached in this manner than bythe usual methods of advertising."Second, the health department orcounty medical society undertakes inany manner that it sees fit, the physicalexaminations and vaccinations."Third, the Parent-Teacher associationmakes a definite contribution byway of advertising, supplying layassistance in the conduct of clinics,(if the clinic method is elected forthe examinations) and assisting inproviding transportation for childrenof certain families that cannot providetransportation for themselves."The State Congress of Parentsand Teachers has sponsored the SummerRound-Up of the Preschool Childfor several summers and their cooperationwith the State and CountyBoards of Health and State andCounty Boards of Education hasproved an invaluable aid."To briefly summarize the problem—gettingin touch with and securingexamination of the preschoolchildren has been most effectivelyapproached by cooperative effort bythe Health, Education and Parent-Teacher organizations."BETTY BLACKIEBetty Blackie is what is called a"oiney woods rooter." She belongs toGapway School. This is a two teacherschool about twenty-six miles fromthe county seat. The day the schoolnurse was there to weigh and measureand examine the children the teachertold her all about Betty Blackie.Bettie Blackie is being right nowinGapway School, what the teacherscall a "project" and the childi'en a"projec." She is kept in a large penseveral hundred yards from theschoolhouse. The teacher said theybought her, when she was small, tofatten and sell to get money to takea trip to the county seat. She saidsome of the children had never beenthere.At the noon recess the nurse andthe teachers went down to the pen toinspect Bettie Blackie and to takeher picture. The pen is real large forsuch a small pig. The children hadbuilt a board fence around it with agate that was put up like bars exceptthe bars were fastened together. Theground all over the enclosure was sorough it looked as if it had beenplowed. It had not though. It waswhere Bettie Blackie had rooted it.The teacher said they first put herin a much smaller pen but she seemedto pine and sicken. She also almost

14 The Health Bulletin March, 1930rooted her way out under the fence.Then is when they decided to enlargeher rooting space. The teacher saidshe was hard to fatten as she tookso much exercise rooting. Perhaps thechildren will get a good price for heras she is sure to make a good "streako-leanand streak-o-fat" breakfastbacon. Piney woods rooters do, so ithas been said, especially if they rememberto feed her more every otherday. Across the road from BettyBlackie's pen is a nice winter vegetablegarden (date is Jan. 6th) ofcollards and turnips.Let us hope the children will havea lovely trip to the county seat,thanks to Betty Blackie.DEATH RATE FROM APPENDICITIS INCREASINGThe keepers of vital statistics everywhereseem to agree that the deathrate from appendicitis is increasingin every state in the Union. The mostrecent and acute increases seem tocome from the Pacific coast. Dr. WilliamBrady has commented recentlyon the observation of a medical writerfrom Oregon who had accounted forthe enormous increase in that sectionas being in part due in delay causedby messing with the cults and quacks,who are thriving on the Pacific coastmore than anywhere else in the country.Other states, however, are reportingconsiderable increases, thereport from one big Eastern state recentlyindicating that there has beenan increase of some eleven hundreddeaths in that state for 1928 over anyprevious year.There can be but one cause for thisincrease and that is the delay in consultinga competent physician whomay make a diagnosis and have thepatient on the operating table, in thehands of a competent surgeon, beforerupture of the appendix and generalabdominal complications have ensued.Many highly competent physiciansand surgeons are firm in their opinionthat the habit of prescribing largedoses of castor oil, especially to children,upon the slightestcomplaint ofpain in the abdominal region is responsiblefor a large per cent, of theincreased mortality. Many physiciansand surgeons also, are of the opinionthat even the administration of asoapsuds enema to a patient sufferingwith abdominal pains which may beappendicitis is almost as disastrous tothe patient as the administration ofcathartics. These observations andsigns are undoubtedly based on fact.The safest advice that any doctorcan give his patient over the telephoneor on a bedside visit, as manyof them daily practice, is to put anypatient to bed in a recumbent position,without food or even water, upon theslightest complaint of abdominalpain, until a diagnosis eliminatingappendicitis definitely can be made.In doing this many lives will undoubtedy be saved which otherwise wouldbe lost. In short, the good old safepracl'cc of watchful waiting on thepart of physician and patient andfamily should be restored to its formerhigh place. In these days of increasinghospital facilities, when acompetent surgeon is available withina few minutes reach of every individualin this State, if the propercare on the part of the patient, family,and physician is exercised, deathsfrom appendicitis should be decreasinginstead of the reverse.Some writer has recently expressedthe view that there is no such thingas chronic appendicitis. This opinionis contrary, of course, to the majorityof medical opinion, and we simplypass it along as a definite and worthwhile idea. It can do no harm, asideas are one of the scarcest thingsin the world, scarcer than anythingelse except perhaps people who havecourage enough to promulgate new

March, 1930 The Health Bulletin 15and advanced ideas in the face of currentpractice. This principle appliesin medical circles stronger than perhapsanywhere else except among ourlegal brethren.The physician who argues thatthere is no chronic appendicitis doesso on the principle that there is nosuch a thing as a chronic toothache.Take the idea for what it is worth. Theprinciple argument is that each attackof abdominal pain may be appendicitis,and every attack of appendicitis,even in the same individual, mayhave to be dealt with on an entirelydifferent basis from every other suchattack. The safest advice that we cangive is for a patient who suspectsthe presence of appendicitis to trustfully to a competent physician and tolose no time ingetting on an operatingtable when the evidence of appendicitisis established.In concluding this sketch we cannotresist the temptation to quote ashort poem written by Edgar A.Guest on the subject of castor oil.This is probably copyrighted, but wehope that Mr. Guest and his publisherswill forgive us for this variationfrom legitimate publishing.There's nothing else that they canthink'Cept castor oil for me to drink.I notice, though when Pa is ill.That he gets fixed up with a pill.An' Pa don't handle Mother roughAn' make her swallow nasty stuff;But when I've got a littleache,It's castor oil I've got to take."I don't mind goin' up to bedAfore I get the chapter read;I don't mind bein' scolded, too,For lots of things I didn't do;But, Gee! I hate it when they say,"Come! Swallow this—an' rightaway"Let poets sing about the joyIt is to be a little boy,I'll tell the truth about my case;The poets here can have my place.An' I will take their life to toil,If they will take my castor oil.""I dont' mind lickins, now an' then,An'' I can even stand it whenMy mother calls me in from playTo run some errand right away.There's things 'bout bein' just a boyThat ain't all happiness an' joy.But I suppose I've got to standMy share o' trouble in this land,An' I ain't kickin' much—but, say,The worst of parents is that theyDon't realize just how they spoilA feller's life with castor oil."Of all the awful stuff. Gee Whiz!That is the very worst there is.An' every time if I complain,Or say I've got a little pain,Raleigh baby 3 years old and neverbeen sick.

16 The Health Bulletin March, 1930RELATIONSHIP BETWEEN THE STATE BOARD OFHEALTH AND COUNTY HEALTH DEPARTMENTSByCharles O'H. Laughinghouse, State Health Officer(Address Health Officers' Conference, Raleigh, January 2, 1930)In undertaking todiscuss with youthe relationship of the State Board ofHealth and the County Health Departmentsit is apparent in the verybeginning that here are two agenciesof distinct and separate units of government,interdependent and correlated,but nevertheless independent.The powers and the duties of theState are constitutional; the powersand duties of the county are all otherfunctions of government not delegatedto the State. Just as an individualis averse to yielding supervision anddirection to some other individual orsocial group, so counties yield to theState the power of supervision anddirection over their local affairs withconsiderable reluctance. Moreover, letit be kept in mind that these largersupervisory powers of the State overthe county are granted by personselected by the individual counties, andnot by persons elected by the State atlarge. The counties control the Stateand not the reverse; the county isthe master and the State is the servant.The larger and more importantfunctions of the State may be expressedunder two sub-divisions:First, the State should deal withthose problems of general interestwhich either in character or in costof handling are such that the individualcounties cannot undertake. Amongsuch problems may be listed: (1) fixingand equalizing taxes; (2) operatingthe courts; (3) maintaining andsupervising a system of common education;(4) protecting and developingthe natural resources of theState, such as agriculture, forestry,water power, and manufacturing;(5) building and maintaining a Statesystem of highways; (6) caring forthe defective and delinquent; and (7)preserving and promoting the publichealth.Second, the State should discover,formulate, advocate and secure theadoption of standard methods of efficientadministrative procedure. Thispurpose results from the opportunitywhich the central agency of governmenthas, through its general point ofview and through its extensive knowledgeof various methods of procedurein operation in the different counties,to differentiate efficient from inefficientmethods. In this way the Statebecomes a clearing house of informationfor the counties in improvingtheir local administration. So it isthat the State acquires a leadershipwhich, properly developed, shouldconstitute one of its larger purposes.The State has no powers exceptthose delegated to it by the countiesthrough their representatives. Thecounties have reserved for themselvesthe right of administering their internalaffairs, among which may beenumerated: (1) establishing andmaintaining county roads which donot comprise a part of the system ofState highways; (2) caring for thepoor; (3) maintaining law and orderthrough peace officers; (4) imposingand collecting all local and countytaxes; (5) supervising the schools;(6) conducting elections; and (7)improving local health conditions.Of course there are many functionsof government which are strictlyState functions and others which arestrictly county functions, and, in discussingthe relation of State and

:PMarch, 1930 The Health Bulletin 17county, we may leave out of considerationthose activitiesfor which ad-ministrative responsibility is singleand not dual. On the other hand it isobvious that the State and countieshave many mutual interests and thatthere are numerous and closely related,overlapping responsibilities. Indealing with these matters of mutualinterest it is important for the sakeof harmony and efficiency that definitelyunderstood and mutually satisfactoryworking relations be established.There are two main principlesupon which such satisfactory relationsmay be developed.The first principle is that of thesegregation of responsibilities and activities,as for example: In the levyingof taxes it is possible, and it isthe practice in many States, to separatethe sources of revenue fromwhich the State is to derive fundsfrom those sources of revenue fromwhich the county is to derive itsfunds; in the building of roads it ispossible and in many states a practice,for the State to build the highwaysthat are more generally used,and for the county to build and maintainlocal roads.I The second principle for satisfactorilyrelating State and county activitiesconsists in the establishmentby the State of standard practices ofadministrative procedure, and the developmentof such standard practicesby official machinery or personnelelected and controlled by the countyand maintained jointly by local andState funds. Standards of work createdby the State should, whereverpossible, relate to definite objects tobe obtained rather than to budgets tobe expended, personnel to be employed,or methods of procedure to befollowed. In short, standards shouldbe directed to results; not methods.With regard to public health workthe State, that is, the federation ofcounties, is rightly held responsiblefor the condition of its death rate. Indischarging this responsibility, twomain avenues of service lie openFirst, the State should assumethose public health activities that canbe carried on, practically speaking,only on a State-wide scale andthrough State administrative machinery.Without entering into a discussionof the more important Statewidepublic health activities they maybe classified and listed as follows:A. Activities of common interest toall the counties and impracticable ofcounty handling, such as:1. State supervision over communicablediseases, for the reason that infectionand contagion do not respectcounty boundaries;2. Registration of births and deathsaccording to a standard system, forthe reason that birth rates and deathrates as between counties to havecomparative value must be establishedby uniform practice; and3. The protection of the purity ofstreams from which public water suppliesare taken, for the reason thatmany streams flow through severalcounties before reaching the one ormore whose citizens make use of suchfor domestic purposes.B. Activities which for economicreasons, for rendering unnecessaryduplication and multiplication of officials,machinery, and equipment, belongproperly to the State, such as:1. The pi-eparation and publicationof educational bulletins, pamphletsand leaflets needed in public healthadministration, for the reason thatthe additional expense necessary foreach county to prepare and publishsuch material would be alike unnecessaryand extravagant; and2. Maintenance of common laboratoryfacilities by the State for thesame reason as that for maintainingcentral common equipment for thepreparation of educational equipment.C. Activities concerned with diseasefactors of such exceptional importancethat the State cannot neg-

i18 The Health Bulletin March, 19 SOlect them and at the same time carrythe responsibility for a State-wide reductionin death rates, such as:1. A State policy for dealing withtuberculosis.2. A State policy for dealing withvenerealdiseases.3. A State policy for dealing withthe factors of infant mortality; and4. A State policy dealing with thecommon physical defects of schoolchildren.Second, the State in discharging itsresponsibility for the death rate shouldmake use of its central position andits federated authority to tactfully,progressively, and persistently lead,not drive, the counties to a clearerrecognition of their opportunities andresponsibilities for local health conditions.The individual county should bemade to understand that, after theState has gone its full length in dealingwith public health conditions bygeneral measures, the county may andcan do much more in a local and moreintense manner for the preservationand promotion of its own health conditions—justas the intelligent individual,after both State and countyhave done all in their power to protecthis health, may still do muchmore for himself than both governmentscombined. The county shouldfeel the same interest in its deathrate and the same responsibility formaintaining a death rate that comparesfavorably with that of othercounties that the State feels in maintaininga favorable comparative Staterate.A reduction in the death rate of acounty is an object of mutual interestto both State and county governments.On the one hand, the greaterthe activities of the county in the reductionof its local death rate themore pronounced will be the reductionof the general death rate of theState; on the other hand, the moreefficient the State-wide general measuresforimproving health conditions,the less the danger of diseases invad-ing a particular county from othercounties. It is clear, then, that aState reduction in death rates isachieved through a reduction of localcounty rates and a reduction bycounties is reflected in a lower Staterate. The interest of State and countyin local health conditions is mutual.Those who recognize local healthwork as a matter of mutual interestto both central and local governmentswill concede the right of the Stateto use every means to encouragecounty activity. They will go further.They will take the position thata matter of mutual interest should bedeveloped, dealt with and financed ifnecessary by both agencies concerned.County health work, then, is a problemcalling for the cooperative relationof State and county.As pointed out in the general discussionof the relation of State andcounty, it is always best, where possible,for the fields of activity oftwo governments to be clearly defined.This means, when the natureof the work permits, a separation ofactivities. In local health work, however,the nature of the work is suchas not to permit of the principle ofseparate or segregated duties, and,as likewise pointed out, in such casesit falls to the lot of the central governmentto develop standard plansand to assist and encourage, not direct,the local governments in theirexecution.Upon these fundamental principlesthe State Board of Health has beendeveloped over a period exceedingfifty yars. Through this system offormulating standard plans and assistingand encouraging their executionlocal county health units havebeen established and fostered till fromGuilford County organized on June1, 1911, the number has now reachedforty-four, representing more thanone-half the population and nearly^

March, 1930 The Health Bulletin 19three-fourths the wealth of the State.It is fitting, and necessary, thatfrom time to time we stop and considerthe basic principles upon whichwe are working. Such a review tendsto clear away the cobwebs of misunderstanding,to steady feet that aretempted to stray from the chartedcourse. Upon the principles whichNow and then the medical professionis upbraided by the proponentsof various notions in the field ofhealth and science because it fails togive to their claims what they conceiveto be adequate consideration.Again and again, the difficulies ofGalileo, Harvey, Jenner and Pasteur,when they attempted to convince theleaders of their times of the impoi-tanceof their d/iscoveries, arecited as evidence that scientists areintolerant. Apparently cultists andothers who have had but little experiencein reasoning and logic, orwith what is known as the scientificmethod, fail to take into account thefact that the world has moved sincethe time of the prophets, and thatscience has advanced more in the pastfifty years than in the previous fiftycenturies. James Harvey Robinsonwrote an interesting essay on "TheImportance of Being HistoricallyMinded." With a proper perspective,one realizes that science is today ina position to demand evidence to anextent that might not have been warrantedin a previous period when thewhole world was dominated by magicand mysticism.Recently, Mr. Chester Rowell, featurewriter for the San FranciscoChronicle, discussed the appeal fortolerance made by faith-healing cultsin the Los Angeles Times, followingan expose by the editor of The Journalof some of the weird quackeriesexisting in Los Angeles. Mr. Rowellsays:"But the appeal for 'tolerance,' bySCIENCE AND CULTISMwe have been discussing, principlesold and tried and true, but ever new,I pledge you the State Board ofHealth will continue to carry on.It asks your cooperation of mind andheart and soul that it may be of moreand more service in your county tothe end that North Carolinians shallhave life and life more abundantly.one 'school' of another, is an exampleof a common fallacy. There is no'tolerance' of astrology by astronomers.There is no 'tolerance' for fortune-tellingby psychologists, nor ofperpetual motion inventors by physicists,geologists do not locate oil orwater by dowsing with a forked stick,nor 'tolerate' those who do. Entomologistsdo not 'tolerate' those whowould exterminate insect pests by interferingwith their spontaneous generation.Scentific agriculture does not'tolerate' the theory that potatoes growwi'ong unless planted in the dark ofthe moon. All these 'schools' exist,and they are all rejected outright asunscientific superstitions by everyscientist in the world."On the other hand, good Catholicstolerate the Holy Rollers, and Buddhiststolerate the Mormons. Atheiststolerate the faith of Christians andChristians the unfaith of atheists.Protestants and Christian scientiststolerate each other's religion, eachrespecting the right of the other toseek God in his own way. But thelaw of the land did not tolerate polygamy,when the Mormons said it wasreligion, and the Regents of the Universityof California do not permitan anti-vaccinationist student to endangerthe health of other students,even though he calls his objection religious."So in medicine. If it were a matterof faith, dogma or canons, one'school' should 'tolerate' another. Ifit is a matter of science, then theonly distinction is that of scientific

—20 The Health Bulletin March, 1930and unscientific. And between scienceand non-science there is no equalityof right, and no basis for tolerance.The fact that millions of devout peoplein India believe in casting theirhoroscopes by the stars does not erectthem into a 'school' of astronomy, norimpose on astrononny any obligation'regular' nor 'irregular' astronomers—they are not astronomers at all.Neither is any unscientific theory orpractice of healing any part of thethe science of medicine. There areonly two sorts of medicine, scientificand unscientific. And of the unscientific'schools,' science has only this tosay—that they are unscientific."How, then, shall we distinguishwhich principles and practices ofhealing are scientific, and which arenot? The simplest test is that whichw^e unhesitatingly apply in every otherbranch of knowledge. That is thejudgment of scientists. If the scientistssay that a certain thing is scientific,we accept it as such. If they allsay it is unscientific, we say likewise,at least until it has succeededin convincing them. Every scientificuniversity in the world teaches astronomy,and not one teaches astrology.All of them teach chemistry andnot one teaches alchemy. Every universityin the world teaches scientificmedicine, and not one of them—nota single one in the whole world —teaches or recognizes any of the'schools' or sects for which the Tim.esspeaks. If the unanimous voice ofscience means anything, this is itsverdict."The next test, and the decisiveone, is that of method. Scientists maybe mistaken, sometimes, in their resultsand conclusions. Sometimes athing which seems true in the light ofincomplete information becomes onlypartly true in the light of later discoveries.But science is not mistaken inits method. That method is systematicobservation and experiment, andthe submission of these observationsand experiments to the scientists ofthe world, for them to repeat, to testand to scrutinize. Whatever pursuesthat method and is approved by thattest is scientific—including, in medicine,light rays for tuberculosis, dietfor many ailments and hydrotherapyfor certain mental conditions. Whateverdoes not proceed by that method,or fails by that test, is unscientific—includingall the cults, sects andschools which Dr. Fishbein rejectsand the Times defends."Mr. Rowell has placed his fingerunerringly on the weaknesses of thecultists. His logic might well serveas a text in the schools, not only thatit might aid the younger generationin learning the art of reasoning andjudgment, but also that physiciansmight realize the basic folly of thestrange schemes which are constantlybeing introduced to the public aroundthem. The A. M. A. Journal.FARM RELIEF, BETTER FOOD, BETTER HEALTHFrom the earliest written recordsmade by man down to our own daythere may be found proof that a largeand influential portion, if not a majority,have held a fixed idea that ournatural cravings were for things intheir very nature hurtful to us. Doctorsdo not need a billof particularsto call to mind a number of drugs,now known to be worthless, which"were once held in high repute for noother reason than because they werebitter or otherwise nasty; many canremember when orthodox treatmentdenied baths to fever patients andgave them water to drink only grudginglyand that tepid.Right now the same line of reasoning(rather, unreasoning) causes oursection to import white flour fromwhich to make insipid bread, to theneglect of our own home grown corn

March, 1930 The Health Bulletin 21and potatoes, which would meet ourneeds far more satisfactorily from thestandpoints ofboth health and appetite.The best of breakfast cakes is madeof corn meal; but it is doubtful ifcorn cakes can be had in a half dozenrestaurants in North Carolina tomorrowmorning. Plenty will serve buckwheatcakes; and the buckwheat cropof the state is so small that few ofits inhabitants would recognize buckwheatgrowing in the field. Thin,plain corn bread is preferred by thegreat majority of those who have hadit plain, made up with milk or waterand a little salt, unspoiled by powders,sugar or other fanciness, foreating with vegetables; and corn mealdumplings boiled in a pot of turnipgreens with ham hock make a mealrarely to be equaled and never excelled.Now about our potatoes. How manyare there, do you think, who wouldchoose cold sliced white bread"wasp-nest," as accurately definedby our epicurean friend, Mr. E. M.Bell) if offered hot potatoes roastedin their jackets? Until we lived someyears outside the South, we wonderedwhy people in other sections ate coldbread: living among them explainedit; they don't eat it; they eat hot potatoes.But even there they orderbread. We all have a hard time gettingaway from the idea that theremust be "meat and bread" on thetable. We are thus bound by tradition,much to our detriment.In Eastern North Carolina, accordingto numerous newspaper accounts,more farmers are unable to pay theirtaxes than in any previous year inthe history of the state. It is reliablyreported that last year first gradepotatoes, barreled by the roadside,were freely offered for the cost ofthe empty barrel.In the name of common sense,selfhelp,good health and pleased appetities,why don't we eat our potatoes?Travelers inthe poorest parts of Ireland,where the potato not only takesthe place of bread, but for days atthe time is the sole article of diet,find a vigorous, ruddy race. With theaccessories which are to be had byeven our poorest people, a diet satisfactoryin every way is in easy reach.The eastern counties of the Carolinasand Virginia grow sweet potatoesin quantities for the market. Apaper in the past 10 days carried anaccount of the growing of 248 bushelson one acre in the Piedmont section.With care this vegetable can be curedso that it will make a welcome additionto every table several days ineach week. It ought to be generallyknown, too, that, as to pumpkin pie,the more sweet potato and the lesspumpkin, the better the pie.Recent investigation has shownthat the peach has dietary elementsof the greatest value, and frequentlywe see in a diet list "orange juice ortomato juice;" why not recommendto our patients that they use tomatojuice, and bear it in mind that oursection grows many peaches and tomatoesand needs to have consumptionincreased, while there's not anorange or banana grove in our territory?On a recent trip through WesternCarolina it was noted that there appearedto be an unusually largecrop of apples, but the fruit wassmall and knotty. Inquiry of the womankeeper of a drink stand elicitedthe explanation. There came a hailstorm when the apples were small.The further information was vouchsafed,"Last year we had plenty ofapples and they didn't bring but 20cents a bushel; this year they offer adollar, but we ain't got no apples."This mountain woman had studiedeconomics only in the hard school ofexperience; but she had come to theheart of the farmer's troubles. Pricesof farm products are always highwhen there are no products to sell.

22 The Health Bulletin March, 1930The winesaps and pippins of Virginiaand the Carolinas are superior in everyway (except in looks) to themuch advertised apples of Washingtonand Oregon. We have just ashandsome an apple as theirs, the"Ben Davis;" but, as might be expected,it isn't fit to eat.In Southeastern North Carolina,centering about Chadbourn, Warsawand a few other points, is one of thelargest strawberry-growing areas inthe world. Year after year a greatpart of the crop, and of the very bestberries, goes to waste because after afew weeks of the season the price goesbelow the cost of picking and crates. Isthere a person in the whole worldwho does not relish strawberry preserves?And where the perfect fruitgoes to v/aste annually by the thousandsof bushels, is there not a goldenopportunity for salvage?North Carolina's herring fisheriesare among the greatest in the world,but entirely too much of the catchgoes to making fertilizer. Ruegger's inRichmond, one of the most famousrestaurants in the country, specializesin a breakfast of salt North Carolinaroe herring and corn cakes; tryto find that breakfast in Wilmington,Raleigh, Charlotte or Asheville!The Health Committee of the MedicalSociety of the State of Wisconsingives out a News Letter to the pressof Wisconsin every week or two. Thisjournal has been kindly placed on themailing list, and it trusts that nothingsaid here will be taken amiss;rather that that state, and all otherslaboring under the major affliction ofgoitre will derive benefit. A recentnews letter says:"The lowly turnip and the onionwere given a rank in the food diethigh above the fancy cakes and saladsby the Health Committee of the StateMedical Society. Some old-fashionedvegetable dishes would become popularif the medical profession had itsway.'Don't despise the turnip and theonion when picking your food,' declaresthe statement in announcinga number of rules for healthful eating.Fearing that suggestion mightnot be sufficient the health committeeadded:'Adopt a cosmopolitan menu—becomeacquainted with goulash, Irishstew, pig's knuckles and sauerkrautand a ragout with vegetables.'The statement declares that manypeople eat continuously the samethings with little variation, and pointout that some of the sjanptoms of alack of appetite come from a 'monotonousdiet.' It declares that so faras health is concerned, 'the cheapercuts of meat cooked with vegetablesare better than a diet of steaks andchops.''One of the evils of the presentdayeating is to depend too much onquick cooking,' continues the bulletin.'Good health will not last with oneminute meals'."The State of South Carolina hasshown that her vegetables have anunusually high iodine content, andhas made out a good case for thecontention that this is the explanationof the astonishingly small number ofcases of goiter among her population.This journal has applauded, and applaudsagain, the fine endeaver, headedby Dr. Wm. Weston, of Columbia,which first formulated the concept,then established the fact, then institutedmeasures to turn the informationto good account in the interestof the health of the country and of theagricultural industry of South Carolina.It is said that milk produced bycows that eat the grass and othervegetation produced in this favoredstate contains much more iodine andiron than that produced by cows inthe areas famed for dairy products.There is every reason to believethat investigations in North Carolinawill disclose substantially thesame conditions; and, if so, there will

:—March, 1930 The Health Bulletin 23soon ensue a demand formore productsthan both states can supply.The farmer has been the footballof politics longer than any of us canremember. During campaigning he isalways promised everything; onceelection results are announced he isgiven nothing except a lot of silly adviceabout "diversification," to thegeneral effect that the cotton farmershould plant tobacco, the tobaccofarmer cotton, the wheat farmercorn, the corn farmer wheat, and soon. And on every possible occasionthe money he has paid into the treasuryis voted to irrigate or drain andbring land now idle under cultivationto further glut the market with farmproducts.We here reveal means by which ourown farmers can be helped; and byno exercise of altruism, for we willbe helping ourselves.By eating potatoes and corn bread,not along with, but instead of,wheaten bread; by eating our ownfruits, vegetables and dairy products;and by letting outlanders know of thesuperiority of our products, we canlive on more appetizing food, producea hardier, healthier citizenry, and gofar toward assuring the farming anddairying industries of our section returnscommensurate with their investmentsin labor and money. Editorialin Southern Medicine and Surgery.INTERESTING LETTER FROM DOCTOR WASHBURNNOW IN EUROPEDoctor B. E. Washburn, formerly amember of the staff of the StateBoard of Health and a native ofRutherford County, is spending ayear in Europe for special study. Afterleaving Raleigh about ten yearsago Dr. Washburn was sent to Jamaicaby the International HealthBoard, where he has made a finerecord.His letter is so interesting that weare sure his many friends in NorthCarolina will enjoy the extracts whichwe are here quoting.Doctor Washburn's wife anddaughter are with him, the latterstudying drawing at the Royal DrawingSociety of London."Dear Doctor Cooper"You will see by the above addressthat my year of study leave has atlast materialized. We came here inSeptember and I am taking the courseat the London School of Tropical Medicine.It is very interesting but alsovery hard; in fact, I don't believe Ihave ever had to work so hard. Weare kept busy from 9 to 5 every dayexcept Saturday and I have to put inmost of the nights in order to keepup. It may be that I am slow with thework as this is my first attendance atschool in about twenty years. We havecompleted the work in malaria andprotozoology under Thomson and onlastFriday had the exam, on helminthology,the course given by ProfessorPeiper. The intensive course endsearly in March and, during the six orsevenweeks of vacation, we plan togo to Italy where I want to study themalaria work being conducted there.When we return in time for the publichealth course at the London Schoolon April 28, I will be in England untilJuly. That month will be spent inScotland, with Aberdeen as headquarters.At the completion of theyear of study I plan to spend my fourmonths of vacation in the States andwe should reach Raleigh sometimeduring September of next year."Living in London is quite an interestingexperience. There is no endof interesting places to visit—museums,galleries, exhibitions, etc. Younever get to the end of the list; and,this is especially true in my case

24 The Health Bulletin March, 1930since I have so much of my time takenup at the School. But I have beenable to vibit quite a number of placesabout London on Saturdays and Sundays.We came over two weeks beforethe opening of the School andduring that time visited Coventry,Kenilworth, Warwick, and Stratfordon-Avon;also we have been toHampton Court, Kew, and HampsteadHeath among other places. One of theinteresting features of being here isthat you run on places of literary andhistorical interest around nearly everyother corner. In the street whereour flat (the English call an apartmenta flat) is situated the housewhere Dickens lived for many yearsis just below us; Sydney Smith'shouse is just across the street; Ruskinwas born two blocks away;Thackeray lived and wrote VanityFair nearby; and, according to theguide book, the Rosettis lived in ourneighborhood, but we haven't locatedthe house yet. And the same thing istrue of most parts of London. A fewSundays ago we visited some friendswho live in Well Walk at HampsteadHeath. Just across the street fromthem is the house where Constablethe painter lived; adjoining them atthe rear is the old home of duMaurier,his son the actor, Sir Gerald duMaurier,living there at present. Butmost interesting of all, in the road intheir block is the old Well which wasfrequented by Shelley and Keats. Andin a nearby lane is the little hole inthe wall where Keats lived and starvedwith tuberculosis."The English have been very kind'\We think this photograph of the perfectly healthy sixteen months olddaughter of a Monroe dentist is one of the prettiest we have ever published.

March, 1930 The Health Bulletin 25to us; in fact, we cannot realize thatwe are in a foreign country, on theother hand we live as if we were athome. The main difference here isthat the houses are old and conditionsof living are not as comfortable as inthe States. But there is certainly acharm in the slow quiet way of lifethat is lacking in the States, especiallyin our cities, and one is content toput up with coal and gas fires andother primitive conditions. Living,however, is much cheaper than athome."The weather has been very goodthis winter—that is, to our way ofthinking. Two things you observe inthe English are, first, they don't halfappreciate their own country and arenot the least attracted by the manyplaces of historical interest. And secondly,they are disappointed if theweather isn't bad and rainy. This pastNovember has been very nice, wethought, as there have been not morethan three mornings with the temperaturebelow 40 degrees F. and it hasbeen well above 50 degrees most ofthe time—it has not been nearly socold as we usually have it at thistime of the year in North Carolina.As for rain, there have been a fewrainy days but, as a rule, the dayswere fair and the rain came at night.Then there were but two fogs andNovember, one is told, is the month offogs. As I said, it was not anjrthinglike as rough as we expected it wouldbe; but by this mornings paper wesee that it has been one of the wettest,most disagreeable months (Novembers)for several years!""Beautiful Day" sold more automobilesthan any other auto dealer inAllboro. His cheery greeting, and hisinevitable, "Beautiful Day!" while hisbrown eyes twinkled, regardless ofwhat the condition of the weatherreally was, had won for Robert T.Mimms, the title of "Beautiful Day."Winning for him the town's title ofchampion optimist it had sold manyan auto for the happy-faced youngauto dealer that might just as easilyhave been a sale for the dealer acrossthe street.Lon Queen handled the agency forthe car that in point of price rankednext to the one "Beautiful Day" sold.Lon was the town's champion pessimist,while "Beautiful Day" was itschiefoptimist.When the bottom dropped out ofthe New York stock market last November,and the greatest slump in its'BEAUTIFUL DAY"BySUDIE E. Pyatthistory hit the automobile industryLon Queen went about the streets ofAllboro telling anyone who would listenthat the country was on its wayto the dogs as fast as it could go.Not even President Hoover and theRepublican party would be able tosave it.The cars in his show rooms wereas good cars as his company had evermade. They were priced as lowas the company dare price them, consideringthe cost of production andcompetition. Despite the advertising,publicity and sales promotion ideasof his company Lon Queen had notsold a car in four months. He wasconvinced that never in the history ofthe country had business been so bad.Lon's ideas about the rottenness ofgeneral business conditions finallyseeped from his head, which was thecause of the trouble all along, downto the mechanism that digested andassimilated his food, and then disposedof the waste products. Lon's brainsconvinced his stomach that the worldwas a rotten place, too.Consequently Lon became a chronic

26 The Health Bulletin March, 1930sufferer from "indigestion," and allof the disorders of the digestive systemthat go along with that idea.One night late in March, just beforethe Easter holidays conditionsin the mechanism of Lon's plant forthe production of heat, good, redblood, body cells, brain cells included,nerves, muscles and pep for sellingcars, reached a high climax of inefficiency,and Lon came near havingwhat a doctor said was an "acute attackof indigestion."People sometimes were said to dieof acute indigestion, Lon knew, andit was, indeed, a pessimistic autodealer who crept down to his salesroomsabout noon of the day theworkers in his own production systemhad staged a near riot.Lon was convinced that no man inthe world had worse luck than he had.While Lon was in this extremely lowframe of mind, a well-dressed mancame into the sales-rooms, greetedLon pleasantly and lost no time inexplaining his business."Queen, glad to know you. Cowl,Owen C. Cowl, is my name. My firm,the Raybar Co., is opening a newbranch in this territory. I am manager.Allboro is to be my headquarters.I need a good light car such asyou sell to cover the territory.""Yes," Lon interrupted his prospectivecustomer, "but with businessconditions as bad as they are now,don't you think this is a bad time toopen up a new office of any kind?"Cowl smiled, "When business is badthat's the time to start something.Your competitor usually thinks youwon't start anything then, and whenyou do go ahead and start somethingyou steal a march on him."Lon dolefully shook his head. "Youtake a tip from an old-timer in thistown, young fellow, and wait a fewmonths until conditions are better beforeyou begin any new business here.You couldn't have picked a worsetown in the county to open up a newbusiness in.""You talk as if you had a grudgeagainst your town, or a case ofchronic indigestion," Cowl grinnedgood-naturedly as he flung this at theman he expected to buy his new carfrom."Indigestion? Why man, you don'tknow anything about indigestion untilyou've had an acute attack as Ihad last night. Just a little worse,and the doctor said I might havedied.""Too bad," the young manager'seyes roamed to the window and caughtsight of the display windows ofMimms Motor Sales, "BeautifulDay's" auto sales rooms. "Thanksvery much for the advice, Mr. Queen.Hope the indigestion gets better, butI've just decided to buy a differentkind of car."A black frown on his face Lonwatched his prospective customercross the street to Mimms MotorSales."Good morning," "Beautiful Day"greeted the stranger."Look here," was Cowl's return to"Beautiful Day's" greeting, "if you'vegot a car to sell me that I want I'min the market for one today, and I'llpay cash, but I'll just be hanged ifI'll listen to any talk of attacks ofacute indigestion or hard times intown from you.""Wouldn't bother you with anysuch talk for the car I'm going tosell you," "Beautiful Day's" eyestwinkled."All right, show me something inyour best business sedan," Cowl lighteda cigarette and followed "BeautifulDay" to the car he wanted to see."New comer in town?" "BeautifulDay" asked, stopping a minute afterhis demonstration of the car's brakes."Yes, opening up a new branch officefor my company here.""Fine!" "Beautiful Day" was enthusiastic."You couldn't find a bet-

March, 1930 The Health Bulletin 27ter town in the state to open up a newbusiness in, and this is a good time tobe starting.""My company thinks so," Cowllooked at the car's motor with coldlyappraising eyes, "but the old birdacross the street tried to persuademe everything was all wrong, andas if that wasn't enough entertainedme with an account of some sortof an attack of indigestion he had lastnight. Guess the old fellow was so busyworrying about bad times he hadn'tgiven his stomach a chance to functionproperly.""Lines and finish of this car arethe finest in any automobile of thisclass," "Beautiful Day" went on withhis sales talk."All right, I'm sure the car is whatI want," Cowl said as "BeautifulDay" stopped for a moment. "Haveher put in shape for driving. I'llwrite you a check and just drive heraway if you don't mind.""Certainly is a beautiful day, isn'tit"? Mimms remarked as Cowl handedhim a signed check."Lovely!" Cowl agreed, and bothmen glanced out of the window wherea fine spring rain was falling."I still contend it is a beautifulday," Mimms said."And I still say it is a lovely day,"Cowl reached for his hat, "and businessis good, this is a good town, wehave no acute indigestion and nonear-deaths, or deaths today."The men shook hands over this andCowl departed in his new car, themachine moving along at a slow,steady pace as became a new automobile.From the windows of his office LonQueen watched his erstwhile customerdrive the shining new car fromhis competitor's sales rooms. Thatnight Lon Queen did have an attackof "acute indigestion" that two doctorssummoned in the middle of thenight, his wife and neighbors, allthought would be the end of LonQueen.Lon was white and trembly and insistentlycomplaining of bankruptcyfor the Queen Motor Co, when hisdaughter, Peggy, came home from hersenior year in college for the Easterholidays."You'll have to leave college forthe remainder of the term," he toldher. "If conditions improve maybe youcan go back for a term later and getyour diploma.Lon expected Peggy to take thisas final, and probably to begin amaidenly tirade against hard times,acute indigestion that struck fathersdown just when they were most needed,and "Beautiful Day," his competitor.A large part of the tirade hewould like directed at "BeautifulDay," but Peggy did nothing of thekind."Let's see,dad," she said shrewdly,"the commission on the sale of onlyone car would more than keep me incollege for the remainder of the year.I'm going to open up the sales roomsin the morning. If I can sell a carbefore time for me to return to college,back to college I go."Lon observed his sprightly daughter,a frown gathering between hisheavy brows."Young lady, I tell you times inthis town are too hard to sell cars.Your old father has sold cars everysince cars v/ere sold here. I haven'tsold a one since the bottom droppedout of the stock market in November.Don't think you're better than yourold dad, do you?"Slowly Peggy shook her shortcurls. "No, daddy, but one never cantell. You know you're always worriedwith indigestion, headaches and hotflashes, and you're always talking tofolks who come in to look at carsabout your symptoms and hard times,I'm going to talk cars and collegeslang to 'em."Peggy was as good as her threat.

28 The Health Bulletin March, 1930Promptly at 9 o'clock next morningshe opened the Queen Motor Company'sdoors, doors which because ofher father's illness, had been closedall week.Her curls adjusted to just the properdegree of careless confusion abouther well-formed head and her pertlittle nose daintily powdered, Peggytook a big cloth, which she foundafter considerable rummaging, andbegan a vigoi'ous polishing of the exteriorof the dusty coach that stoodon display nearest her father's office."Why, good morning, Peggy! Ididn't know you were at home.""Beautiful Day!" Peggy screechedin delight, dropping her polishingcloth, "And why did you forget togreet me with your favorite 'BeautifulDay'? I feel terribly neglected.""0, Peggy Queen, forgive a man,"and "Beautiful Day," gallantly handedthe college girl who would be anauto salesman her cleaning cloth."Every time I see you I'm remindedanew that queens do actually thriveand pi'osper in this democratic landof ours.""Perhaps," Peggy frowned, viciouslyusing the polishing cloth, "but Idon't see much of it right now.Gosh—!" She broke off, "—I forgotyou're our worst enemy, and here Iam telling you secrets.""Is there anything I might do tohelp you, Peggy?" "Beautiful Day"inquired anxiously."Oh, no," Peggy was quick on theretort. "That nice, cheerful way youhave, 'Beautiful Day' just makes everyonewant to tell you everything.No wonder you sell cars. I'll bet youdon't have indigestion and talk it andhard times to your customer, either.""You can just bet your pretty curls.Queen Peggy, I don't."They both looked up as a mangreeted them in the doorway of theauto sales room."Mr. Minims, I believe," the mansaid speaking to "Beautiful Day,"ignoring Peggy."Yes.""My name is Witherow. Cowl ofthe new Graybar Co., sent me downto see you about a car for myself. Hebought one from you early this week.It's a fine car, and he says you'regreat to do business with.""Beautiful Day" looked at Peggyas the man talked. The eager, hungrylook in her eyes arrested his thoughtsthat were hurrying along the lines ofa sales talk for his own car. To hisown knowledge her father hadn'tsold a car in four months. The girlwas probably right about being neitherprosperous or thriving. The Queenfamily evidently weren't prosperingfrom the auto business.Again there was that eager look,and Peggy smiled at him a slow, patheticlittle smile.Then and there "Beautiful Day"did something he had never done before.He to his own, Peggy's andWitherow's surprise voluntarily turneda prospective customer over to acompetitor. Turning his customerover to his competitor was not all. Hestayed and assisted in the sales talk,though Peggy didn't need much assistanceonce she had a prospect.An hour later Witherow drove thecar Peggy had been polishing out ofthe Queen Motor Company's showrooms. He had paid cash, fifty percent, and Peggy's commission on eventhe fifty per cent cash paid wouldkeep her in college the needed sixweeks."Why did you do it, 'BeautifulDay'?" Peggy asked when Witherowand the car were gone."Beautiful Day" looked across thestreet to Mimms Motor Sales. He hada swift vision, of Peggy's hands onthe wheels of the best car he sold,driving it down to take him homewhen the day's work was over."Because I've always loved you,Peggy."

March, 1930 The Health Bulletin 29"Alwaj's loved me? 'Beautiful Day'you fib!" Peggy jumped to her feet,the warm color mounting to hercheeks."You've known me for only fiveyears, since you opened up your agencyin opposition to dad, and we'vebeen competitors every since we'veknoTVTi each other.""Perhaps your dad, and I havebeen, Peggy, but not you and I.""No," Peggy shook her short curls,"I've always sort of liked you."With that "Beauiful Day" tookcourage. "Will you marry me, Peggy,after you graduate in June?""Couldn't put us out of businessany other way, so you think you'regoing to marry us out?" Peggy jeered,her soft moment gone."No, dear," "Beautiful Day" waspatient. "I'd like your dad to keepthis agency as he has it, only I'd liketo help him change his methods andmake money in the business.""Poor dad, with his indigestion andhis hard times, he does need someoneto help him.""I'd do anjiihing for you, dear,""Beautiful Day" reminded Peggygently."—Even marry me," she teased,and "Beautiful Day" took her in hisarms.If Peggy thought her father wouldbe happy over the sale of the firstcar he had disposed of in four monthsshe was mistaken. It would have beenbad enough for his daughter to havesold it, but to discover that his competitorhad practically disposed of thecar was both humiliating and embarrassing.His indigestion immediately reachedthe point of another acute attack.The doctor was hurriedly summoned.Along with the doctor, a local justiceof the peace was called to seethat the sale of the car was cancelled,and cancelled legally."Beautiful Day" should never havea chance to say that he had sold acar for Lon Queen. Charity that'swhat the man was trying to givehim. He wouldn't take it.He groaned sharply, as an extrapain shot through the center of hisbody. Maybe this time he would die."Beautiful Day," his contemptiblecompetitor, and hard times would bethe cause of his death. Yes, he'd be amartyr to the modern economic system.While the doctor and the justice ofthe peace were being summoned forLon, Peggy was hurrying down to"Beautiful Day." After her fewbreathless words of explanation"Beautiful Day" tucked her into hiscar, the one he had imagined herdriving down for him in, earlier inthe day, and they went in search ofthe justice of the peace."Sure, I understand," the man ofthe law said, when "Beautiful Day"and Peggy had together explainedthe trouble. "I'll drive to the houseand mollify Lon, but I won't botherthe man who bought the car."Peggy and "Beautiful Day" followedthe justice of the peace to Peggy'shouse. Arrived there they found Lontelling the man that he wouldn't bedictated to by a judge of the UnitedStates Supreme Court, much the lessan Allboro justice of the peace."I'm going down and tell thatWitherow man, he can't have thecar," Lon announced, getting angrilyout of his bed.Mrs. Queen was standing by Lon'sside, vainly endeavoring to get himto remain in bed, and the justice ofthe peace was helpless when "BeautifulDay" and Peggy burst into theroom."Get out of here!" Lon's voice roseto a scream when he saw "BeautifulDay."Peggy placed herself in front ofher lover, and spoke to her father."Dad, 'Beautiful Day' isn't going toleave until you and mother give usyour parental blessings, or whatever

30 The Health Bulletin March, 1930it is parents give daughters who havejust become engaged. 'Beautiful Day'and I are going to be married when Ifinish college in June."Lon took one glance at his daughter,and the detested man she was goingto marry and subsided groaning inhis bed, his hands, clutching the midsectionof his body helplessly."I'm going to die! They're goingto kill me!" he moaned.Mrs. Queen fussed helplessly abouther sick husband. She had never beenable to manage him, and admitted it."No, Dad, you aren't going to die!"Peggy put firm, young fingers on herfather's forehead. "You're going toget out of bed, forget you ever hadindigestion and such things as hardtimes, and together you and BeautifulDay' are going to revolutionizethe automobile industry in Allboro,and make loads of money for theQueen family and the proposedMimms family.""Who says so?" Lon asked weakly."I said so!" Peggy spoke firmly."I want to back up the businesspart of it, Mr. Queen," "BeautifulDay" said. "If you'll permit me tohelp you I think we can make a realsuccess of the auto business in Allboro."Lon was silent. Through his mindran the memory of the last fourlean months. Just how near he hadcome to bankruptcy and his family toactual want, only he would ever know."Beautiful Day" did sell cars. Maybehe could help him."What sort of business arrangementsdo you want to make?" he askedfeebly."Tell you what, Mr. Queen, I wantyou just to lie here in your bed andrest for today. While you're restingI want you to read this little typewrittenbooklet, and let what it sayssink in.""Yes," Lon reached for the booklet"Beautiful Day" handed him as if hereallj' meant business."This little booklet," Mimms explainedcontains 14 short secrets ofhealthful living and efficient sellingto which I attribute my success asan auto dealer. Five years ago myhealth broke down completely. I hadto go to a sanatorium for six months.While there I had time for reflection.I studied and read a good bit, andfinally hit on these 14 secrets. In mycase I have found them most workable,real secrets of success. I hopethey will help you as much as theyhelped me."Lon was already starting to readthe first page of "Beautiful Day's"book of secrets as his daughter andhis future son-in-law and businesspartner left his room.The Secrets were as refreshinglyoriginal as was "Beautiful Day" himself.Grudgingly Lon admitted it wasinteresting reading.Secret One read this way:Whether you sell cars, real estateor lingerie you've got to talk thething you're selling, and the personyou're selling to. You can't talk yourself,and your digestive and healthtroubles and make sales.Secret TtvoPeople have enough attacks of indigestionand sleepless nights of theirown without listening to more of themfrom the man they're buying as expensivea commodity as a car from.Secret ThreeBegin talking about your stomachand hard times when a man is tryingto buy and there'll be no sale.Secret FourIt's all right to talk about the otherfellow's troubles if he insists, but forGod's sake keep your own under cover.Secret FiveIf the prospect insists on talkingabout his health, or hard times sympathizewith him, but get him offhis health and the times as soon as

March, 1930 The Health Bulletin 31you can, for hissake, your sake, andthe sake of the sale you're going tomake.Secret SixA man who talks his poor healthand hard times when he ought to betalking business deserves to losesales.Secret SevenIf you're always talking hard timesthe times will be hard. Talk goodtimes and there may not really begood times, but everybody will certainlyhave a better time listeningto you.Secret EightA man or woman can't successfullyconduct a business and meet moderncompetition who are always talkingabout the poor state of their health,and who insist on always talkinghard times.Secret NineHave a thorough physical examinationonce a year from a good physician.Correct all disorders after theexamination, and regularly as theyappear.Secret TenHave a good family physician, andif illness comes up between physicalexaminations go to him immediatelyand let him treat you.Secret ElevenDon't worry about your physicalcondition, or any ailment. Tell it tothe doctor and let him do the worry-"RICH MAN, POOR MAN"ByIra S. Wile, M. D.'ing. It's his business to worry aboutpeople's health. It's yours to sellcars, or whatever you happen to beselling or doing so you'll have thewherewithal to pay the doctor, "thebaker, the butcher and the candlestick maker."Secret TwelveNever burden your customers withyour own fears whether they be ofyour health or the times.Secret ThirteenIf you talk bad health and badtimes, both your health and the timeswill be bad.Secret FourteenGive everyone who comes into yourplace a pleasant greeting and say theday is beautiful, though it may beraining, snowing, sleeting, hailing,the legendary "pitchforks and toads"outside.Lon had read the secrets carefullytwice, when he placed the booklet onthe table by his bed. At last he understoodhow "Beautiful Day" hadearned his name, for really earned ithe had.He was going to put those secretsto work Monday morning. Bet he'dsell a car, too, he thought as hedropped off to sleep. Oldest autosalesman in Cochran county, he'dshow young upstarts he could stillsell cars, if he did have to use hisformer competitor's health and businesssecrets to help him do it.Teachers, subjects, school compan- quick, the dull and the bright, theions, rules, regulations, examinations stupid and the brilliant, the defectiveand disciplines are far more importantthan most other elements in crippled, the mute, the blind, the deaf,and the genius, along with theschool hygiene. The school world has the diseased, the neurotic and theits currents and eddies, its deserts prepsychotic are seeking their levelsand shifting sands, its jungles and in schools, in education and in socialarid plains, over and through which relationships. Children are bornchildren must swim, crawl and struggleto reach some goal that is said make the truth too apparent, but oftenneither free nor equal and the schoolsto be desirable. The slow and the at great sacrifice of children.

(sooiomoODiO12;p^o

Published bn TI\£.l^°KJI\QI^Lm^ STATLDPARDs^AmUn1 This Bullelirwvillbe .serxl free to oixg citizer\ of the State upor\ request, jSntered as second-class matter at postofflce at Raleigh, N. C, under Act of July 16,1894. Published monthly at the office of the Secretary of the Board, Raleigh, N. C.VOL. XLV. APRIL, 1930 NO. 4MAKE MAY DAY CHILD HEALTH DAY

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTHA. J. CROWELL. M.D., President CharlotteCYRUS THOMPSON, M.D JacksonvilleTHOMAS E. ANDERSON, M.D StatesvilleB. J. TUCKER, D.D.S RoxboroD. A. STANTON, M.D High PointJAMES P. STOWE, Ph.G CharlotteJOHN B. WRIGHT, M.D RaleighL. E. McDANIEL, M.D JacksonCHARLES C. ORR, M.D AshevilleEXECUTIVE STAFFCHAS. O'H. LAUGHINGHOUSE, M.D., Secretary and State Health Officer.RONALD B. WILSON, Assistant to the Secretary.C. A. SHORE, M.D., Director State Laboratory of Hygiene.G. M. COOPER, M.D., Director Bureau of Health Education.H. E. MILLER, C.E., Chief of Bureau of Engineering and Inspection.F. M. REGISTER, M.D., Director Bureau of Vital Statistics.H. A. TAYLOR, M.D., State Epidemiologist.GEORGE COLLINS, M.D., Director Bureau of Maternity and Infancy.C. N. SISK, M.D., Director of County Health Work.ERNEST A. BRANCH, D.D.S. , Director of Oral Hygiene.FREE HEALTH LITERATUREThe State Board of Health publishes monthly The Health Bulletin,which will be sent free to any citizen requesting it. The Board also hasavailable for distribution without charge special literature on the followingsubjects. Ask for any in which you may be interested.Adenoids and TonsilsCancerCatarrhCare of the BabyConstipationColdsClean-up PlacardsChickenpoxDiphtheriaDon't Spit PlacardsEyesPliesFly PlacardsGerman MeaslesHookworm DiseaseInfantileIndigestionInfluenzaMalariaMeaslesPellagraParalysisPublic Health LawsPrenatal CareSanitary PriviesScarlet FeverSmallpoxTeethTuberculosisTuberculosis PlacardsTyphoid FeverTyphoid PlacardsVeneral DiseasesW^ater SuppliesWhooping CoughSPECIAL LITERATURE ON MATERNITY AND INFANCYThe following special literature on the subjects listed below will besent free to any citizen of the State on request to the State Board ofHealth, Raleigh, N. C:Prenatal Care (by Mrs. Max West)Infant Care (by Mrs. Max West)Prenatal I^etters (series of ninemonthly letters)Minimum Standards of Prenatal CareWhat Builds Babies?Breast FeedingSunliglit for BabiesSave Your BabyHints to North Carolina Mothers WhoWant Better BabiesTable of Heights and WeightsPAGEDoctor William Henry Welch,Medical Statesman 4An April Medley 5Visual Minded 8A Contributor Submits Some ValuableSuggestions 9Vacation Resolutions 9Nutrition Studies in ElementarySchools 11A Bouquet from a Competent Critic_12CONTENTSThe Runabouts in the House of Health(pamphlet for children from 2 to 6years of age).Baby's daily Time Cards: Under 5months; 5 to 6 months; 7, 8, and 9months. 10, 11, and 12 months; 1year to 1,9 months; 19 months to 2vears.Diet Lists: 9 to 12 months; 12 to 15months; 15 to 24 months; 2 to 3years; 3 to 6 years.PAGEThe Value of Milk in the HumanDiet 14The Control of Measles 16The Use of Immune Human Serumfor the Prevention of Measles 18Epidemic Meningitis 21Points to be Considered in Case ofa Poliomyelitis Epidemic 22Things That Can Be Added forHealth and Efficiency 24Endemic Typhus Fever 25Typhus Fever 26

VOL. XLV. APRIL, 1930 NO. 4WILLIAM HENRY WELCH, M. D.

The Health Bulletin April, 1930DOCTOR WILLIAM HENRY WELCHMEDICAL STATESMANThrough the courtesy of Dr. JohnA. Kingsbury, secretary of a nationalcommittee formed for the purpose ofcelebrating the 80th birthday of Dr.William Henry Welch in WashingtonCity on April 8, we are presenting acopyrighted photograph of Dr. Welch,who has been designated as a MedicalStatesman. The celebration of Dr.Welch's 80th birthday will be held inMemorial Continental Hall in Washington,April 8. The ceremonies willinclude the presentation of a portraitetching of Dr. Welch, made by a celebratedartist. We are devoting thisspace in honor of Dr. Welch becausehe is the greatest living member ofthe American medical profession.Besides, he is one of the greatestpathologists in the world.Doctor Welch founded the Chair ofPathology and was its first professorin John Hopkins University.He filledthat chair for more than thirtyyears, resigning in 1918 to found theSchool of Hygiene and Public Healthin that institution. Last year, at theage of 79, he was made the first professorof the Department of Historyof Medicine in Johns Hopkins. Hehas exerted a greater influence onmedical education and public healthother man in it.in the United States during the lasttwenty-five years than possibly anyDr. Welch was presentin a German laboratory at thetime Robert Koch, a great Germanpathologist, offered the first definiteconclusive proof that bacteria maycause disease. This occasion was oneof supreme importance to the humanrace.Doctor Welch had spent -two yearsin Germany and in study in Europewhile a young man, coming in contactwith some of the most brilliant youngstudents in Europe, whose nameswere later to become famous throughout the earth. He so distinguishedhimself as a student while in Europethat many years later, when the presidentof Johns Hopkins Universityfollowed the habit and custom of thetimes in proceeding to Europe insearch of a professor to fill the newChair of Pathology in Johns HopkinsMedical School, in Germany he wastold that there was no need for himto undertake to engage any European;that they had in New YorkCity one of the greatest pathologists inthe world, although his fame at thattime had not reached the proportionsit did in subsequent years. So thepresident of Johns Hopkins came backto New York and engaged Dr. Welchfor this important post.Thus the career of Dr. Welch emphasizes,among other things, the factthat when great things are to be accomplished,there are always availablein every comn ac,\ty ur state menfully capable of undertaking andsuccessfully executing any proposedhuman project. We wish for Dr.Welch many more years of healthand happiness.Out for a morning "constitutional"up in Franklin County.

April, 1930 The Health BulletinAN APRIL MEDLEYA NUMBER OF THINGS, INCLUDING "PATENT" MEDICINES, NEWS-PAPER ADVERTISING AND TESTIMONIALS FROMPROHIBITION LECTURERSTo those people who think that thepatent medicine industry is eitherdead or in a dying condition we wouldlike to suggest that they make someobservations for themselves. First,spend a lot of time each day in lookingover the advertisements appearingin the average daily or weeklynewspaper. Take a rule and measurethe amount of space utilized in anydaily issue, say, of any morning newspaperpublished in North Carolina,in advertising. Then measure thepercentage of the advertising devotedto so-called "patent medicines." Youwill be amazed to see the large percentageof high priced newspaperspace bought and paid for by thepatent medicine industry every day.Second, take a seat by the fountainin any busy drug store, especially thecut-rate places, where they sell dollarpackage medicine for ninety-ninecents, and note how rapidly theshelves are thinned out of packagestuff. It is almost equal to a raid ona chain grocery store in a busy hour.These things indicate that people areyet buying and consuming largequantities of the stuff sold in suchatractive packages, bottles, and so on,and advertised so attractively by peoplewho know how to exploit suchthings.Along about this time of year, whenthe winter is vanishing and thespring and sumer is beginning to influenceour feelings, the most of usrevert to type and either have thespring fever feeling or we think thatour blood needs purifying, our systemneeds clearing, or we need some kindof a tonic to make us feel better. Inthe sassafras tea area, where sulphurand molasses form the chief base, notmuch damage is done except to thefeelings of the youngsters who areforced to take on a good bit of thisstuff. For most of the population,however, the dependence must still beplaced in the "patetits." So whatmore natural than for us to experiencethe usual human reaction whenwe look into our favorite morningnewspaper and see a testimonial fromsome great man or noted actress proclaimingthe cure-all qualities of oneor another nostrum, all of which invariablyhas a fine alcoholic content.The newspapers help these thingsalong mightily. Naturally it is notour pi-ovince to undertake to regulatethe ethics of the newspaper profession,as we have a hard enough timeregulating the ethics of our own profession;but some of these days weare going to write an editorial underthe heading, "Advertising for ResultsThat Cannot Be Got." That however,is another story which must wait awhilelonger.Science News Letter carried a storya few weeks ago quoting a womanphysician who had lived in the SouthSea Islands with one of the mostprimitive tribes encountered in thatfamed area. This woman physician,on coming back to civilization, announcedin her first interview thatshe had come to the conclusion, fromliving among these Islanders, thathuman nature had changed but littlesince the Stone Age. That is reputedto have been twenty to thirty thousandyears ago. It is even so in therealm with patent medicine exploitation.Manners may change andmethods may be altered, but we arethe same gullible kind of people thatwe have always been when it comes tolistening to the siren voice of thefellow who has something to sell us,especially if he can succeed in making

The Health Bulletin April, 1930us believe that it is something thatwill benefit our health or mean moneyto our pockets.A New Patent Star AppearsSometime late last summer wenoted in nearly all the papers ofthe State attractive semi-news articles,sometimes with the little abbreviation"advt." stuck at the bottom,and sometimes not. All of the literatureconcerning this new wonder inthe proprietary field brought to ourmind familiar memories of some fifteenyears ago when Tanlac washelping support a great number ofexploiters in this State. All of thematter had a strangely familiarsound. So, to satisfy our curiosity,we wrote to the Bureau of Investigationof the American Medical Associationfor information concerningthis new star among the patents,namely, Sargon. Sure enough theanswer to our inquiry revealed thesecret; in fact, two of them. Thecommunication is so interesting thatwe are herewith publishing the letterin full. But the two secrets, as thereader wil note, are; first, the sametalented artist who made a fortuneout of Tanlac is now promoting Sargon;and, second, whisper this, itcontains about 17 per cent of alcohol.The American Medical Associationletter follows:"Sargon' comes in two forms, aliquid and pills. The liquid is thechief product and is simply one moreof the nostrum that, apparently, owetheir popularity to the alcoholic 'kick'that they contain. In this case, weunderstand that it is 17 per cent. Inaddition, the stuff contains some vegetablebitters, according to an analysismade in the Drug Laboratory of theUniversity of Kansas. The 'SargonSoft Mass Pills," which are recommendedas a complimentary treatment,are essentially phenolphthalein—in other words, they are laxative."Sargon is being exploited in theballyhoo manner that was used toadvertise 'Tanlac' a few years ago.In fact, the man who is back of thestuff is the former exploiter of Tanlac."When the reader recalls that inthe balmiest days of liquor traffic inthis State good strong corn whiskeycontained only about double thatamount of alcohol, one grand reasonfor the popularity of this cure-all isno longer a secret. We had only towait a few weeks after the beginningof this fine advertising last summerand fall before the appearance of theinevitabletestimonials.Testimonial from Prominent ProhibitionLecturer and FormerCongressman.True as the Pole Star, along inJanuary we clipped the following advertisementfrom the Raleigh Newsand Observer. Now, this advertisementis not unusual, and there wouldbe nothing in it out of the ordinaryrun of testimonials, but in this casethe testifier is none other than Hon.W. D. Upshaw, for eight years a memberof the United States Congress,This little nephew of the ruralschool supervisor of Edgecombe Countyis getting his share of the springsunshine in a costume designed forthe purpose.

"April, 1930 The Health Bulletinifrom the great city of Atlanta,Georgia. Mr. Upshaw is not unknownin Raleigh, having appeared inthis city at least one or more times,engaged in fighting the liquor traffic.Of course he was lecturing at somuch per lecture plus expenses, all ofwhich was a perfectly legitimate enterprise.To those among our readerswho have heard the Congressman talk,nothing could seem to him to bemore heinous in this world than theuse of alcohol in any way, shape, orform. We shall not undertake topaint the lily, because anything wecan say here could not approach theheartfelt testimonial of this prominentprohibition worker proclaimingthe merits of a wonder medicine containing17 per cent of pure grainalcohol. The advertisement from theNews and Observer follows:"Hon. W. D. Upshaw EndorsesSargon."I'm Simply Following The GoldenRule in Telling Others of RemarkableBenefits," Says FormerCongressman."Few men in America are knownto more people from coast to coastthan William D. Upshaw, formerCongressman from the Fifth (Atlanta)District of Georgia. During hiseight years in Washington he attainednational prominence. A wellknown national magazine describedhim as "the most amazing man inCongress.""Mr. Upshaw has lectured in everyState in the Union and is the authorof numerous books. His home is nowin Asheville, North Carolina. Mostof his time is devoted to the lectureplatform."So remarkable and gratifyingwere the benefits derived by Mr. Upshawfrom the use of Sargon, thathe recently gave it his endorsementvoluntarily and without solicitation,in the following statement:" 'Obeying a grateful impulse becauseof the great physical blessingreceived, I feel it my duty to othersufferers to tell what Sargon did forme. Three experiences with it, eachsome six month apart, have so convincedm.e that it is an honest andthoi'oughly helpful medicine, that Iam simply 'doing unto others as Iwould have them do unto me,' in makingthis voluntary statement." 'My first experience with this remarkableinvigorator came in thesummer of 1928, when Sargon wasbrand new. I was suffering fromnervous debility and an alarmingphysical depletion as the result ofover-work on the lecture platform,and really feared I would not havestrength enough to get me throughthe political campaign of July andAugust. Unbelievable as it mayseem, two bottles taken with the SargonPills simply made me over. Afterthe most hectic speaking campaignthrough which I ever passed, I cameout actually feeling far stronger thenwhen I began.*''Later, rushing away on anotherbusy speaking tour covering severalStates, I did not persevere in the dailyuse of the medicine until my systemwas thoroughly cleansed, with the resultthat twice since then I found myselfsuffering from general debility,constipation and dizziness, and eachtime the Sargon combination hascleared me up and left me feelingtip-top." 'Living now in the aftermath ofthose refreshing experiences, I ammoved by common gratitude to heartilycommend this wholesome and effectivemedicine to everybody whoserun-down condition calls for completerestoration.'The Prohibition cause in the UnitedStates has not only had to sufferfrom the fanatical and selfish criticismof the wets, but it has often hadthe humiliating experience of discoveringmany hypocritical advocatesamong its ranks, who do not practice

8 The Health Bulletin April, 1930what they preach. North Carolinahas not only cast its official vote forthe prohibition of the liquor traffic,but the State Board of Health wouldIn a recent letter to the Editor ofthe Bulletin from the chairman of theBoard of Medical Picture Films of theAmerican College of Surgeons, andfrom Dr. Franklin H. Martin, theDirector General of the Medical FilmDivision, the following significantstatement is used:"Most of us are visual minded."Come to think about the matter itis certainly a fact. Normally, everybodyis visual minded. Every schoolteacher knows that the children whoearly develop their powers of obsertionare the children who make themost rapid and satisfactory progressin school.The American College of Surgeonshas encouraged the production of aseriesof films on medical subjects tobe used in the teaching of medicalstudents in the colleges, and also tobe used in instructing physicians inthe post-graduate medical schools. TheEastman Films, Incorporated, ofRochester, New York, has producedthese medical films. The AmericanCollege of Surgeons, of course, hasno financial interest in the proposition,but their interest is confined tothe most practical and intensive disseminationof medical information.It would seem at present that thetendency is to eliminate all of thesilent films, and, through what ispopularly known as the talkies, theamusement film from now on is to bean admixture of talk and sound combinedwith the visual method. Thiswriter is not in a position to criticise,but it does seem that confusingthe listener or spectator, whicheverlike to see a prohibition of so manyworthless remedies, loaded with alcohol,which are sold to the peopleinVISUAL MINDEDthe audience is to be designated, willbe the result, unless the process isto be simply a return to the beginningthe guise of "cure-alls."of the old picture business, which wasthe old lantern slide, or what was firstknown as magic lantern with thelecturer and his stick pointing out onthe screen and describing the processstep by step.It may work out all right in thisage of haste and speed. The humanear and brain may be able to accommodateitself to the excess burdenwhich it is constantly being calledupon to carry. The statement, however,of the high officials of theAmerican College of Surgeons, thatmost of us are visual minded, is astatement that should be seriouslyconsidered in all schools and collegesas well as the medical schools.The tendency of this age, of course,is to go to extremes in everythingthat we undertake. Those of us whoread the papers will remember thatonly a short time ago some supposedlyresponsible official in educationalcircles in New York or Pennsylvaniawas advocating the use of the radioin order to eliminate the services ofteachers in the schools and install aloud-speaker in each schoolroom, andto let some of the experts dispensewisdom over the radio for the younghopefuls to absorb.This proposal is getting away fromthe American College of Surgeonsidea with a vengeance. It is goingabout as far in the opposite directionas it would be humanly possible to goat the present time. We hope, however,that the methods always founddependable in the field of visual educationwill never be junked untilsomething better comes along to takethe place.In the meantime numbers of thelargest cities in the country are very

April, 1930 The Health Bulletin ybusy at present enacting ordinancesto curb the noise nuisance. Suchpapers as the Washington Post andsome of the great' New York Citydailies have recently been carrying ona voting contest in order to ascertainwhat kind of noises are most objectionableto the average resident. Itis interesting to note that next to theraucous toot of the automobile hornsthe radio loud-speaker is second inobjection.It is altogther possible that sometimein the future, as population becomesmore congested, that the worldwill have to come back, largely speaking,to the visual methods of educationand communication, including theprinted word, in order to preserve thesanity of the people. This statement,of course, is relative, becausethe vast influence of the radio willincrease as the years go by, and controlof the stuff that is broadcastedwill have to be rigidly regulated bythe Federal Government. It willhave to be confined sometime to thebest music and to the best of informa-This six months old daughter of a'popular Raleigh dentist is being raisedaccording to instructions -providedby State Board of Health literature.You can see for yourself how she appreciatessuch wise parents.tion along educational lines of everydescription.A CONTRIBUTOR SUBMITS SOME VALUABLESUGGESTIONSWe are publishing below an articleentitled "Vacation Resolutions." Mrs.Walker, the writer, writes that shehas especially prepared this articlefor exclusive publication in theHealth Bulletin. She writes that shethinks these questions are very importantfor every parent to consider.She writes, not as a physician or asa nurse or as a public health worker,but as a mother of young children.Mrs. Walker is the mother of sixchildren, ranging in age from 2 to 16years. In her note to the Editor,submitting the article, she statesthat "it is strange, very strange,after all that has been written on thesubject of vaccines, and particularlyon the subject of guarding againstdiptheria, how many parents thereare who neglect having this done untilthey are compelled to do so after thechild has started to school, or afterappearance indiptheria has made itsthe neighborhood, if not in the immediatefamily." Again we remindour readers that this is the contributionof a parent for the considerationof other parents at this particulartime. The article follows:VACATION RESOLUTIONSByNaomi W. WalkerMrs.Along about the first of the yearwe hear quite a good bit said about"New Years' resolutions," but aboutthe time school closes we hear nothingat all said about "Vacation Resolutions,"and if we happen to be "par-

10 The Health Bulletin April, 1930ents," those resolutions are most importantof all for us to make; that is,of course, if we keep them as well asjust make them.Vacation, like everything else worthwhile, to be a success requires forethought.The long summer monthswhich our children have for theirvacation, can be made for them eithera source of very great good, or theymay be a positive drawback to them,and even do them actual harm, andwhich of the two it is to be, dependsalmost entirely on the parents.In the first place, after eight ornine months of continuous school,most children are more or less rundown, at least they are not quite upto normal and are tired out mentallyand physically and often very much"on edge," and wise parents, whenschool closes see to it that their children,first of all, get the rest they somuch need at this time. Instead of lettingthem stay up much later at night,going to parties and other amusementsand raising all restrictions becausevacation has begun, for the firstweek or two at least, make them goto bed at the usual time, or earlier,and then insist on their staying in bedlater in the morning until they reallyget "caught up" on rest. Duringschool months the children have, fromnecessity, had to keep fairly regulareating habits but as soon as vacationbegins they seem to think they justmust be eating all day long to makeup for lost time, and nothing is worsefor them as we all who have childrenknow, so this is something else forparents to be on their guard against,and it is not so easy as one who hasnot tried it may think!Then another important thing forparents to resolve to, do for theirchildren during the summer monthsis to resolve to get them in the bestphysical condition possible beforeschool starts in the fall. To do thisit may be necessary to have sometonsils removed, and if this needs tobe done, have it attended to as earlyin the summer as possible so the childcan have all summer in which to recuperate.Then if there are anychildren who showed eye-strain atthe end of the school year, have theireyes looked after before vacation isvery far along, so if glasses shouldbe needed, they can be getting usedto them before they have to go toschool.It seems strange that it should beso, but in this enlightened age, in thestate of North Carolina, there arestill many parents who have not safeguardedtheir children against diptheria.If there are any children inthe family who have not had theSchick test to see whether or not theyneed the toxin-antitoxin administered,this should be attended to at once.Then, if there are any children whohave not had the smallpox vaccination,have that attended to also.Possiblythere is a six-year old who willstart to school in the fall, who hasnever been vaccinated. It would bevery much better to have that donenow at the beginning of vacationthan to wait until school begins andthen have it done and possibly have itcause the child to miss several daysfrom school right at the beginning ofhis school life, or, if he doesn't actuallyhave to miss school on account ofhis sore arm, he may have all his lifehave a feeling of resentment towardsschool for the discomforts he sufferedat that time, with children knockinghis arm and hurting him and alsobeing away from his mother probablyfor the first time in his life. Thebeginning of school is hard enoughfor the little fellows at best, makingnew adjustments and all as they haveto, without the added burden of havinga sore, feverish arm to contendwith!Now if our children's physicalhealth needs looking after in anespecial manner during vacation, soalso does their mental health if their

:April, 1930 The Health Bulletin 11vacations are going to mean whatthey really should mean to them.Except in rare instances I do notthink children should be required tostudy in the summer, but they shouldhave the proper books and magazinesaround them, and, if left to themselvesthe children will -do much towardsadding to their own education.Another good resolution for parentsto make at the beginning of vacationis to resolve to encourage each childin the family to learn to do one thingwell. That "one thing" may be anyone of a number of things. One childmay decide to learn to swim, anotherto learn some special piece of music.another may plan to earn a certainnumber of Scout Badges through thesummer and still another may decideto earn a certain sum of money by hisor her own efforts. Whatever theydecide to learn to do, if they stick totheir resolutions and carry out theirplans, their vacations have been farfrom wasted.Then in the fall, when school timecomes around again, if their parentshave done their full duty, our childrenwill be much better equipped fortheir school years work than theywere at the beginning of vacation,and in the long run, of course, muchbetter equipped for life.NUTRITION STUDIES IN ELEMENTARY SCHOOLSOne of our nurses sends into thisoffice a newspaper description ocurringin the Whiteville School News,which is presumably a column in thelocal Whiteville paper describing anexhibit presented by the fifth gradein the Whiteville schools this winter.We are publishing it because it illusstartesthe interest that is now beingaroused throughout the State to anextent never known before in thequestion of foods and nutrition. Thedescription of the exhibit put on bythe Whiteville school children follows"Our Food Exhibit""Last week 5 A. gave an exhibit offoods. We invited several grades andtheir teachers. We also invited MissThoroughgood and Mr. Rogers."The room was divided into groupsand a captain was appointed for eachgroup. The groups exhibited the followingfoods: 'Growth and RepairMaterial,' *Regulators and FoodMagic,' 'Go Material,' 'Iron Foodsand Bone Builders.'"We learned that milk is the bestfood because it contains so manyneeded things for the body."We would like for every boy andgirl in our school to eat some cerealevery morning for breakfast."We have found that eggs andvegetables make us grow and we aretrying to eat more of these and lessmeat."Every boy and girl in our room istrying to drink at least one glass ofwater before breakfast and three orfour during the rest of the day."We want to cooperate with GovernorO. Max Gardner's 'Live at HomeWeek.' Why not raise our own food?In North Carolina there is enoughfertile land so that we can do this.We have been discussing this in ourhealth class and find that most of thefollowing good foods can be grown orraised in North Carolina and a greatmany in Columbus County.(1) Growth and Repair MaterialMilk, Columbus County, N. C.Eggs, Columbus County, N. C.Cheese, Columbus County, N. C.(2). Regulators and Food MagicCelery, a small quantity is gvovrain North Carolina. Most of it comesfrom California and Florida.Milk, Columbus County;Apples, a few in Columbus County,many in North Carolina;Potatoes, Columbus County;Oi-anges, Florida and California;Rhubarb, Columbus County;

;12 The Health Bulletin April, 1930Cabbage, Columbus County;Grape Fruit, Florida and California;Bread, Columbus County;Lettuce, Columbus County,(3). Go Material.Cereal, Columbus County;Bread, Columbus County;Potatoes, Columbus County;Cream, Columbus County;Raisins, California and around theMediterranean Sea;Spaghetti, Italy and SouthernFranceButter, Columbus County;(4). Iron Foods and Bone Builders.Carrot, Columbus County;Spinach, Columbus County;Eggs, Columbus County;Fruits, many fruits grow in NorthCarolina, but we get our best orangesfrom California and Florida;Lettuce, Columbus County;Celery, a small quantity is grownin North Carolina, most of it comesfrom California and Florida."A cow is good for milk, butter,cream and meat. It is very easy tokeep cows in the rural sections ofNorth Carolina; because we can growthe grains on which they are fed, andwe have many acres of good pastureland."Since grains are so easily grownhere the raising of poultry is profitable.They furnish us with eggs andmeat and keep insects out of the gardens."While too much hog meat is notgood for us, we need some of themeat. We can raise the hog cheaplybecause he eats corn and scraps."The meat that we do not eat canbe shipped to other states."We can have our own gardens andget the vegetables without going totoo much expense. The vegetablesthat are gathered from our own gardensare fresher than those whichhave ben shipped from great distances."We are going to help GovernorGardner by eating and growing thefoods that are good for us. 5 A.hopes to be a healthy grade."A BOUQUET FROM A COMPETENT CRITICSometime ago we received a letterfrom Miss Josephine Sharkey, ofChapel Hill, who is a specialist in thefield of child study, and is thereforea competent critic who can write withunderstanding on the subjects thatconcern her as well as us.Miss Sharkey has kindly given uspermission to publish her letter. Wereceive almost daily letters of similarcharacter, but Miss Sharkey's letternot ony comes from an expert but itis concise, and moreover, it is beautifullyillustrated by the two accompanyingphotographs of little MissHilda Sharkey, the adopted daughterwho, as Miss Sharkey says, is growingand thriving at six months of ageon cod liver oil, spinach, carrots, lacticacid milk, and orange juice.The reader will note that MissSharkey points out in her letter thatthe Federal and State publicationsdevoted to the dissemination of availableinformation on the subject ofpublic health, which includes, ofcourse, child cai'e and study andtraining, comprise information whichis reliable and which may be utilizedby any family in the State to advantage.We feel grateful to Miss Sharkeyfor this letter and for permission topublish it just as she writes it. Theletterfollows:"When giving my child study classesI have always made the point thatit is not necessary to buy expensivebooks in order to have the best adviceon food, care and up-bringing ofchildren. Uncle Sam and the Stateof North Carolina are both tremen-

April, 1930 The Health Bulletin 13dously interested in the children, theirgreatest asset."Whenever I lecture I carry withme and exhibit the State and Federalbooklets and explain that the bestauthorities in the country are paid towrite them."I asked the members of the classin one North Carolina city to writefor these publications and to have theHealth Bulletin sent them so thatonce a month they would have a littleprod and be made to think and alsothat they might learn of the splendidthings North Carolina is doing forthe health of her people. At the endof the course when a raising of handswas asked for those who had sent forGovernment and State publicationsthe number was far smaller than itshould have been. Then I askedthose who wanted the Health Bulletinsent them to sign up. Enclosedis the list. If you have some backnumbers please sent them as it reallyshould have started with the Januaryissue but I have a little adoptedbaby who keeps me hopping."She's being brought up on governmentbulletins and she's a hum dinger.Age six months, never had acold, weighs 19 pounds, sleeps fromsix till seven next morning and iscrazy about cod liver oil, spinach,carrots, lactic milk and orange juice,"I hope these people read the Bulletinwhen it comes."More power to you.Josephine Sharkey."^wsi-?5iir-4^% ->:Here are two photographs of the little adopted daughter of Miss JosephineSharkey of Chapel Hill. It ivill be noted that we are departing from our usualcustom of anonymity in publishing photographs. We do this because MissSharkey is a lecturer and expert in child study, and the two pictures illustratevery plainly that she is able to practice what she is ^yreaching.The first photograph was taken when the baby was nearly four monthsold. The second shows her at six months, at which time Miss Sharkey says sheis thriving on cod liver oil, spinach, carrots, lactic acid milk and orange juice.

14 The Health Bulletin April, 1930THE VALUE OF MILK IN THE HUMAN DIETByA. C. KiMREY, Extension Dairyman N. C. State CollegeMilk is not a recent discovery,neither is it something concocted byscience, but it is the first food in importanceamong all the foods madeuse of by mankind. It is the oldestfood and the one and only one whichhas been found to be absolutely indispensable,not only to the life ofman, but to all other mammal life aswell. It is a food that has no substitutein the diet of the young, andwithout which they die. I do not findon record a single child that has livedmore than a few days after its birthwithout having received milk in someform from some source, either the naturalone, or an unnatural one. In Americanearly sixty percent of the childrenare raised unnaturally on cow'smilk. In view of this, it is easy tounderstand that the milk producingcow plays a tremendous part in thevery beginning of the life of our people..It is not possible to raise a child,a calf, a pig, or even a puppy dog.without milk from some source, eithera natural source or an unnatural one.When milk is thought of in this connection,then one begins to realize itsimportance to the animal life of theworld. If it were possible to take milkfrom all sources out of the world, theearth would be depopulated in onegeneration, because solely upon milkall mammal life must depend for itsfirst food.Some years ago Professor OscarErf, of the Ohio State Universitytried in every possible way to getcalves to live and grow without milk.These calves were given every foodthat could be suggested as a possibleone to take the place of milk. Everysingle calf that received no milk diedin a very few days after its birth,simply because of the fact that nofood except milk can nourish the veryyoung.Dr. E. V. McCollum, of John HopkinsUniversity, found the same thingto be true with reference to rats andother small animals, and he furtherstates that cow's milk has been thegreatest single factor in the advancementof man from a stage of barbarismto his present state of civilization.Why Is Milk Essential To the Young?This is a very natural question inthe face of the facts knowm aboutmilk. It has been known for agesthat the young could not survivewithout milk, but it could only be explainedby saying that milk was thefood provided by nature for the nourishmentof the young. It was formerlybelieved that the proteins, fats andcarbohydrates, together with mineralmatter constituted all the essentialparts of a food, but some recent discoveriesalong this line made by Dr.E. V. McCollum of John HopkinsUniversity, and others have thrownnew light on the subject and openedup a new field of knowledge aboutfoods. He finds that besides the alreadyknown constitutents of foods,there are at least three other very essentialones, which he has called vitamines.It has been proven beyond theshadow of a doubt that these vitaminesare absolutely essential to humanlife. It is the vitamine constituentfound in the fat in the milk ofmammal animals, that the young childmust have or else it dies. This particularvitamine is known as the fatsoluble one since it seems to be dissolvedin, or at least closely associatedwith milk fat.

April, 1930 The Health Bulletin 15Is This Vitamine Not Found in OtherFoods Except Milk?It is found in a few other foods inlimited quantities, but the nature ofall the other foods in which it is foundis such that they cannot be eaten insufficient quantities and digested bythe very young, and therefore thevitamine content is not available fortheir use. The other two very essentialvitamines are also found in milk andare known as the water solubleones.Investigation shows conclusively thatwithout these vitamines animal lifecannot exist. In addition to these threethere are two other more or less essentialvitamines—one of them foundin milk and the other widely distributedinthe various cereals.Besides being the only food that canstimulate and start the young childto grow, milk is also an importantand essential food for the use of achild during its growing period. Inorder that the bones can properlygrow and develop, a good supply oflime and phosphorus must be availablein the food. These minerals arefound in milk in just the form bestadapted to the use of a growing boyor girl for bone building. Without agood supply of whole milk and sunshinethe bones fail to develop and adisease known as rickets is generallythe result, in which the bones oftenbend under the strain of trying tocarry the load of fat and muscle placedon a weak and insufficient bonystructure. When this condition of thebody is brought about, tuberculosisand other diseases very often takehold.Not only is milk a valuable and indispensablefood to promote growth,but being the perfect food that it is,it enables the grown person as wellas the child to keep up the body vigorand thus be better able to resist andthrow off the various disease germs,which we come in contact with daily.Good physicians invariably prescribemilk as the chief food for people whohare suffering from tuberculosis, becausethey know that the most nourishingfood possible must be supplied,and that at the same time it must bea food easily digested. Milk meetsthese requirements as no other fooddoes. If it is so valuable as a meansto arrest the disease, it is certainlyreasonable to suppose that it will atall times help the body to resist theattack of thedisease.In sections where milk is neglectedin the diet a great number of peopleare found suffering from pellagra.This disease is rarely, if ever, foundamong people who consume an abundanceof milk.The United States as a whole consumesabout one pint of whole milkper person per day. Thirteen of oursouthern states taken together consumeless than one-third of one pintper person per day. What are someof the results? The south has a veryhigh death rate from tuberculosisand pellagra, due so physicians tellus, to a great extent to a scanty milksupply.During the recent war when youngmen were being drafted into the army,from all parts of the country, it wasfound that a larger percent of youngmen in the Southern states were unfitfor military service, because ofphysical reasons, than was the case inother sections of the country. A greatpart of this is traceable to undernourishedbodies during the growingperiod, and the undernourishmentwas chiefly due to a lack of milk.The child that grows up without agood supply of milk will be undernourished,and is destined to be a partialcripple, either physically or mentally,and possibly both.There are thousands of boys andgirls in the schools all over this countrywho are dull, listless and inefficientbecause they are not given a dietin which milk is used freely. Thechild whose breakfast is made upchiefly of meats and bread, washed

16 The Health Bulletin April, 1930into the stomach with coffee or tea,cannot do good school work that dayand ought not be expected to. Thechildren who do the best school workare invariably the ones that are thebest nourished and good nourishmentis impossible without a reasonableamount of milk in the diet.In the whole history of the world,no nation has ever amounted to much,as measui-ed by its literature, learning,art and its contribution to civilization,that did not have milk cowsand consequently plenty of milk as apart of the food for its people. Thenation that has been a world powerin any era of history has always beena nation of milk drinking people. Ifthis is true of the nations, and it is,it may be true among the states of anation, or it may be true to a greateror less degree with respect to thefamilies and individuals that composea state.Because milk is not chewed, peopleare prone to think of it as a beverageto satisfy thirst and not as a food. Itisn't a beverage, but instead is a realfood in every sense of the word. Asan aid to banishing the beverageidea from the mind, it might be rememberedthat a quart of whole sweetmilk is equal in energy food value toeither of the following amounts offood: Two pounds of fish, four-fifthsof a pound of pork, three-quartersof a pound of steak, or eight eggs ofaverage size.It is possible to dispense with manyof the foods that we are accustomedto consume, and which we like, withoutsuffering any ill effects whatever,but if we permit the use of milk, evenin the diet of adults to fall much belowthe present consumption, its effectswill become apparent in our nationalefficiency. It is the concensusof the opinion of careful investigatorsand competent dietitians that natureintended that the growing childshould live largely on milk, eggs, andthe leaves from certain vegetables, butbecause many mothers do not followthis plan of nature in preparing themeals for their children, and becausethe schools have not put forth asmuch effort to teach children what isbest for them toeat as they have toteach them Latin and other classics,the result is that there are millions ofundernourished children in Americatoday suffering from various diseasesas a result of malnutrition. No wonderthat in the early record of thehistory of man we find that when anideal land was to be described, "a landflowing with milk and honey" as themost fitting and tempting expressionthat could be thought of.It is nothing less than criminal todeny the growing child an abundantsupply of wholesome sweet milk; todeny it is to cripple the body andweaken the mind, thus paving theway for a career that can never bewhat it might have been.Let us, as intelligent North Carolinianssti-ive to so raise our childrenthat they may grow into stronger peoplethan their parents, and thus bebetter able to battle for their place inthe world. This can only be broughtabout by proper nourishment, andproper nourishment is impossiblewithout milk.THE CONTROL OF MEASLESA SIMPLE NEW METHOD FOR PHYSICIANSAt last, after years of study, weseem to have arrived at a point wheremeasles, that most prevalent of children'sdiseases, may be to a considerabledegree controlled. The procedureis extremely simple and so safe andeffective that we urge all physiciansto adopt it.The Virus of MeaslesFor years laboratory workers in

April, 1930 The Health Bulletin 17various parts of the world havesought to isolate the specific germ ofmeasles, in the hope that once thiswere accomplished, a vaccine or serumcould be devised for dealing withthe disease. These studies, however,have been fruitless. To be sure, thework of Kektoen in 1905 and of Andersonand Goldberger in 1911 showedthat the virus of measles was presentin the patient's blood and in the catarrhalsecretions of the nose andthroat a day or two before and severaldays after the appearance of the rash.Anderson and Goldberger also showedthat the virus would pass through aBerkefeld filter. All experiments byvarious authors to produce measles byinoculating the desquamating epitheliuminto susceptible children havefailed. In other words, the virus appearstoexist principally or solely inthe blood and in the nasal and buccalsecretions. Thus far, however, all attemptsto isolate the virus in pureculture have failed.Difficulties in Controlling MeaslesThe long incubation period ofmeasles (usually from twelve to eighteendays), the fact that the diseaseis highly communicable during thepre-eruptive stage when the natureof the disease is not recognized, andthe universal susceptibility of humansto infection, have heretofore renderedall efforts to control the disease byadministrative measures well nigh futile.The Use of Convalescents' SerumIn 1916 Nicolle and Conseil publishedthe first definite results on thetreatment and prevention of measlesby means of serum obtained fromconvalescents. The serum is most activebetween the tenth day and thirdmonth of convalescence. About 5 cc. ofthis serum is sufficient to protect ayoung child against measles. The immunity,however, being passive, soonwears off and cannot be depended uponfor more than a few weeks.Following this work. Park andZingher took up the study of convalescents'serum. They injected 41recently exposed children, i. e., thosecoming in contact with cases ofmeasles. Twenty of these were given8 cc. of the serum and none developedmeasles. Twenty-one received 4 cc.of the serum and three developed thedisease.The Use of Whole Blood from AdultsIn 1920 Degkwitz, of the Universityof Greifswald, Germany, announcedthe results obtained by himself andassociates in the use of adult bloodin more than 1,000 cases. These resultswere very favorable, for evenwhere the disease was not prevented,the injected adult blood lessened theseverity of the attack.These observations have been confirmedby extensive investigationscarried on during the past few yearsby Park in cooperation with variouswell-known pediatricians in this city,in the course of which the relativevalue of convalescents' serum and ofadult blood was carefully studied. Recently,for example. Dr. Alfred Hessused the convalescents' serum and theadult blood in a large institution forchildren, giving one portion of theexposed children the adult blood andthe other portion convalescents' serum.The children receiving the serumdeveloped fewer cases of measles, butthose receiving the adult blood hadmodified measles. The latter outcomeis preferable because those in whommeasles was absolutely prevented developedno lasting immunity, andafter one month were again liable tocontract the malady, while the childrenwho had modified mild attackswere rendered immune to measles forlife.Measles in Non-Immune PopulationsIn this connection it is well to rememberthat measles is a malignantdisease in virgin soil. Thus in theFaroe Islands where there had beenno measles since 1781, and where thedisease was reinti'oduced in March,

18 The Health Bulletin April, 19301846, out of 7,782 inhabitants 6,000were stricken. Similarly when measleswas first introduced into the SandwichIslands in 1775, within fourmonths 40,000 persons died out of apopulation of 150,000. In 1874 a similarinstance occurred in the Fiji Islandswhere one-fifth of the populationdied of measles introduced fromSydney. During the war measles oftenran a severe course among nonimmunerecruits coming from ruraldistricts where they had never beenexposed to the disease.The New Method Now AdvocatedOn the basis of the experiences ofthe past ten years, and especially becauseof his own extensive investigations.Park now advocates the use ofwhole adult blood in a city-wide campaignfor the control of measles. Thetechnique of collecting and injectingthe blood is extremely simple, and themost suitable donor is always one ofthe parents. The blood is collected ina sterilized glass syringe having acapacity of 30 cubic centimeters, andis most readily withdrawn from avein at the elbow. The skin about thedonor's elbow is cleansed in the usualmanner and may be disinfected withiodine. A piece of rubber tubingwound around the upper arm causesthe vein to distend so that it mayreadily be pierced by the sterile needleattached to the syringe. Thirty cubiccentimeters are withdrawn and halfof the blood is then injected intramuscularlyinto the child's right buttockand the other half into the leftbuttock. Coming directly from theparents no deleterious effects needbe feared. If only a 20 cc. syringeis available, two drawings of bloodare made, each one 15 cc. This is adetail which presents no difficulties.While this dosage holds good forchildren under five years of age, it isadvisable to use double the amountin older children. It must be borne inmind, however, that the object isnotto prevent measles entirely, but topermit the development of a modified,milder type of disease. For this reasonit is not advisable, even in olderchildren who have been exposed tomeasles, to give more than 60 cubiccentimeters of the parent's wholeblood.It is hoped that physicians will familiarizethemselves with this methodof controlling measles and will immunizeall children encountered intheir practice who have been exposedto the disease. — New York CityHealth Bulletin.THE USE OF IMMUNE HUMAN SERUM FOR THEPREVENTION OF MEASLESByC. C. Hudson, M. D., City Health Officer, GreensboroThe first recorded use of human serumfor the prevention of measlesdates back to 1916 when Park &Zingher, of New York City, reportedthe successful use of serum from convalescentmeasles cases for the preventionof measles in young childrenin certain hospitals in New York City.Nicolle and Conseil, of Paris, also reportedsuccessful results from the useof convalescent measles serum duringthe same year. In 1926 Park andFreeman reported the results securedon 1500 patients by the use of serumfrom convalescent measles patients,and thus established this as a definiteprophylactic measure. A numberof other physicians have reported

April, 1930 The Health Bulletin 19good results from the use of serumsince that time.In considering the use of serumfrom convalescent measles cases, wemust first decide what we desire toaccomplish with it. It is possible toeither protect the child entirelyagainst measles or toallow the patientto have a very mild type of thedisease. If the child is entirely protectedit may develop measles at alater date, as human serum, like horseserum, only gives a temporary protection.To secure complete protectionit is necessary to give the serum duringthe first five days after exposure.By giving the serum between the 5thand 6th days after exposure the patientwill have a modified type ofmeasles with a very slight cough, ifany, and a mild, convalescent eruption.The disease is apparently freefrom danger, and it will be protectedfrom measles for the remainder oflife the same as though it had had asevere case of the disease. It is impossibleto tell just when a child hascontracted measles, even though itmay have been exposed to the disease.A rather large percentage of childrengiven serum between the 5th and 8thdays after first exposure will be completelyprotected.Blood for securing serum may betaken from persons who have hadmeasles as early as seven or eightdays after the fever has subsided.Blood contains most protective substancefrom that time until the 15thday, but may be used until the 60thday. Even after the 60th day the bloodundoubtedly contains protective substances,but it is necessary to giveit in a much larger dose in order tosecure protection than when serum istaken soon after recovery frommeasles.In securing blood for serum it isof first importance that a very carefulphysical examination be made ofthe individual to ascertain whetheror not he is suffering from any othercommunicable disease, especiallysyphilis and tuberculosis. It is verydifficult to secure serum from childrenunder ten or twelve years of age andmost of the blood will be taken fromchildren between ten and twenty yearsold. This is undoubtedly the healthiestage and by having the donors given acareful physical examination andchecking the history for syphilis withthe family physician and then givinga Wassermann test it is possible toalmost eliminate the danger from diseasebeing transmitted in the serum.The Chinosol or other preservativeused also has an antiseptic actionand helps to eliminate the danger ofpassing along a disease in the serum.Blood for securing serum is drawnthrough a 16 gauge Luer needle intoa 50 cc. or 100 syringe into which hasbeen placed 2 cc. of a twenty-five percent solution of sodium citrate to preventcoagulation. It is possible to secure200 to 500 cc. of blood from onedonor at a time. The blood is thenplaced in a Florence Flask and .3 to.5 gram of Chinosol to each 500 cc.of blood is added as a preservative.More Chinosol may be used if desiredas it is apparently non-irritating. Theflasks are then placed on ice and theclear serum withdrawn the followingday in a 50 cc. pipette, after whichthe blood is centrifuged and more serumsecured. From 100 cc. of blood itis possible to secure about 50 cc. ofclear serum. All utensils used to secureblood and serum must be thoroughlysterile and it must be handledin an aseptic manner. It is usuallybest when withdrawing blood to havethe donor lie on an ordinary operatingtable with a screen of some kindover the arm. The blood is taken fromone of the large veins at the elbow.After the serum is secured it isplaced in sterile 6 to 10 cc. ampoules.Tests are made to determine whetheror not it is sterile. If it has been

20 The Health Bulletin April, 1930handled in an aseptic manner and sufficientpreservative used, it will retainitsmore.protective substance for a year orImmune human serum should beused as a protection for all smallchildren who have been exposed tomeasles, especially children who aresuffering- from malnutrition or whoare debilitated from other diseases.As about three-fourths of all deathsfrom measles are of children under 3or 4 years of age, it would seem thatall children at that age should begiven a dose of serum if exposed tomeasles. The best time to give it isprobably between the 5th and 8thdays from exposure, thus allowingthe child to have a mild type ofmeasles but protecting it against severecomplications which cause death.Where there is a previous case ofmeasles in the home we can considerthat all children in the home havecontracted measles at least threedays before the eruption appears inthe first patient and that serum shouldbe given to the babies in the home onthe 2nd and 3rd day after the eruptionof the first case.The dose of serum depends to alarge extent upon the time at whichit is taken and the age of the child.Children under three or four years ofage will usually be protected by adoes of 6 cc. ; older children should begiven 10 or perhaps 12 cc. If a serumis secured from a patient who hashad measles only two or three weeks,this will usually protect other children,but if the serum is taken fromchildren who have had measles 50 or60 days it is advisable to give a somewhatlarger dose in order to secureprotection.Another method of protecting childrenagainst measles is by the useof whole citrated blood. This may beused in essentially the same manneras serum with the exception that 20or 30 cc. of blood are withdrawn fromthe donor into the syringe to whichhas been added the sodium citrateand this is immediately injected intothe child to be protected. Any physiciancan use this method to protectthe small children in the home.In order to secure an adequate supplyof immune measles serum, it isnecessary that all physicians in thecommunity cooperate. Each physicianmust be on the lookout for healthyindividuals who may act as donors,most of whom will be among patientsmore than 10 years of age. As only 19per cent of measles cases are under4 years of age and about 23 per centoccur in individuals 10 years of age,or over, it should be possible to securesufficientserum to immunize allthe children under 4 years, providedall physicians secure the cooperationof their older patients. If a centralphysician needing it.laboratory is available, the patientsmay be sent to the laboratory for thewithdrawal of the blood and the preparationof the serum, which maythen be stored for future use by anyThe family physicianshould always check the familyhistory of the patient and heshould then be given a careful physicalexamination before the serum iswithdrawn. It is advisable that asmall fund be available with whichto pay a small sum to those individualscontributing blood. The serumcould probably be sold for enough tocover the expense.It is necessary that considerablepublicity and education work be donein order to let people know that theirchildren can be protected againstmeasles, and that the disease is particularlydangerous for small children.This enables the physician to get intothe homes to treat all the first casesand to give protection to the smallerchildren. It is especially importantthat it be emphasized that every caseof measles should be under the careof a physician if best results are tobe secured.

April, 1930 The Health Bulletin 21EPIDEMIC MENINGITISEdward L. Bauer, M. D.Professor of Children's Diseases, Jefferson Medical College;Imviunologist to the Department of Public Health, PhiladelphiaMeningococcic meningitis is presentin this community almost constantlybut is epidemic only in occasionalyears. The organism causing this diseaseis the diplococcus -intracellularisof Weichselbaum. It is found in thenasopharynx of some healthy individuals,that is in carriers, and in thenasopharynx and the blood circulationof sufferers with this malady.The organism belongs to the gramnegative group.In epidemics w^here contact withcarriers is extremely close, ventilationpoor, and sanitation bad, direct transmissionis doubtless operative. On theother hand, numerous observers withlarge clinical experience have notedthat these cases treated in generalhospital wards and without any particularprecautions being taken havenot been the source of secondarycases. Again, a carrier will infect anumber of people using a swimmingpool, but will not infect other contactswho have not joined in this pastime.Infection occurs through the nasopharynxand studies in the army duringthe World War would indicatethat the organisms are taken up bythe blood stream so that a systemicinfection occurs prior to their passageinto the ventricles through the choroidplexus. In children the period of systemicinfectionbefore involvement ofthe meninges must be short indeed,really a matter of a very few hours.It is important to remember the portalof entry into the cerebrospinalcanal.The disease is ushered in with fever,prostration, then stiffness of theneck. This rigidity is followed by retractionof the head. Opisthotonos occurslater. Convulsions may occur atany time during the illness. Nystagmusor ocular muscle palsies may bepresent. Kernig's sign is usuallyfound. These and other neurologicsigns vary in given cases. Particularlyis this true in children and certainlyin infants. When vomiting occursit is usually projectile. Petechialhemorrhage into the skin occurred in30 per cent, of the writer's cases.The blood count shows a leukocytosisof 20,000 to 40,000, with a predominanceof polymorphonuclear leukocytes.Cerebrospinal fluid is cloudyand contains a fibrin or more frequentlypus. Globulin will be foundbut little or no sugar is present. Cellsare increased, the polymorphonuclearpredominate, and the organisms arefound intra and extra cellularly.The diagnosis is made on the clinicalevidence of meningeal irritation,the diagnostic tap, and is clinched bythe identification of the organism.A SpecificRemedyA specific remedy is available inmeningococcic meningitis. Antimeningococcicserum is antitoxic and bacteriocidalbut only for the particulartype from which the serum has beenmade. Consequently while concentrationof serum is desirable a polyvalentserum should be used, at leastuntil the offending type has beenidentified by an agglutination test.The site of injection should be asnear the portal of entry as possible.The most favorable point for the injectionof the serum is into the cisternamagna. This point of entry hasmany advantages over the lumbarroute. In the first place the fluid will

—22 The Health Bulletin April, 1930be cloudy and organisms will be recoveredearlier than via the lumbarroute. Secondly, drainage downthrough the spinal canal is more rapidthan occurs when introduced in thelumbar region. Thirdly, concentrationof the serum is greater where it isneeded most when given through thecisterna. Fourthly, in a large numberof cases blocking occurs in the foraminaof Luschka or Magendie. Lumbarinjection will never get abovethese points. The intravenous use ofserum is of no value without the introductionof serum directly into thecerebrospinal canal, by reason of thefact that it is too greatly diluted.Antimeningococcic serum should beadministered at eight-hour intervals,the dose being determined by theamount of fluid removed under pressure,but care being taken that thepressure is reduced even after the introductionof serum. The serum shouldbe used until the temperature is normaland the organisms have disappearedfrom the fluid. Cloudiness of thefluid is no criterion because the serumitself will becloud the fluid for sometime after its injection.The mortality from epidemic meningitiswithout the use of serumranges from eighty to one hundredper cent. With the serum treatmentit now stands at twenty to forty percent. The reduction of this mortalitydepends upon the early use of theserum, the speed with which the serumof proper type destroys the organisms,and phagocytosis. This isaided materially by the use of the cisternalroute.The sequellae of epidemic meningitismay perhaps be reduced in numberby the early use of serum. Internalhydrocephalus, deafness, blindness,paralysis, feeble-mindedness, or idiocymay follow in the wake of meningitis.These cases are utterly hopeless afterthe damage is done and if the livesof the unfortunate victims of thismalady are to be saved at all it isto be hoped that early, prompt andvigorous specific serum therapy willsave them from these aftermaths.Philadelphia Health Bulletin.POINTS TO BE CONSIDERED IN CASE OF APOLIOMYELITIS EPIDEMICByJ. P. Leake, Surgeon, United States Public Health ServiceIn connection with plans to combatand to care for an epidemic, one ofour first concerns is the recognition ofan approaching outbreak. The PublicHealth Service is analyzing the figuresavailable from that point ofview, and at present it may be consideredthat throughout the greater partof the country we may expect about1 paralytic case per 100,000 populationbetween the 1st of December andthe 1st of June each year, and in theother six months about 4 to 14 casesif the reporting is very thorough.The maximum incidence, an averageof 2 cases in three weeks per 100,000is reached in mid-September.Ever since 1916 we have lookedwith especial concern on a definiterise during the month of June, butthere have been several examples ofa notable increase in reporting whichwas not paralleled by any such actualincrease in incidence. In the warmerparts of the United States fewer casesoccur, though the distribution followsabout the same proportion by seasonsas in the North. On the Pacificcoast the rise appears to begin a fewweeks earlier and to reach a less

April, 1930 The Health Bulletin 23abrupt peak somewhat later, with arelatively high prevalence maintainedlonger than is usual elsewhere. Itwould seem that other places whichhave a comparatively even temperaturerange throughout the year, witha slightly retarded maximum, shouldshow the same characteristics.All recent information has onlyemphasized the view previously expressedthat not much inthe way ofprevention can be expected by toorigid or prolonged quarantine of thereported case.Every facility and encouragementshould be given to early reporting,and the affliction of such an infectionshould be mitigated as much as possiblein families where it occurs. Theusual quarantine of three weeks fromdate of onset is reasonable in thatthe patient should be kept absolutelyquiet for that length of time. Manyof the cases of supposed secondary infectionturn out to be simultaneousinfections, and the incubation periodis more likely to be two weeks thanless than one week in length. Thereis some evidence of infectiousnessduring this incubation priod, but Isee no reason for retracting the opinionthat the disease is spread largelyby healthy carriers—acute carriersrather than chronic—and by humancontact rather than by food or watersupplies. It has been proved thatpoliomyelitis has no necessary connection,with summer insects. Contactincludes infection by way of themouth (though wholesale infectionof a food supply appears to be rare),and we should remember that the initialsymptoms are likely to be referableto the digestive tract in the unrecognizedcases.The only rneasures through whichwe should expect any real diminutionof incidence are those which diminishhuman contacts in general, but thedrastic closing of all places of assemblyis justifiable only early in the seasonwith a very high incidence of,say, five or ten times the usual, andeven in such a case the long incubationperiod would make it likely thatin a restricted community the actualspread of the infection had begun todiminish before the alarm was sufficientto resort to such extremes.Every help should be given to themedical profession and the public toaid inthe prompt and accurate diagnosisof the cases. Pamphlets areavailable for distribution to physicianstorefresh their memories on theearly suspicious and characteristicsigns of the disease.Organization for treatment of preparalyticcases by convalescent serumis one of the first measures to be considered.Since, however, this is adaptedmore for metropolitan areas thanfor widely scattered settlements, itprobable that in most cases it will bea function of medical societies, medicalschools, and local health authoritiesrather than of the State. There aremeasures of support and coordinationin this mode of treatment, however,which may well be undertaken by theState department of health. In anycase, favorable as the results appearto be, we must remember that themethod is still on trial, and every effortpossible should be used to secureits practical evaluation.Probably the greatest good that theState department of health can do isin the prevention of deformities andcrippling as an aftermath of recognizedparalytic cases. The early treatmentshould certainly be under thecontrol of the local physician. In connectionwith the circularization andpublicity, to aid in the early diagnosis,emphasis should be placed on the necessityof absolute and prolonged restin bed, in a position to forestall andprevent any tendency to deformity,by fixation if necessary. There comesa time in practically every case, however,and it may come very soon,when the proper care becomes too irksomefor the family to carry onis

—24 The Health Bulletin April, 1930without the moral support and stimulusof some such agency as a consultantorthopedist with nurses orphysiotherapists particularly skilledand trained in this disease; and it isa rare family which can afford theexpense of such pi'olonged, continuous,and special skill unless the treatmentis supervised under some suchauspices as thoe of the State or municipaldepartment of health. Adequatehopitalization of these cases isout of the question. One especiallyuseful aid is the pamphlet on muscletraining by Miss Wilhelmine C.Wright, which is now available as areprint from the Public Health Reports.Since paralysis of the lowerlimbs is the most dangerous form asregards permanent crippling, I wouldalso mention a useful short articleon crutch walking, by the same writer,in the Annals of Surgery for December,1926.In closing, I would urge that bothof these programs—that for the distribution,use, and evaluation of convalescentserum, and that for aftercareand muscle training—be madepermanent, for if they are not organizeduntil an outbreak becomesapparent half the damage will havebeen done before the machines begintofunction.Public Health Reports.THINGS THAT CAN BE ADDED FOR HEALTHAND EFFICIENCY"Putting First Things First" wasthe subject of the Sunday school lessonlast Sunday. The Golden Text, asmany will remember, was "seek yefirst the Kingdom of God and Hisrighteousness and all these thingsshall be added unto you." Near theclose of our class, some of the menpresent became engaged in a discussionof "needless worry" which subjectbecame very interesting and lasteduntil long after the assembly bellhad rung. After the discussion hadgone on for some time, one of themen present who had been quietly listeningopened his mouth and threwsome very interesting light on thesubject. He is well educated, a thoroughstudent of the Bible and an ordainedminister of the gospel. Hesaid that while he was a firm believerof spiritual power and influences, hewas sure that a great deal of man'sworries, or that state of mind oftencalled "blues," is due to his physicalcondition.The spiritual, mental and physicalparts of man are so closely relatedthat they are bound to influence eachother backwards and forwards; andthere is no doubt in our mind that anunclouded spiritual outlook is an aideven to those who are heavily ladenwith physical cares and ailments.HoAvever, one can not get away from'the fact that one's physical conditionhas a great deal to do with his temperament.And the physical condition has agreat deal to do not only with one'stemperament, but with one's efficiency.This brings us to somethingthat can not be stressed too much atthis time: More and better gardensfor better health and efficiency.The health authorities tell us andthere is little need of argument tomake us understand, that one of ourgreatest needs is a well balanced dietand that nothing is needed so much inthis section of the state as plenty offresh vegetables. Pellagra and otherdreaded diseases, we are told, arecaused by lack of fresh vegetables inthe diet. But in addition to that, thereare no doubt,many farm hands, andothers too for that matter, whose efficiencyas workers is cut off becauseof a lack of the proper food. Theymay not appear to have developed any

—.April, 1930 The Health Bulletin 26definite disease, and yet the lack ofproper balanced food is making themfall short in energy. They are slowand droopy.This editor had a conversation afew days ago with Miss Millsapps,home demonstration agent of Scotlandcounty, where a movement isnow on to encourage the planting ofa garden by every farm family, especiallj'among the tenants who haveheretofore paid too littleattention tothis important item. Miss Millsapssays that the landlords who are cooperatingheartily in the movementwill see to it that each tenant plantshis ovm garden ,and some landownersin Scotland have suggested that theyintend to force their tenants to makea garden by withholding the weeklyration or advances until they haveworked their gardens.This newspaper has been emphasizingthe importance of the familygarden a great deal lately and we believeit is something in which everycitizen should be interested. But perhapsthe most can be done in this directionby the landowners themselves.It will not only be to their interest,economically speaking, to get theirtenants to growing good gardens, butit will make for better health andsave lives. First things should comefirst, but although first things areof first importance, many secondarythings are so important that a personin full possession of the first thingscan not resist the appeal that is wrappedup in the need for these secondarythings. Perhaps this is one way toexplain "all these other things shallbe added. . . . "—The Scottish ChiefThe dogs have rabies, rabbits havetularemia, parrots have psittacosis,and we'll bet a nickel the goldfish andcanaries will be to blame for something.Reidsville Review.ENDEMIC TYPHUS FEVERWe are publishing elsewhere in thisissue of the Bulletin an interestingpaper on the subject of Typhus Fever,read by Dr. John H. Hamilton at arecent meeting of a county medicalsociety. Dr. Hamilton himself says inhis paper that "endemic typhus apparentlyis a small public health hazard."He goes on to say, however, that"the patients undoubtedly feeldifferentlyabout this, for they are miserableand wretched during the courseof the disease." We mention this inorder to forestall any criticism thatmay be directed at us for utilizingthe space in the Bulletin to discuss adisease that is comparatively rarein this State, and which the authorhimself states isof small importancefrom a public health standpoint.Wefeel amply justified in publishing thispaper for several reasons. In the firstplace, it is a historical document ofgreat interest to medical students,physicians, public school teachers,and libraries. Another reason is sooneror later nearly every physicianpracticing in the State will probablyrun across a case of this disease, orthe Brill's Disease, which is so interestinglydiscussed in Dr. Hamilton'spaper. Another reason is that withthe rapid intercommunication allthroughout the country and especiallyfor the people of North Carolina withthe states of the southwest borderingMexico, it will become easier in thefuture for the Mexican form of the

26 The Health Bulletin April, 1930disease to be conveyed into North Carolina.Finally another important reasonis that it is often rather difficultto distinguish endemic typhus fromother diseases of very great importancefrom the public health standpoint.The article is well worth acareful reading, and we believe everyone who reads it will find it to be anhour well spent.TYPHUS FEVERByJohn H. Hamilton, M. D., Health Officer, WilmingtonTyhus fever has a long and colorfulhistory. It has turned the tide inwars, influenced the destiny of nations,caused heated quarrels in themedical profession, and now rebels inbeing placed in the sepulchre preparedfor it.Vaughan's Epidemiology and PublicHealth is authority for the statement"Some medical historians aresatisfied that they find evidence ofthe existence of typhus fever amongthe ancient Hebrews and their contemporaries,but this is a matter ofconjecture . In his book on epidemics,Hyppocrates describes caseswhich are certainly suggestive oftyphus fever. . The great pestilencewhich devastated Athens andwhich was so well described by Thucydides,was either typhus or thepneumonic form of plague. . Livyand Tacitus described many epidemicsin the classical period of Rome. Someof these were undoubtedly epidemicsof the plague, while descriptions ofothers suggest typhus. During theDark Ages, medical science was soovershadowed by credulity and superstitionthat the records of that timeare of little value. In the seige ofGranada in 1489, no less than 17,000of Ferdinand's soldiers died of feverwhich was designated as 'tabardillo'on account of the spots appearing onthe skin. This term still remains asone of the Spanish names for typhusfever. In the Sixteenth century twoItalian physicians, Fracastoriis ofVerona and Cardanus of Pavia describetyphus fever so plainly thatthere can be no doubt about the diseasewhich then prevailed. In fouryears (1550 to 1554) it is said thatmore than one million people in Tuscanywere destroyed by typhus."Wars in the 16th and 17th centuriesboth disseminated and nurturedtyphus. In 1566 it appeared inthe Army of Maximillian 2nd in Hungaryand spread over the greater partof Europe. It was so prevalent inthe jails of England during the 16thcentury that it was called jail fever.Not only were prisoners infected butcourt attendants as well. Both medicaland lay writers in prose and in poetrydepicted the scourge of typhus associatedwith the famine and pestilenceaccompanying the Thirty YearsWar, 1619 to 1648.During the 18th century, there wasno abatement of the epidemics oftyphus. The disease had afflicted Irelandfor years, although there wereno permanent records kept of its ravishesuntil 1708. Under the name ofIrish Ague, it collected its toll by repeatedepidemics for more than a centuryand a half. Want, poverty, andtyphus were characteristics of thetime.To quote again from Vaughan: "Itis interesting to know that duringthe 18th century, English physiciansfor the most part were not much concernedwith the poor and many ofthem saw but little typhus, while colleagues,busy among the poor sawmuch of it. A Doctor Moss, writing

April, 1930 The Health Bulletin 27of the disease in Liverpool, statedthat typhus was rare, while at thesame time and in the same city, aDr. Currie was seeing more than 3,-000 cases a year. In 1790, Liverpoolwas the second city in England, witha population of 56,000, while that ofLondon was estimated at 800,000.According to Currie, 7,000 of the peopleof Liverpool lived in cellars and9,000 more in backhouses with smallcourts and with narrow passages intothe streets. In ten years (1787 to1796) 31,343 cases of typhus wereregistered, an average of 3,124 peryear. In the last quarter of the 18thcentury, Chester was regarded as themost desirable residence city in theKingdom. Within the walls, it had apopulation of about 3,500 and from1764 to 1773, the death rate was only17.2 per thousand, but the poor livedoutside the walls and Haygarath describesthe condition as follows: 'Thehouses were small, close, crowded anddirty, ill supplied with water, undrained,and built on the ground thatreceived the sewage from within thewalls. The people were ill fed andthey seldom changed or washed theirclothes; when they went abroad theywere noisome and offensive to thesmell—In these poor habitations whenone person was seized with the fever,others of the same family are generallyaffected with the same fever in agreater or lesserdegree.'"The second half of the 18th centurysaw the great manufacturingdevelopment of England due to theemployment of machinery. During thistime the poor were exploited by themanufacturer. The houses occupiedby the operatives are said by Ferrierto have been dirty, without ventilation,and the beds almost touching.'As soon as one poor creaturedies or is driven out of his cell, heis replaced by another generally fromthe same country, who finds in histurn the consequence of breathing infectedair.'"Practically the only voices heardin behalf of the poor were those ofthe medical men, and in Manchester,Ferrier pleaded for them in stronglanguage, from which the followingquotation is made: 'I have seen patientsin agonies of despair on findingthemselves overwhelmed with filthand abandoned by everyone who coulddo them any service. . The situationof the poor at present is extremelydangerous, and often destructiveto the middle and higher ranksof society. . The poor are indeedthe first sufferers, but the mischiefdoes not always rest with them. Bysecret avenues it reaches the mostopulent and severely revenges theirneglect or insensibility to the wretchednesssurrounding them.'"It was the fact that typhus occasionallyfound its way into the midstof the rich, and, when it did, killedso many and so quickly that they werecompelled to recognize that the misfortunesof the poor were of concernto themselves. Finally, in a halfheartedway, urged by physicians,growling about the wastefulness andimprovidence of the laboring classesand driven by the occasional deadlyoutbreaks in their ranks, the rulingclasses began to pi'ovide special hospitalsfor the isolation and care ofcases of typhus. The London FeverHospital was established in 1802."Although war had done much toprovide favorable conditions for thespread of typhus, it has also thrownlight on the true causes of the disease.Vaughan states : "Epidemiologicalhistory of Britain during the Napoleonicwars presents many points ofinterest. Food prices were high. Fora time American markets were closedto the British manufacturers. Still,the period (1803 to 1816) was comparativelyfree from typhus, so faras Britain was concerned. In peacethe poor man's business is to servethe rich, clothe himself in rags, ]*earhis family in a sty and eat nothing.

28 The Health Bulletin April, 1930In war he becomes a hero, the defenderof his king and country. He iswell clothed, well fed, and all that isasked of him is that he die for hiscountry, if need be. The wife and childrenat home must be cared for becausethe man at the front must becontented and more soldiers will beneeded.'"Immediately after the declarationof peace (1816) typhus began to increaseand within another year it tookon epidemic proportions."Typhus was probably first introducedto the North American continentby the conquest of Mexico in 1530.There it has occurred in both endemicand epidemic forms ever since.It retains its Spanish name "tabardillo."Typhus fever has never attainedserious epidemic proportions in theUnited States. There was a small outbreakin Philadelphia in 1883 andNew York experienced a small epidemicin 1891 and 1892. One of therecent epidemics in this country occurredin 1916 at Fort Madison,Iowa, and was reported by Boyd. Thisepidemic started in a camp of Mexicanrailroad laborers. There wereeight cases including a physician andthree nurses in the hospital. Effectivedelousing checked this outbreakimmediately.In the years 1900 and 1919, therewere 109 deaths from typhus reportedin the registration area of the UnitedStates. 35 of these occurred in 1916.Of these, 26 were in Texas, 4 in Colorado,2 in Missouri, and 1 each inCalifornia, New York, and NorthCarolina. Most of the typhus deathshave been in newly arrived immigrants.During the world war there wasbut little typhus. In the armies ofEngland, France, Italy, the UnitedStates, and Germany, although therewas a considerable amount in the Russianand Austrian. In 1915 typhuswas introduced into Serbia by theAustrian prisoners. During April ofthat year as many as 9,000 deaths perday were due to this disease. The totalnumber of deaths during the epidemicexceeded 150,000. The epidemic extendedinto Bulgaria and Rumania.An epidemic in Poland in 1920 gavethe opportunity for a most intensivestudy by a tjrphus commission underthe auspices of the League of RedCross Societies.From a clinical point of view, therewas at first much confusion about alarge group of "pestilential fevers."As clinical knowledge progressed anddiseases became more systematicallyclassified, confusion still existed betweentyphus and typhoid. Pathologicalinvestigations developed a heatedcontroversy between the French physicianswho described and rarelyfailed to find the intestinal lesions oftyphoid and the English physicianswho found only occasional intestinallesions. The explanation being thatthe French were seeing typhoid andthe English principally typhus. Itwas not until 1829 that the famousFrench physician Louis named typhoidfever. His pupil Gerhard atPhiladelphia in 1838 clearly laiddown the differences between the twodiseases. Murchison, the greatestEnglish authority of the 19th century,defined typhus as follows:"A disease attacking persons of allages, generated by contagion or byover-crowding of human beings, withdeficient ventilation, and prevailingin epidemic form, in periods or undercircumstances of famine and destitution.Its sjTnptoms are: More or lesssudden invasions, marked by rigorsor chilliness; frequent, compressiblepulse; tongue furred and ultimatelydry and brown; bowels, in most casesconstipated; skin warm and dry; arubeoloid rash appearing between thefourth and seventh day, the spotsnever appearing in successive crops,at first slightly elevated, and disappearingunder pressure, but, after the

April, 1930 The Health Bulletin 29second day, persistent, and often becomingconverted into true petechiae;great and early prostration, heavyflushed countenance; injected conjunctivae;watchfulness and obtusenessof the mental faculties, followedat the end of the first week by delirium,which is sometimes acute andnoisy, but often low and wandering;tendency to stupor and coma, tremors,subsultus, and involuntary evacuations,with contracted pupils. Durationof the fever from ten to twentyonedays, usually fourteen. In thedead body no specific lesions; but hyperemiaof all the internal organs,softening of the heart, hypostatic congestionof the lungs, atrophy of thebrain and edema of the pia mater arecommon."This description is so accurate andconcise that today it needs but onecorrection. There are characteristic lesionsbut they are revealed only bymicroscopic histological study.A laboratory aid to diagnosis thatis generally accepted by authoritiesis the Weil-Felix reaction. This test isthe agglutination of B proteus X bythe serum from patients. No one considersthe proteus organism as beingan etiology factor. This reaction isrecognized as a non specific agglutination.Microscopic examination of theblood reveals no characteristicchanges.The infectious agent is rather definitelyaccepted as Rickettsia prowaziki.The Rickettsia represent a newgroup of microorganisms. They aresmall, bacteria-like bodies but areprobably protozoa. They occur inpairs measuring one long and in clusterswithin the intestinal cells of thelouse in typhus and the tick in RockyMountain spotted fever. In trenchfever, they occur outside the intestinalcells of the louse. They do notgrow on culture media but have beencultivated in tissue. Difficult to stain,they show up best by the Giemsamethod. They are frail and are easilykilled. They show great specificityfor their insect hosts.There has been more than the usualamount of controversy about themodes of infection of typhus. In theearly days, theories ranged from badair to the curse of the Devil. Protestantsregarded typhus as the diabolicalmachinations of the Papists whilethe Catholics regarded it as thescourge of God. In Ireland, the causewas attributed to potatoes. The lousewas suspected of being the vector asearly as the beginning of the 17th century.It was not until 1909, however,that Nicolle, Compte, and Counseil repoi'tedthat they were able to transmitthe disease by means of the bodylouse (pediculosis vestimenti). Theyalso demonstrated that the diseasecould be transmitted to susceptibleanimals by the injection of bloodfrom infected persons or animals.Their findings have been confirmedby numerous workers. Anderson andGoldberger in 1912 reported that theyhad been able to transmit the diseaseby means of the head louse (pediculosiscapitis). The work of the RedCross Typhus Commission tended toshow that P. vestimenti was a genuineintermediate host for typhus.There seems to be adequate proof thatthe disease cannot be transmitted bydroplet infection or by body dischargesnor by bedbugs, fleas, flies ormosquitoes. In fact the case againstthe louse seemed to have been provedrather conclusively until patientswith a condition indestinguishablefrom typhus were noted where thelouse could not be considered a vector.The real beginning of this line ofcleavage dates back to the work ofBrill and of Anderson and Goldberger.At the time their first reportswere published and for several yearsafterwards, the louse was still consideredthe unchallenged vector.In 1910, Brill presented a clinicalstudy of 221 cases under the title "An

30 The Health Bulletin April, 1930Acute Infectious Disease of UnknownOrigin." In this paper Brillstates "I hesitate to submit the followingtheme which is based on anexperience of 221 cases of an acuteinfectious disease which has probablyfor a long time, been considered byothers as typhoid fever, but which Ihope to show by definite clinicalsymptoms can have no relation totyphoid fever per se, but that it hasa distinct clinical entity entirely separatefrom typhoid, from typhus, orfrom any other disease known to me."Brill proceeded to show by blood, fecal,and urine cultures and by agglutinationtests that these patients didnot have typhoid. After discussingsome of the epidemiological and clinicaldifferences from typhus. Brillstates: "Clinically, this disease resemblestyphus fever more than itdoes any other disease, and I shouldhave felt that I had offered nothingto our noselogy if it had been provedthat typhus fever had lost its virulence,that it was constantly presentin the community, that it was notcommunicable, that when itwas presentepidemics of it did not occur, andthat it was no longer a grave and fataldisease. But with typhus fever,as the great masters of medicine havetaught, and as I have seen it, such aconception would be unjustified;therefore, I believe this disease nottobe typhus fever."Anderson and Goldberger afterinjectingsusceptible animals with bloodfrom patients suffering with Brill'sdisease were unable to infect themwith Mexican typhus. This immunitythey regard as sufficient proof andtherefore stated in their report of1912 that Brill's disease was identicalwith Mexican typhus. Brill's diseasethen began to be known as endemictyphus.In a paper in 1919, Brill suggestedthat endemic typhus might possiblybe transmitted by some vector otherthan the louse. However, the work ofthe Red Cross Typhus Commission,as published in their report of 1922,seemed to prove so conclusively thatthe body louse was a genuine intermediatehost that Brill's suggestionseems to have been forgotten.The body louse is so highly domesticatedthat its temperature andhumidity requirements as well asthose of its food and feeding timesfall within narrow limits. It thrivesbest at a temperature between 92°and 95° F., and even occasional exposureto 60° F. causes a marked fallingoff in egg production. Therefore,the person who removes his underclothingdaily discourages louse production.Temperatures in excess of95° F. are injurious, especially whenthere is a humidity in excess of 60%.Consequently the lice are inclined tomigrate when the host's temperaturebegins to climb. When the air temperatureis high enough to cause peopleto perspire, the increased humidityin the small space between clothingand skin soon makes life impossiblefor the lice. Numerous authorsreport automatic delousing of infestedpeople traveling from a cold dry climateto a warm humid one. For thisreason body lice are cold weather infestations.The body louse does notwander over the body but attaches itselfto the clothing, preferably to aseam. It prefers coarse fabrics butsilk will not inhibit it. When theclothing is not suitable it may attachitself to a hair. Once attached, itholds on tenaciously by at least oneleg even when feeding. Complete removalof the clothing frequently removesall lice. The body louse preferstwo meals a day, although the adultcan go several days without food.Newly hatched lice, however, musthave food within thirty-six hours. Underfavorable conditions, the femaledeposits eggs or nits at the rate ofabout five a day. These are generallydeposited in nests of fifty or more andare attached to coarse fiber or hair.

April, 1930 The Health Bulletin 31One mating will insure fertility of theeggs for twenty days. When conditionsare favorable, the eggs hatchin about six days. The young beginto feed immediately and develop intoadults by undergoing three moults inabout eight or nine days. The averagelength of life is from thirty-five tofoi-ty days, although occasionally individualswill live for two or threemonths. The body louse has been closelyidentified with every epidemic oftyphus of which there is adequaterecord.A North Carolina physician. Dr.William Allen of Charlotte, was oneof the first southern physicians toreport cases of endemic typhus wherethe louse could not be considered avector. Dr. Kenneth Maxcy of theU. S. Public Health Service has madeintensive investigations of this conditionthroughout the southern states.In his papers of 1923, 1926, 1927,1928 and 1929, he has done much toadd to the knowledge of this disease.Because of its characteristics thebody louse cannot be accredited thevector in the south. In most of thecases reported in the south it has beennoted that there was an absence ofthe louse, both the body and headtypes.A comparison of the epidemiologicalcharacteristics of epidemic and endemictyphus is interesting.EpidemicEndemicCold weather Warm weatherAll agesMiddle aged adultsPovertyAffluenceFilthCleanlinessCrowdedUncrowdedSevereMildFatality— Fatality—nil12 to 20% Not lousyLousy Not contagiousHighly contagiousClinically the two conditions areindistinguishable except that the endemictype is milder. Both give positiveagglutinations with B. proteusX. Infection with one gives protectionagainst the other. Histologically,the lesions are similar. There is abundantevidence that epidemic typhusis louse-born and that endemic typhusis not. There seems to be adequateevidence that endemic typhus cannotbe conveyed by lice. The question naturallyarises can these two conditionswhich differ so much epidemiologicallyand are so similar clinically, seriologically,histologically, and immuniologicallybe one and the samedisease. The final answer cannot berendered at the present time.There is one explanation whichwould meet all the known facts, yetthis is based on theory and so remainsuntil it is proved. This explanationis that endemic typhus may bear thesame relation to epidemic typhus thatcow pox does to smallpox. It may bea disease of some lower animal andsecondarily and accidently of man.Anderson, in 1912, suggested that thevirus of Brills disease was an attenuatedtyphus virus and might some daybe used as a vaccine to combat epidemics.Endemic typhus apparently is asmall public health hazard. The patientsundoubtedly feel different aboutthis for they are miserable andwretched during the course of the disease.However, its non-communicabilityhas been noted by every investigator.Even when occurring amongthe lousy it does not spread. Its mortalityis nil. In the south our climatemay hazard us to malaria and denguebut it protects us from typhus in itsepidemic form.It cannot be denied that we haveoccasional cases of Brills disease.This fact gives every physician anopportunity to see a patient and theprivilege to contribute to medicalknowlede if he is fortunate enough todetermine the mode of transfer of infectiousmaterial. The discovery ofthis fact might do much to unlock theremaining secrets of typhus.

This little five year old Columbus county colored child is readyfor school this fall. She is reported as a "1930 model" preschool child-That is, she is physically perfect. The health officer will see that sheis immunized against smallpox, diphtheria and typhoid fever beforeschool starts.* .%This is a small one room Negro schoolhouse in a southeasterncounty. Only 15 children are enrolled but the parents of all of themown their own farms. And the nurse reports a healthy bunch.

|PutlislyedbM TAZ. ^°RJ/\ C^^LI/^A 5TATL D^ARD s^AB\LTAThis Dullelirwvillbe 5er\1 free 1o ar\y citizen of the 5"tcrteupoi\ requestEntered as second-class matter at postoffice at Raleigh, N. C, under Act of July 16,1894. Published monthly at the office of the Secretary of the Board, Raleigh, N. CVOL. XLV. MAY, 1930 NO. 50«0«0»0»0«0»0»0«0»0»0»0»0»0»0«0«0»0»0»0»0»0«0»0«0«0«0«0«0«0»0»0»0»0»0«0«0»0»0»0«0»0«0»0«0«0

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTHA. J. CROWELL. M.D., President CharlotteCYRUS THOMPSON. M.D JacksonvilleTHOMAS E. ANDERSON, M.D StatesvilleE. J. TUCKER, D.D.S RoxboroD. A. STANTON, M.D High PointJAMES P. STOWE, Ph.G CharlotteJOHN B. WRIGHT, M.D RaleighL. E. McDANIEL, M.D JacksonCHARLES C. ORR, M.D AshevilleEXECUTIVE STAFFCHAS. O'H. LAUGHINGHOUSE, M.D.,Secretary and State Health Officer.RONALD B. WILSON, Assistant to the Secretary.H. A. TAYLOR, M.D., Deputy State Health Officer.C. A. SHORE, M.D., Director State Laboratory of Hygiene.G. M. COOPER, M.D., Director Bureau of Health Education.H. E. MILLER, C.E., Chief of Bureau of Engineering and Inspection.F. M. REGISTER, M.D., Director Bureau of Vital Statistics.A. B. McCREARY, M.D., State Epidemiologist.GEORGE COLLINS, M.D., Director Bureau of Maternitv and Infancy.ERNEST A. BRANCH. D.D.S., Director of Oral Hygiene.D. A. DEES, M.D.. Field Assistant in County Health Work.FREE HEALTH LITERATUREThe State Board of Health publishes monthly The Health Bulletin,which will be sent free to any citizen requesting it. The Board also hasavailable for distribution without charge special literature on the followingsubjects. Ask for any in which you may be interested.Adenoids and TonsilsCancerCatarrhConstipationColdsClean-up PlacardsChickenpoxDiphtheriaDon't Spit PlacardsEyesFliesFlj^ PlacardsGerman MeaslesHookworm DiseaseInfantile ParalysisInfluenzaMalariaMeaslesPellagraPublic Health LawsPrenatal CareSanitary PriviesScarlet FeverSmallpoxTeethTuberculosisTuberculosis PlacardsTyphoid FeverTyphoid PlacardsVen«ral DiseasesWater SuppliesWhooping CoughSPECIAL LITERATURE ON MATERNITY AND INFANCYThe following special literature on the subjects listed below will besent free to any citizen of the State on request to the State Board ofHealth, Raleigh, N. C:Prenatal Care (by Mrs. Max West)"Our Babies"Prenatal Letters (series of ninemonthly letters)Minimum Standards of Prenatal CareWhat Builds Babies?Breast FeedingSunliglit for BabiesHints to North Carolina Mothers WhoWant Better BabiesTable of Heights and WeightsPAGEComing in the June Issue of theBulletin 3First Few Years of Life Is BestTime to Prevent Tuberculosis-. 3The Young Mothers' Club LearnsAbout Feeding the Child FromTwo to Six 5Some Phases of Diphtheria andScarlet FeverThe Prevention of Infantile Diarrhea1215CONTENTSThe Runabouts in the House of Health(pamphlet for children from 2 to 6years of age).Baby's daily Time Cards: Under 5months; 5 to 6 months; 7. 8, and 9months. 10, 11, and 12 months; 1year to 19 months; 19 months to 2years.Diet Lists: 9 to 12 months; 12 to 15months; 15 to 24 months; 2 to 3years; 3 to 6 years.PAGEThe Significance of the DevelopingTeeth in the Health of the DevelopingChild 18Mrs. Armstrong' Gives Mrs. YoungSome Sensible Suggestions onChild Care 23Jean's Dream 26Dicky Boy's Visit to the Country- 28BirthsShould Be Reported WlfhinFive Days 30A New Book on Posture 31

PUBU5ME.D BY T/AL nOR.TA CAgOUhA 5TATE- E)Q*vgD »^M£ALTMVOL. XLV. MAY, 1930 NO.COMING IN THE JUNE ISSUE OF THE BULLETINWe feel sure that it will be of considerableinterest to our readers toknow that we are promised anotherarticle by Miss Pyatt for the Juneissue of the Bulletin on the generalsubject of cooking for young children.This article by Miss Pyatt will followher story in this issue about feedingyoung children from two to six.In the June issue we will have anarticle on the subject of milk supplyratings for the cities and towns ofthe State which have had m'lk surveysmade. This article will have agood deal of information about milkwhich should be helpful to the readersof the Bulletin. There is no more importantpublic health problem thanthat of a safe milk supply forthe infants and children especially ofthe State. This material is being suppliedby the officials in the Bureau ofSanitary Engineering of the StateBoard of Health. The agitation beingcarried on throughout the State thisyear about the necessity for the productionof more home supplies hasserved toaccentuate the fact that themilk production in this State is considerablybelow what it ought to be.We hope that before the end of theyear the average production and consumptionof thoroughly safe and puremilk will be 'ncreased throughout theState.FIRST FEW YEARS OF LIFE IS BEST TIME TOPREVENT TUBERCULOSISThere is no better time than now,and no better place than the BabyIssue of the Health Bulletin, for usto discuss the important question ofpreventing the contraction of tuberculosisin childhood. It is a fa'rly wellestablished fact that a large per centof the cases of tuberculosis whichdevelop in the earlier years of adultlife especially is the result of infectionincurred during the first fewmonths, or at least the earlier yearsof life. This fact has been more orless thoroughly established by the useof the tuberculin test, which indicatesthe presence of tuberculosis in schoolchildren, and which can be accountedfor in no other way except that theinfection was contracted while thechild was a baby, or in the very earliestyears.We need not go into technical termsin this matter, because the officialsof the State Sanatorium for tuberculosishave literature available on thesubject, and they also have technicalinformation and advice to offer to anyperson interested. We may state, however,that there is a type of tuberculosiswhich has been carefully describedand has received the name of the"childhood type of tuberculosis," givento it by the American SanatoriumAssociation. It is pointed out that this

s'The Health Bulletin May, 1930type is a result of a first infection ofthe lung tissues with tubercle bacilli.There are other terms, but the aforementionedis more descriptive and isbeing used in responsible professionalcircles. It may be mentioned, however,that this type usually occurs inchildren, but very rarely in adults. Itis sometimes localized in only a singlepart of the lung. The adult type of tuberculosis:'s often a result of a reinfection.If active tuberculosis occurs in children,and if the infection becomes diffusedand widespread, recovery ishard to effect. Our chief interest, ofcourse, is in calling attention to theimportance of preventing any baby oryoung child from coming in intimatedaily contact with a pat'ent, especiallya careless patient, who is in theactive stages of tuberculosis, and inwhich there are bacilli being excretedin the sputum daily. An infant oryoung child can catch tuberculosis almostas easily as they can catchmeasles or diphtheria. Babies andvery young children should never beallowed to crawl about on the floor oraround the room of a patient who hastuberculosis. It ought not to be necessaryto say that babies and youngchildren should never be kissed on themouths by any grown up person,whether s'ck or well.One of the sei'ious things about achild contracting tuberculosis in infancyis that tuberculosis so frequentlydoes not make its appearance inthe form of active symptoms in anythinglike as short time as is the casewith adults after being exposed repeatedlyto the disease. There is anotherserious consideration in youngchildren, and that is the fact thatbones or other parts of the body maybe attacked by the disease, in whichcase few or none of the more famUiarsymptoms of tuberculosis are recognizeduntil it is often too late.The North Carolina State Sanatoriumhas the records of thousands uponthousands of children in which theyhave made the tuberculin test, andthey would be prepared to supply anybodywith definite figures as to whatpercentage of the children have reactedpositively to the test. It is frequentlythe case that a positive tuberculintest will be present in a child inwhich both parents are apparentlyhealthy, and often in which there isno history of tuberculosis. Such achild may be underweight, althoughthat is not the case in every instance.The child may have an irregular appetite.It will generally be found thatsuch a child is irritable and nervousand fretful, sometimes complains ofheadache in school and at home, hasa habit of eating between meals, andgenerally partakes of too much carbo-hydrate food, is frequently addictedto the candy habit, and generally doesnot sleep a sufficient number of hours,and the sleep is fretful.In preventing the contraction of tuberculosisin very young children parentscannot be too careful. Thereshould be no morbid fear of any individualhaving the disease in the house,but the baby should not be allowed toplay around the room, crawling onthe floor, where such a patient is bedriddenespecially. In other words, keepthe babies and young children awayfrom close contact with tuberculosa'patients of any age.The work and play of childrenshould be so regulated that they haveplenty of time for quiet rest, andtheir food habits should be carefullyestablished on a correct basis at theearliest possible age. The kind of foodthey ought to have should be carefullyprepared and put before them,and they should be required to eat itat regular intervals, and there shouldbe no between meal eating. When thedays are long, babies and young childrenshould be required to spend atleast an hour or two or more, dependingupon the age, in quiet sleepin the day time. Every baby and

May, 1930The Health Bulletinyoung child should certainly have atleast twelve hours or more uninterruptedsleep every night. The roomshould be so arranged that the lightdoes not fall on the baby's face. Ventilationshould be arranged to makesure of the child's wartnth and comfortwhen the weather is cold, and toaid in keeping it cool when the weatheris extremely hot.At present tons of literature areavailable to anybody who cares tostudy the question of nutrition andbalanced diet. It is suffic'ent for us tosay here that milk, fresh, clean, safe,whole sweet milk, in abundanceshould be given to every baby andyoung child in sufficient quantity everyday of its life. Milk together withfruits and fresh vegetables and somecereals should form the basis of thebabies' and young children's diet.From the day of birth the familydoctor should be consulted at frequentintervals. There should be a carefulall over physical examination by acompetent doctor made at least fourtimes a year until the baby is well outof infancy. Then twzce a year untilthe child starts to school would besufficient. Visits to a good dentistshould be started on the appeai-anceof the very first baby teeth. These visitsshould be repeated just as oftenas in the opinion of the family dentista visit is necessary. Preventionat this point is a most important matter.T'he family physician is equippedand fully competent to apply the tuberculintest to babies and young children.All that such a phys'cian needsin the way of experience is to seethe reaction that occurs in a fewchildren when given by a specialist,and in which some of the reactionsare positive and some negat've. Thisis a matter that the physicians areprepared to discuss with the parent.When a child is found to have a positivereaction, the family physicianwould advise that the child be takento a competent specialist for x-rayexaminations and other importanttests.The death rate from tuberculosishas declined within the last twentyfiveyears from its position at thetop of the listuntil now there are atleast five other diseases that causemore deaths than tuberculosis. Butit still causes an immense loss of lifein our State, and in our opinion thetime to do most about it is to beginat the beginning and prevent theoccurrenceof the infection in babiesand children.THE YOUNG MOTHERS' CLUB LEARNS ABOUTFEEDING THE CHILD FROM TWO TO SIXBy SUDIE E. Pyatt"Mother, Junior is two years oldthis summer. I know he is just enteringthe critical time from two to sixwhen it is so important that he learnthe proper habits of eating."Eloise Batchelor removed her glovesand hat as she spoke, and sat downon the divan beside her mother."Yes, dear, I have been thinkingabout Junior, and I am planning togive you some tested menus for hismeals through the summer months,"Mrs. Ross said, adjusting a pillow onthe divan to make it more comfortablefor her young daughter, who wasthe mother of a two-year-old babyboy."That will be fine. Mother, but,"Eloise's smooth forehead becamewrinkled. She was thinking. "I am

The Health Bulletin May, 1930 Ito be in charge of the program forthe next meeting of our Young Mother'sclub. There are ten of us, Mother,all young married women with one ortwo babies between two and six years.They are all worried, just as I am,over what they ought to feed theirbabies during the warm days justahead. Tell you what, Mother, supposeyou come to our next meeting,and talk to the girls about the propermenus and d'ets for their children."Mrs. Julian Ross, who had writtenseveral books on the feeding and careof children, smiled at her eagerdaughter, "Want to exploit your famousniother ? ""0, no. Mother," Eloise was quickto remonstrate, for she knew hermother never made any effort toplace herself inthe limelight becauseof the excellent books on child careand feeding that she had written, "1was just thinking of how much youcould help the mothers who are needingjust the advice you can givethem.""Certainly, dear, I will be glad totalk to your club, but I am going toask you to have your next meetinghere in my house, because if I presentmy message to the mothers as Iwish I will want to do it here in myown home where everything I w'llneed is convenient."""WTiy you dear, mother, I did notexpect you to invite us here to yourhome. I was expecting to have youcome to my home.""You must come here, and all ofthe mothers must bring their babies,simply dressed for a party," Mrs. Rossinstructed while Eloise hugged hermother and promised that her conditionswould be filled."Next Wednesday afternoon at 5o'clock, here in my home, all of youwith your babies, Eloise," Mrs. Rossreminded as her daughter left to goto her own home and telephone theten members of the Young Mothers'Club, of Grafton, as tothe plans forthe next meeting of the mothers andtheir sons and daughters.The afternoon for the regular weeklymeeting of the Young Mother's'Club of Crafton, was one of thoselovely spring days that come duringthe early part of May. Spring flowerswere blooming in the garden of theRoss home where the mothers withtheir babies were meeting that afternoon.The windows of the living roomand dining room were open and softspring breezes floated gently throughthe rooms.At low tables places were laid fortwenty-two guests, the number of themothers and children of the YoungMothers' Club. The low chairs wereadjusted by the addition of pHlowsand books in such a way that no childfound it a strain to reach the tablefor his food.Eloise, one of the hostesses, washelping her mother welcome and seattheirolder and younger guests, whileher two-year-old Junior, played quitecontentedly with the daughter of Mrs.Ernest Swarts, Marian, aged three.As Mrs. Ross and Eloise, assistedby Eloise's younger sister, Dorothy,served the Egg-in-the-nest on toast,ribbon sandwiches, and milk flavoredwith cocoa, that made up the principalpart of the party menu, Mrs.Ross talked informally to the mothers,who were watching to see thattheir young folks behaved themselvesin a party manner."For parties for children, girls,"Mrs. Ross said, "you want to rememberto serve easily digested foods, andserve them around 5 o'clock, lettingthe party meal take the place of theregular supper. You must watch newfoods. Be careful not to let a childbe introduced to a new food at aparty.""Yes, I am always afraid of parties,because of the new foods Marianalmost always eats," Mrs. ErnestSwarts said, as she fed her three-yearolddaughter, a small portion of the

May, 1930The Health BulletinEgg-in-the-nest on toast, without anyfears of bad after results."It is a good idea to remember, too,young ladies, that too much excitementand fatigue is not good foryoung children at parties. Don't allowthem to engage in boisterousgames that are too much for theirslender strength, or become fussedand overheated."By now the children and their mothershad eaten heartily of the simplefood served for the first course at theparty, and they were given orange icethat was the color of ripe, yelloworanges and thin little Nabisco wafers."I see now," Mrs. Kenneth Hill saidto Mrs. Henry Casteel, "what Mrs.Ross means by simple, easily digestedfood for parties for children. Thisfood is all good, and in larger servingssubstantial enough for grown-ups, butthere is no food here that would hurteven an invalid, who was not on a specialdiet.""I had been worrying about themenu for a party for Richard's thirdbirthday next month, but I am notgoing to worry any more. I am goingto get this menu, vary it a bit andserve it to the children, knowing thatno bad effects will result.""Girls, now that you and the childrenhave finished -with the refreshmentsDorothy, with one of her younggirl friends to help her, is going totake your children out into the sunparlor where they will entertain themwith music, games and stories for thenext hour, while you, their mothers,make yourselves comfortable here inthe living room, and we will have anice, informal chat together aboutfeeding the dear, little folks."Dorothy's and Lillian's smiles, andthe sound of music and sight of interestinglooking toys waiting! forthem in the sun parlor, made the separationof the babies from their mothersquite easy, and soon happy littlevoices sounded from the sun parlor."Girls, I know you all want to findout as much as you can about howyou can best handle your problems ofthe care of your children. Now thatthe little folks are having a good timeyou mothers can forget them whilewe talk of the things that will helpyou keep the youngsters happy andwell and make them grow as theyshould.""I'd like something on the fundamentalprinciples of child feeding,"Mrs. Henry Casteel, said as Mrs.Ross stopped talking."All right," Mrs. Ross answeredMrs. Casteel's request. "There are fivefundamental principles of child feeding.They are regularity of meals,good eating habits, carefully balancedmenus, well cooked food, and theright amount of food. As to regularityof meals there are several schedulesthe mother may follow. I haveseveral here."The ten mothers began a hasty openingof bags for pencils and bits ofpaper, but Mrs. Ross had anticipatedThe picture of this Wake Countybaby was made one month after anattack of diphtheria. Up to that timethe parents did not know she couldhave been protected by toxin-antitoxin.Fortunately prompt and competenttreatment saved her life.

8 The Health Bulletin May, 1930this very thing, and she now passedout typewriten sheets on which weretyped four different schedules forthe ordering of the day for healthyyoung folks.Eagerly Mrs. Casteel read herschedules: "Number 1, A. M —6:30,Water and fruit juice; 7:30, Breakfast;11:30, Dinner; P.M.—Nap; 2:30Milk and crackers; 5:00, Supper; 6:00,Bed. Number 2, A. M.—6:30-7:00, Cupof water; 7:30, Breakfast; 10:30,Lunch; 11:30, Nap; P. M.—1:30, Dinner;5:30, Supper; 6:30, Bed.""You see, young ladies, that theseschedules give the children approximatelya twelve-hour day, with a napof one and one-half to two hours duringthe day. TTie other two schedules,which Mrs. Casteel did not readare practically the same as the twoshe read, only following those schedulesthe child rises from 7:00 to 7:30and goes to bed at 7:00 instead ofrising at 6:00 or 6:30, and going tobed at 6, as in the first two schedules.Sunshine, fresh air, rest, andexercise must all be mentioned in thefundamental principles of ch'ld feeding,for it is upon these as well ason food, that the body cells depend fortheir development.""What is the best method of adjustingdiets, Mrs. Ross?" Mrs. ErnestSwarts asked."Add new foods in small quantitiesand never more than one new fooda day. A good diet for a two-year-oldbegins with two ounces of orangejuiceor strained, canned tomato juiceat 7:00 o'clock, cereal, preferably acooked cereal at 7:30, dry bread, oneor two slices,one-half teaspoonful ofbutter, and one cup of milk. At 11:00o'clock give a glass of milk, and oneor two unsweetened crackers."The main meal at 2:00 o'clockmay consist of eg^ or meat, vegetablesand a simple dessert. For the meatone may give minced chicken, lamb,or scraped beef, one to three tablespoonsful,of wh'chever meat is given.One to three tablespoons of starchyvegetables, potato, rice or hominy maybe given, and one to three tablespoonsof some green stewed vegetables suchas spinach, peas, string beans, celery,lettuce, carrots, asparagus, Swisschard. Dessert may be junket, custard,blanc mange, rice, or tapioca,about one-third to one-half cup ofeither."For the evening meal at 5:30, orwhatever houi' the schedule you selectcalls for it, give one-quarter to onethirdcup of cereal, one cup of milk,one small slice of hard bread or drytoast, a small serving of butter, andone to three tablespoons of somecooked fruit as prunes, dried peachesor apples with the skins removed.""Mother, my difficulty is in balancingdiets for Junior," Mrs. Batchelorasked the next question, as her mothercompleted the menu for the twoyear-old."A well-balanced diet means a wellbalancedchild," Mrs. Ross answeredher daughter, while the other ninemembers of the Young Mothers' clublistened. In balancing diets climaticconditions have to be taken into considerationas well as foods, and thechild's general health condition. Inwinter give hot milk. In the summerthe child needs less of hot cereals, butmore vegetables, particularly green,leafy ones. Dried fruits may be used,but the menu should be varied withfresh fruit. Fresh fruits are essentialduring allseasons of the year, but anexcess may be harmful. Eggs may befed five to seven times a week, butbe sure they are fresh when served.Serve meat two to three times a week,and fish once a week. Jelly or marmalade,may be served with bread, andso served acts for a simple but nourishingdessert."Every child should have one andone-half pints to one quart of milkevery day. Milk may be served as adrink, cooked as a food. Raw fruitand vegetables are a part of the daily

May, 1930 The Health Bulletin 9menu of every well-balanced diet.They may be served canned or stewedwhen the fresh article is not available,but in balancing the menu themother must see that some raw fruitor vegetable is included once a day,if possible."Mrs.Paul Helms, who had a smalldaughter, Mildred, two and one-half,and a son, Elmer, five, held up herhand as a signal that she had a problem."Teaching my boy and girl to eatwhat they should has always been mybiggest problem," she said, and all ofthe other mothers looked at her withsympathetic understanding."Children have to learn to eat newfoods," Mrs. Ross began. "He shouldbe taught to look foi'ward to his mealsand to welcome a new food. Servingthe food in atractive, comfortable surroundingswill help. Follow balancedmenus, and allow the child to have nofood between meals. Don't talk of yourown, or other people's food dislikesbefore the child. Cook all vegetablesto preserve the taste, and be firmlypersistent in teaching the child toeat what he should."In teaching the child to eat whathe should use indirect methods whendirect ones fail. In working the indirectmethod, stop, serving the dislikedfood or foods for awhile, orserve the food in small quantities.Serve foods that are likedonly afterthe disliked food has been eaten.Leave the disliked food before thechild while you and its father eat.When you are through take the foodaway without offering any of it to thechild.""That's allvery good," Mrs. Helmsagreed, "but what about milk? Mildredhas fought milk every since thefirst drop was given her.""If Mildred doesn't like milk tryserving it to her in a small pitcher,allowing her to pour her own milk.Praise her when she drinks the largerpoi'tion of the milk, and when shedrinks all of it, make her feel that sheis a little princess, a Milk Princess,perhaps.""Do you think it is a good idea topraise children when they eat theirfood without being forced to?""I most assuredly do," Mrs. Rossquickly answered."It seems to me that the milk andfresh fruits and vegetables you havebeen suggesting we feed our childrenregularly, would cost a greatdeal of money, Mrs. Ross," said Mrs.Ernest Swarts, whose husband was ashoe store clerk. "What would yousuggest for the mother who musteconomize. Marian is just three and,of course, I want her to have the bestof everything, but Ernest's salary isnot large, and he has his mother andan invalid sister as well as a wife anda baby to support on his salary.""Food is the last thing on whicha family should economize, Hermoine,"Mrs. Ross replied. "But if one mustThe father of this two and one-halfyear old baby is a Snow Hill physicianand a college mate of the Editorof the Bulletin. The baby has alreadybeen initiated into the mysteries ofthe D. A. R., as her mother is an officialof that organization. But in hersun-suit on the laivn of their homeshe is not bothering about meetingsof the "Daughters" or the MedicalSociety either.

10 The Health Bulletin May, 1930economize there isa minimum standardbelow which it is not safe to goin feeding young children. They shouldhave at least one pint of whole milka day, two vegetables a day, potatoesand one other, and a green leaf vegetablethree or four times a week, whennot in season, every day when greenvegetables are in season."Fresh fruit should be given threeor four times a week, every day ifpossible. Dried fruit may be given onthe days when fresh fruit is not given.Dark breads and whole grain cerealsevery day. Give eggs, dried beanor pea soup, cottage cheese, fish ormeat, one of each, every day. Butteris always included in the menu, evena menu for economy. Sweets need notbe stressed. Cooked cereals arecheaper than ready prepared ones,and better for the child. Tomato juicemay be given instead of oi*ange juice.Cake can be omitted, and sweet sandwichesmay be made for the childrenby using brown sugar, molasses, fruitsand jellies. In economizing remembernot to stint on milk, vegetables andfruit.""You stressed milk, Mrs. Ross.Won't you tell us a bit about milk?"Mrs. Casteel asked."Milk contains protein, fat and calciumin such proportions that it iscalled the perfect food," the authorof books on child care and feeding, respondedto Mrs. Casteel's request."Without milk undernourishment mayresult and seriously affect teeth andbones. A pint and one-half to a quartof milk a day will take care of thechild's need for milk. It should beheated on cold mornings. Teach yourchildren not to swallow milk in gulps,but to take it slowly. Use only boiledor pasteurized milk. Milk may be usedin combination with desserts andsoups. Menus for young children canbe balanced without milk, but onlyon the advice of a physician.""George is bothered a great dealwith constipation, Mrs. Ross," Mrs.Kenneth Hill stated, as Mrs. Rosscompleted her remarks on milk. "Howcan a mother feed her child to helprid it of constipation?""There are certain foods, which ifgiven children consistently, followinga plan will cure constipation," Mrs.Ross answered, Mrs. Hill's question,while the other mothers listened interestedly."First, give the little boy or girlbothered with constipation a cup ofwater before breakfast, betweenmeals, and at bed-time. Green vegetables,and leafy vegetables are thenatural enemies of constipation. Theseare celery, cabbage, string beans,spinach and lettuce. Fruits share withgreen vegetables as aids in riddingone of constipation. Fruits containingvegetable acids, oranges, apples, andwhite seedless grapes are good, asare the cellulose fruits such as prunes,figs and pears. Fruit and fruit juicesare often invaluable in combattingconstipation, if given before breakfastand between meals."Habits of eating are quite as importantas the food that is eaten incuring constipation. Teach your littlefolks to eat slowly, regularly, andmasticate well. What is equally asimportant as either the food eaten, orthe method of eating the food, teachyour boy and girl to go to the toiletat the same time every day, and avoidcathartics.""Does the proper food help thechild to develop good teeth?" Mrs.Morton Wright, who was the motherof a young son, Richard, just pasttwo, asked."It most assuredly does," Mrs. Rossresponded."Exercise food is to make the teethwork, building foods contain the necessarycalcium and phosphorus, andaccessory foods, such as cod liver oil,eggs yolk and butter' furnish the necessaryvitamine D. Clean, well-fedteeth are an invaluable asset to ahealthy digestive system."

May, 1930 The Health Bulletin 11"Both of my boys are underweight,Mrs. Ross. What can I do to remedythis condition?" Mrs. TTieodore Rudolph'svoice was anxious. She hadheard that children who were underweightwere liable to become the victimsof most any disease. She wassincerely anxious to bring both of hersons, Oliver, four and one-half andHail'y, two and one-half up to theaverage normal weight for their ages."The underweight child, that is thechild who is usually 10 per cent ormore underweight for his or her ageand height, should have rest, outdoorexercise, fresh air and sunshine aswell as food," the author of bookson child care and feeding was positivein her statement."Use extra milk and cod liver oil.The problem of the underweight childis really more serious than that of theoverweight child," Mrs. Ross said."Janet is overweight, Mrs. Ross.What would you suggest that I doto reduce her weight?" Mrs. HaroldZiegler asked."Follow your balanced menus withproperly prepared foods, discourageeating of starchy foods, fats andsugars. Avoid excitement at mealtime for your overweight child, aswell as for the underweight child,increaseoutdoor exercise, but don't allowit to tire Janet. Let her have nofood between meals. If she continuesto gain weight under this regime,consult your doctor.""Candy is Jimmie's worst eatingfault," Mrs. James Fisher spoke forthe first time during the discussionof food and food values by the YoungMothers Club, and their hostess."The best answer to the candy problemis that the well-fed child has nounsatisfied cravings," the hostess ofthe Young Mothers' Club answered."Candy should be avoided. It bluntsthe proper development of the tastenerves, and lacks the elements neededfor growth. It satisfies hunger withoutproviding nourishment, and causesdigestive disturbances."There was a murmur of assent toMrs. Ross' statements about candyamong the ten mothers."Now, girls, I feel that I have talkedlong enough for this meeting.There are some really importantthings about the cooking offood forchildren that I would like to tell you,but I feel that you have had enoughfor this time. I will now turn themeeting over to your president, Mrs.Casteel.""I am sure that we have all enjoyedMrs. Ross' talk very much, and thatwe all thank her for the lovely afternoonshe has given us, and for hermost interesting and instructive talk.Mrs. Ross says that she has somemore important things to tell us aboutcooking for children. Suppose we askher to meet with us at our next meeting,next Wednesday afternoon, andcontinue with a discussion of this veryimportant matter of feeding the childfrom two to six.""Certainly, we will be more thanl^

—12 The Health Bulletin May, 1930glad to have her with us again nextweek," the members of the YoungMothers' Club all said, as they all roseto welcome back back their happyboys and girls, who had just been allowedto return to their mothers."Remember 'Cooking for Children'will be the theme of our meeting nextWednesday and Mrs. Ross will be ourspeaker," Mrs. Henry Casteel, presidentof the Young Mothers' Club ofCrafton, said as she told Mrs. PaulHelms, her daughter, Mildred andher son, Elmer, goodbye, after themeeting at Mrs. Ross' home, wherethe young mothers had learned aboutfeeding the child from two to six.Author's Note: "Feeding the ChildFrom Two to Six," published by TheMacMillan Company, New York City,a most readable, and easily understoodvolume on the important subject offeeding the young child, is the authorityfor the statements in thisstory.A report of the next meeting ofthe Young Mothers' Club of Crafton,at which they will learn about cookingfor children will appear in the nextissue of The Health Bulletin.SOME PHASES OF DIPHTHERIA AND SCARLET FEVERByA. S. Root, M. D.(Extracts from paper read to a local medical society)Diphtheria and scarlet fever are diseasesin which the pediatrician andgeneral practitioner have a commoninterest and I thought that it mightbe worth while to discuss togethersome phases of these two diseases.First, Diphtheria. We need not dwellupon the usual clinical forms of diphtheriawhich all of us see. You realizeas fully as I the importance of institutingtreatment at the earliestpossible moment. For the first 24 or48 hours the toxins generated are freein the blood current, but after thistime they attach themselves to theprotoplasm of the body cells in increasingamounts and out of proportionto the lapse of time, and in thisevent no amount of antitoxin willi-each them. TTie results of culturingthe throat should not be waited forin any bi»Drder-line case—excep^. inthose children who are subject tobronchial asthma, hay fever, or whohave eczema. I would urge the intramuscularinjection of diphtheria antitoxinas the routine method of administration— never subcutaneously.It has been shown that the absorptionof the antitoxin when given thisway is twice as rapid as when givenunder the skin—and that 24 hourscan be saved in time— by giving itdeep into the muscles—preferably ofthe buttocks. For any child at anyage 10,000 units intramuscularly, onetime, is all that is necessary. Lessthan half this amount will neuti-alizeall the free toxins in the blood stream—and any other toxins in the bodywill be fixed to the tissues, and hencenot reached.In very toxic cases, intravenoususe of antitoxin should be resorted to,and if this is done care should beobserved that the product is clearnot cloudy.In cases of diphtheria in asthmaticsor those who have eczema: The serumshould be given very slowly—one dropevery ten minutes, three or four times,then if no reaction, the rest of thedose.Despite the use of toxin-antitoxin.

May, 1930 The Health Bulletin 13which each year has become more andmore general—the incidence of thisdisease is still entirely too high. Onepotent source is the child with nasaldiphtheria, who suffers no constitutionalreaction because the nasal mucousmembrane does not absorb thepoisons. He circulates among hisplaymates in school and at play withno other symptoms than a persistentblood-tinged nasal dischai-ge. I wonderif you and if I are vigilant enough indetecting, isolating and treating thesecases ?Laryngeal diphtheria deserves especialconsideration. The mortality ofthis clinical type of case is very high— 30 percent in young infants and representsa high percentage of thegeneral mortality from diphtheria. Wehave had a sufficient number of casesto have some definite ideas about thistype, which might be emphasized.During the past two years we haveintubated 45 cases in ages from 1 to10 years. Of the 45 cases 28 requiredone intubation while twelve requiredfrom 2 to as many as 12 in one particularcase. Those patients recoveringfrom one intubation left the hospitalafter 4 days. There were 7 deaths,two from ovei'whelming toxemia,three from myocarditis, and two frombroncho-pneumonia. The mortality ofthe series was 15.5%. Six of thesecases were moribund on admissionand lived less than 24 hours fi'om thetime of admission. Two children becamechronic tube cases. One of thesefinally recovered under the treatmentof Dr. Jackson after having been 6months in the hospital. The other died.The duration of symptoms before admissionaveraged 5 days—in mostcases less than this. Practically noneof these children had received antitoxinuntil just before they were sentto the hospital. All of them were sufferingwith severe laryngeal dyspnoea,and most of them with embarrassedcirculation. The rapid courseof the disease from first symptoms tothe point when intubation becomes imperativeto prevent asyphyxia (being1 to 5 days usually) emphasizes thenecessity of making an early diagnosis.Children with catarrhal laryngitishave higher temperature andgreater constitutional reactions at theonset than in laryngeal diphtheria.They are hoarse and croupy throughpart of the night, but through theday they breathe freely and the voiceis rarely completely lost. In diphtheriathe laryngeal breathing is progressivethrough night and day andreal dyspnoea rapidly develops. Usuallythey can only speak in a whisper,but it must be remembered thatif the membrane is below the vocalcords as it sometimes is, the voice isnot lost. After the development ofdyspnoea the condition is grave andprobably will not now be relieved byantitoxin.I wish to emphasize this: That wehave seen no cases showing decideddyspnoea helped by the administrationof antitoxin in less than 12 toThe mother of this eight monthsold Duplin County baby writes that"He has never been sick a minute,and I am sure The Health Bulletinhas played a large part in developinghis healthy body."

14 The Health Bulletin May, 193024 hours after its administration.They continue to become progressivelyworse during this period andrequire invariably relief by intubation.A difficult differential diagnosissometimes has to be made betweenlaryngeal diphtheria and the symptomsproduced by a foreign body aspiratedinto a bronchus. In both thereis laryngeal stridor, but the historyof the case, the asthmatic rales, andlocalized signs in the chest will usuallydesignate these foreign bodycases. Culture from the throat willhelp decide thecase.In some of the hospitals for contagiousdiseases, notably the Willard-Parker in New York City where itwas first performed, the suction methodof removing the membrane is practiced.By this method broncho-pneumoniaas a complication has beenreduced 33 1-3%, and hence the mortalitygreatly decreased. About 50%of cases receiving suction treatmentultimately require intubation. Broncho-pneumoniadoes not seem to complicatecases in this climate as it doesfurther North for we had only 4 ofsuch cases in our series with 3 deaths.The mortality from diphtheria is33 1-3% less than it was 10 yearsago when toxin antitoxin was introducedas a prophylactic measure. Dr.Wm. Park with whom I recentlytalked stated that 80% of children inNew York City who were rendered immuneagainst diphtheria 10 years agowere still immune as shown by theSchick test. Five weekly doses of1 c. c. will render over 90% of childrenimmune 6 month after the lastdose. If 3 doses are given a Schicktest should be made after 6 monthstime, and if this is positive 2 or 3more doses given. TTiere has beenrecently some controversy as towhether or not toxin-antitoxin rendersa child more susceptible toserum reactions in case antitoxins ofany kind should have to be given subsequently.Dr. Park does not feel thatit does to any perceptible extent. Howevermany are using toxin-antitoxinmade from goat serum and this is tobe preferred to that made from horseserum. There is a product "toxoid"which is advocated for active immunization.Here the diphtheria toxin isneutralized by a chemical and notantitoxin. It is claimed that immunityis more rapid than with toxin-antitoxin.Such is not the case and moreviolent local and constitutional reactionsare seen from its use. The antidiphtheriaclinics conducted by theState Board of Health have been productiveof great good and now NorthCarolina has more children of the preschoolage immunized than any otherState except New York. It is a verygrave mistake, however, for anyhealth officer or any physician inpractice to tell parents that three oreven five doses of toxin-antitoxin willprevent diphtheria. If they go awaywith this feeling—then they may failto call their physician in case the childhas sore throat and again if one ofthese children supposedly immuneshould contract the disease—then thisone case may militate against the useof toxin-antitoxin in many other childrenwhose parents have heard aboutit.Scarlet fever: Scarlet fever is notthe problem with us that diphtheriais. The further South one goes theless virulent is this disease. Yet wedo from time to time have under ourcare toxic cases—and very seriouslyill children they are.There has been much written uponthe serum treatment of scarlet feversince the Dicks in 1922 proved thatthe causative organism was a hemolyticstreptococcus which made possiblethe manufacture of a specific serum.There have been reports frommany different parts of the countryupon the results of its use and thereis a wide variation among the differentauthors. At best the results arenot generally striking—in marked

—May, 1930 The Health Bulletin 15contrast to diphtheria antitoxin. Thisis probably because scarlet fever antitoxinis antitoxic but not bactericidal.A summary of these reports analyzedby Toomey— (Nov. 1928 JournalA. M. A.) indicates that the feveris lowered, the rash fades, the toxemiais relieved a day or two earlierin treated as compared with untreatedcases. Complications seem to be lessenedin the treated cases, but howmuch it was difficult to say. In over50 "/f of cases a violent reaction to theserum occurs which often makes thechild sicker than the disease did. Ofthe 12 or 15 cases we have personallytreated with serum roughly 60% havehad violent late serum reactions. Itis unwise to give serum treatment toany mild case of scarlet fever, or touse it as a prophylactic agent unlessthere has been a very definite andclose contact with the sick child. Atthe Willard-Parker Hospital the criterionfor its administratis a in anygiven case is where the fev.^r at theonset is as high as 102° by mouth.Unless the serum is given earlywhile the rash is still bright—it isineffective and should not be used.We have followed the Willard-Parker Hospital rule and give it tocases which start out obviously sickand with a temperature 102° or over.Active immunization with scarlet fevertoxin is not nearly as satisfactoryas active immunization withdiphtheria toxin-antitoxin. Active im.-munity in scarlet fever only lastsabout 3 years. We would not recommendits use in this climate except inorphan asylums, or where largegroups of children live together.The Dick test shows practically thesame age susceptibility in scarlet feveras the Schick test does in diphtheria.The intensity of scarlet fevervaries from year to year and is differentin different epidemics, consequentlyit will be some years beforethe true value of scarlet fever antitoxinwill have been determined.THE PREVENTION OF INFANTILE DIARRHEAByCharles R. Bugg, B.A., M.D.Each year at this time the problemof infantile intestinal disturbancesassumes increased interest andimportance. While these disturbancesare not confined to the summermonths they reach their peak of frequencyand severity at that time. Itseems wise for us therefore to be prepared,as far as possible, for this annualoccurrence.Preventive medicine is destined tobecome an even more importantbranch of our science than it has inthe past. It has now to its credit thenear eradication of smallpox, malaria,and yellow fever, and the marked reductionin the incidence of diphtheria,where the methods have been activelyutilized. The more careful supervisionof milk and water supplies byboards of health and the disseminanationof knowledge of rules of infantcare have done much to prevent intestinaldisturbances. Much is yet tobe accomplished, and most of the preventivemeasures of the future mustbe in the hands of the parent.The first step in studying the preventionof any disease must, of necessity,be the determination of thecause.For pi-actical purposes infantilediarrhea may be considered to fall intotwo general groups. TTie firstgi'oup is a large one which we willcall acute intestinal indigestion. This

16 The Health Bulletin May, 1930group includes vomiting and diarrheaproduced by a variety of causes. Thesecond group is the disease dysentery,often called "colitis."Some of the most frequent causesof diarrhea of the indigestion typeare (1) Improper food (2) Improperschedule of feeding (3) Contaminatedor spoiled food (4) Excessive heat,due either to summer weather or tohot houses or to excessive clothingor covering (5) Infections somewherein the infant's body which indirectlylower his ability to digest his food.It seems wise to take these up inorder—Improper food means foodwhich is too complicated for the baby'sdigestive capacity. It is impossible todiscuss this whole subject. The dietshould be prescribed by the physician.One or two points however areworth stating. No child under fouryears should have fried or greasyfood, sweet potato, corn or nuts.The schedule of feeding must beprescribed for the individual child.The commonest error is overtaxingthe infant's digestive system by irregularor frequent feedings, whichprovide insufficient stomach and intestinalrest.It has been long recognized thatthe hot days bring trouble for babies.This is partly due to the increasedvirulence of the bacteria that producesome of the intestinal disturbancesin hot weather and partly tothe direct influence of atmosphericheat on the infant's digestive system.We cannot control hot weather. However,the baby should have the advantageof our knowledge that heatoutdoors is less harmful than heatindoors, and that removal of all clothingand frequent sponging of the bodywith cool water on the extreme dayscounteracts, to some extent, the effectof the excessive atmospheric heat.It cannot be doubted that some digestivedisturbances in cool weatherare produced by the almost universalhabit of overheating houses and overdressingbabies. Many of the babiesin our very mild climate of NorthCarolina are dressed and covered ina way that would be almost sufficientfor an arctic expedition, and the temperatureof many of our houses inwinter is such that upon entering oneexperiences a definite sensation of impendingsuffocation.Special emphasis should be givento the final one of these causes of indigestion—acuteinfections outsidethe digestive system. It is not clearlyunderstood how these infectionsbring about their effect on digestion,but there has been almost universalacceptance of the fact. So much impressedwith it are physicians thatthe first step in the treatment ofdiarrhea always consists of a completeexamination to findor eliminatesuch an acute focus of infection. Itis likely to be acute ear infection,acute throat infection, bronchitis,pneumonia, boils or acute pyelitis(pus in the urine). Usually this infectionis obscui'e, frequently itssymptoms are overshadowed by theintestinal symptoms, and very care-These three beautiful Thomasvillechildren are visiting their grandmotherwho is eighty years old and tvholives at Farmer, N. C. Guess tvho isenjoying the visit most.

May, 1930 The Health Bulletin 17ful search is necessary to find the infection.The treatment of the diarrheais much handicapped if the infectioncausing it is not found and treated.Of the greatest importance is thetremendous preventive value of breastfeeding, if this is wisely carried out.It is rare to see a nursing infant developany type of severe intestinal disturbance,and vi^henhe does, recoveryis the rule. In this same connectionit should most emphatically be statedthat some of our most severe and fatalcases of diarrhea are seen in babieswhere maternal nursing has beencontinued beyond the normal nursingperiod, which is 9 or 10 months. Theharm of prolonged maternal nursinggives us one of the most interestingchapters in infant psychology andhabit formation. It is the rule thatbreast feeding continued to 14 or 15months is associated with a gradualtendency to refuse other necessaryarticles of food which means an insufficientand inadequate diet alwaysfollowed by loss of weight andstrength and development of anemia.In such an infant the intestinal disturbancesfind their ideal field forwork, and the germ of dysentery itsideal soil for growth.To eliminate this dangerous habitwe must first eliminate that largemass of false superstition on whichmost of it rests. In some peculiarway past generations have connectedweaning with the eruption of teeth,with the signs of the Zodiac, withphases of the moon, etc. Such considerationsof course must be completelyeliminated from the problem in ourenlightened age.It is a good general rule that intestinaldistui'bances are more likelyto occur in babies who are failing togain weight normally. The old ruleof limiting an infant's diet to preventintestinal disturbances has beendiscarded. The whole plan is to havehim taking adequate amounts of necessaryfoods in order to properlybuild and develop all his bodily systems.Such an infant has the bestform of insurance against diarrhealdisease.The second type of diarrhea is thatwhich is properly called dysentery,often called "colitis." This diseaseis caused by the presence and growthof the dysentery bacillus in the intestine.This germ is very widespreadespecially in hot weather, and gainsentrance into the body in one of threeways—milk, water or flies.With the knowledge of the causethe necessary preventive measuresare obvious. But obvious does notmean easy. TTie careful supervisionof milk and water supplies has materiallyreduced the incidence of thisdisease, especially in the towns andcities. In the rural districts less improvementhas been noted, and it isin the rural districts that most of thecases now occur. It is frequent enoughin the cities, however, to still constitutea very important problem.No matter how carefully supervisedthe milk supply is, all milk shouldbe boiled for babies under 2 years.Three minutes of slow boiling will killall harmful bacteria, and if the milkis then kept cold no harmful bacteriawill grow in it. Vessels and bottlesthat are used for babies' milk shouldalso be boiled, as should the nipples.The baby should have his bottle heldfor him to avoid its falling on thefloor or otherwise contaminating thenipple.Where there is the slightest doubtabout the purity of the water, this alsoshould be boiled before allowingbabies to drink it.The control of flies is more difficult.Screening of houses has savedmany lives and, where possible, shouldbe practiced. If this is impossible atleast pantries and kitchens should bescreened, and in no case should flieshave opportunity to get to excretedmaterial. These insects are responsiblefor many cases of dysentery.

18 The Health Bulletin May, 1930for after alighting on infected materialthey not only carry the bacteriato food but to other articles whichchildren put in their mouths. The bacteriaare frequently present in the intestinalmaterial of a person who hasno symptoms of the disease.Of course many of the cases of dysenteryare contracted from othercases. It is quite contagious, especiallyfor other children. This means thatany infant who has dysentery shouldbe isolated from other children. Hisclothing and diapers should be soakedin an antiseptic solution such asbichloride or Lysol and then boiled.Where the child is old enough to usea receptable the same type of antisepticsolution should be poured overthe stool before it is desposed of.Dysentery is characterized by asudden onset, often with violent symptomsof fever,prostration and vomiting.Very soon the diarrhea startsand the diagnosis is made on the typeof diarrhea. The stools are strikinglyfrequent, contain blood and pus, andare usually preceded by cramp-likepain and passed with considerablepainful straining. The persistence ofblood and pus is the distinguishingpoint from diarrhea of the indigestiontype.The mortality from dysentery isstill alarmingly high in spite of ourimproved methods of treatment. Wehave no specific method of preventionor treatment such as a serum andmust depend on other methods.It is to be hoped that the principlesoutlined here may stimulate an increaseddetermination to put them intopractice, for it is on these principlesthat we must depend in the fightagainst this enemy of infants.THE SIGNIFICANCE OF THE DEVELOPING TEETHIN THEHEALTH OF THE DEVELOPING CHILDByBaird U. Brooks, M. D.The coordination and the coopei'ationof the medical and dental professionsin the care of teeth in childhoodhas not been very great in thepast, but as we learn more of theimportance of this subject, and thedangers of neglect in this matter,each profession has become moreaware of its responsibility, and morealert in remedying a condition whichhas long existed to the discredit ofboth professions. I am unable to assignany reason for this neglect inthe past except the unwillingness onthe part of each profession to inflictpain on these helpless individuals, orelse an unworthy desire on our partto shirk a responsibility which requiresthe greatest patience andtact on the part of any one undertakingsuch a task.However, our knowledge has nowadvanced to the point that we realizethe danger of neglect of the temporaryteeth, dangers which in many instancesare hidden from the casualobserver, and we must either prepareourselves to face this obligation oracknowledge that we are supercededby a younger and more alert memberof our profession.Our apparent neglect of this conditionseems more difficult to understandwhen we recall the significancethe eruption of the teeth has an indexto the development of the infant. The

May, 1930 The Health Bulletin 19mother even realizes this significance.Every mother looks anxiously for thefirst tooth, and points with just prideto its early eruption, and it is a rareand unusual occurrence when any onemakes this important discovery beforethe proud mother. It is householdknowledge handed down formany generations that the early,regular and orderly eruption of thetemporary teeth indicates a regularand orderly development of otherparts of the body, and therefore agood and healthy baby.Just as the early and orderly eruptionof the temporary teeth indicatesan orderly and good development ofother members and functions of thebody, so also does the slow and disorderlyeruption indicate some faultydevelopment elsewhere. So the prideof the mother in this development,which is either instinct or traditionon her part, is well justified in truth.The good pediatrician, just as thegood old fashioned horse trader, canfairly accurately tell the age of hispatient by a look at his teeth. Thereare two at six months, four at eightmonths, six to eight at ten to twelvemonths, and any great deviation fromthis rule leads us out on a search forthe reason why. During the secondyear of life the four molars and thefour canines are erupted and at thistime the baby is ready to be refei-redto the dentist.It is unfortunately true that withthe eruption of the stomach and eyeteeth the mother feels her anxiety inregard to the teeth has come to anend, and generally she heaves a sighof relief and from that time onwardthe teeth of her child receives veryPriscilla Alden is six months old and Nancy Bascom is eighteen monthsold. They are children of the Craven County health officer. Neither has everbeen sick. The principal item of food is lactic acid pasteurized milk. Both weresuccessfully vaccinated against smallpo.r at six tvecks of age. Had their toxinflititoxin to prevent diphtheria at six months, and Nancy had her vaccinationfl lainst typhoid at one year of age. If all Parents were as carefid to protecttheir children, North Carolina could soon say faretvell to those three dangerousdiseases.

20 The Health Bulletin Maij, 1930littletheconsideration. From this time onlurking dangers of diseased teethbegin to show themselves.It has been stated that after theeruption of the firstsixteen teeth thechild should be referred to the dentistfor regular inspection. This serves atwofold purpose. It gets the motherin the habit of frequently inspectingthe child's mouth for evidences oftrouble. When trouble appears shefinds it early and can get it corrected.On the part of the dentist it enableshim to discover early evidences ofdecay and gives him an opportunity tocorrect it before it has advanced tothe point that it becomes a dangerto the health of the child. It giveshim the opportunity to instruct themother in the proper precautionarymeasures for the teeth. In other wordsit gives him an early opportunity tolay the foundation of one of the mostimportant measures in preventivemedicine. The decay and destructionof the temporary teeth produces oneof the earliest foot holds for underminingthe future health of the child,and hence the importance of discoveringthese defects early and remedythem as soon as they are discovered.The normal state in childhood isone of gro\\i;h and development andanything which retards this normalcondition assumes the same relativeposition in child life that does thatthing which limits the earning capacityor usefulness in adult life. Indeedit may be of even greater significancein childhood than in the adult, forwhatever retards the child vdll gatherits toll in the adult by limiting theusefulness of that life.A few words regarding the beginningof these conditions may not beout of place at this time. As soon asthe temporary teeth are erupted the3'^are attacked by bacteria and as a resultwe have to combat conditionsvarying from green stain to completelossof the teeth.an excellent incubatorThe mouth isfor bacteria, having moisture, heat,food and dai'kness, all of which tendto promote their growth. Many varietiesof organisms are found but thepredominating ones are, streptococcushemolyticus in acute alveolar abscessesand streptococcus viridans inchronic alveolitis. The bacteria do notaffect the teeth directly but by decomposingsaliva and ingested sugarthey are able to overcome the resistanceof the enamel and dentin.Decay depends upon the state of acidityof the blood and the number ofbactei'ia present.The first step in the carious processis the formation of the "bacterialplaque," which is composed of mucin,bacteria and of food debris. Theseplaques may be made to appear onthe teeth by painting the surfacesof the teeth with 7% iodine solution.The plaque appears as a small darkspot. Large accretion of mineral saltsmixed with mucin and bacterial debrisappear near the openings of the salivaryducts and in other places in themouth. This is known as tartar. Greenstain is found at the gum margin andis due to irritation, at this point, ofputrefactive bacteria in combinationwith mucin and the coloring matterof the blood. Pyorrhoea, or gum abscesses,is the result of irritating andneglected deposits of tartar, and byan unhealthy condition produced bypoor mouth hygiene.I would not attempt to say whatdental work is necessary to be donein the child's mouth as these defectsappear, but I would emphasize theimportance of correcting the defectsas they appear, and not to pass overthem lightly by feeling and saying,'Oh, they are only the temporaryteeth and will soon be lost." They areneeded to bring about proper developmentof the jaw." It is my impressionthat, while the proper development ofthe jaw is of the utmost importance,itdoes not, and cannot ever be justifiedto sacrifice the health of the child

May, 1930 The Health Bulletin 21for the proper development of thejaw.If we consider some of the physicalresults of decaying teeth we will easilyrealize the importance oi\ correctingthese defects early. As thedecay develops we get all the evidencesof a focal infection which areseen in later adult life. The first signswill probably be found in the presenceof toothache as some sensitiveportion is exposed. Who of us hasbeen spared these agonizing painsof toothache in childhood? The hoursof agony and sleeplessness, not tomention the nervous strain, still loomup in our minds as nightmares ofthe past which we fain would forget,and which we would spare the childhoodof our present generation if sucha thing be within our power. T^iedirect ti-ansmission of these organismsof the mouth, together with the particlesof decay, born into the stomachand intestinal tract can but give riseto many digestive disorders too numerousto mention. But the absorptionthrough the blood stream gives riseundoubtedly to greater dangers thanthose by direct transmission into theintestinal tract. We have then all thefar reaching results of a focal infectionwhich gives rise to as many seriousconditions as they do in lateradult life. Pyelitis, endocarditis, rheumatismfollow as a result of abscessedteeth. The end results are morefar reaching than could be enumeratedin a discussion of the limited timeallowed for a paper of this kind. Sufficeit to say that decaying or abscessedteeth are, next to infected anddiseased tonsils, a greater source ofdanger, and a greater cause of illhealth than any oher condition whichconfronts the pediatrician.Next to evidences of infection asmentioned will be found evidences ofmalnutrition. This may be due in thefirst place to incomplete mastication,and in the second place to the presencein the intestinal tract of the resultsof the decaying particles. Whenthe childfor any reason becomes deprivedof the full power to exercisecomplete digestive functions then thevery foundation of his physical structurehas been undermined. The presenceof the decaying matter in thestomach and intestinal tract not onlyimpairs the digestive capacity but itlessens the appetite as well, and thuswe find a child with little or no desirefor food and with a limited capacityto digest even the small amounthe takes into the stomach. The resultis the child rendered nervousand irritable by sensitive teeth, appetiteimpaired, digestion impaired, resistancelowered, and all these strongholds of health removed at the sametime invading organisms are standingready to overpower and to lay wastethe normal functions of the body.Small wonder it is then that thesepitiful creatures become the prey ofinvading hosts of disease, and inmany cases almost hopeless invalids.Malocclusion is another conditionproduced by faulty condition of theteeth, most commonly by misplacederuption of the six year molars. Inmalocclusion of his type the upperfront incisors protrude and the lowerlip does not close over the upper frontincisors, or meet the upper lip, andThe mother who sends in this beautifulphotograph of this Chapel Hillbaby taking her daily dose of sunshinesays, "I don't go off and play bridgeand leave my baby to a maid, and Iprepare all her feedings myself." Thebaby looJxS it, too.

22 The Health Bulletin May, 1930the child breathes through his moutli,producing a narrow upper arch, cariousteeth, and mental retardation.Purulent conditions of the gums.or alveolar processes are said toproduce20 9r of all diseases. The intimaterelation of pyorrhoea to systemicdiseases has been mentioned.The relation of diseased mouths toepidemiology has been brought outby Fones in a report in which heshows a most favorable differencewhich he attributes to the improvementin the conditions of the mouthsof school children after the introductionof school hygienists in the schoolsof Bridgeport. Fones also studied therelation of retardation to defectiveteeth and finds it is reduced 50 9f). Healso believes that the dental workdone in the Bridgeport schools hasraised the mental status 15 Tf.Wm. R. Woodbury says, "There isno longer the slightest doubt concerningthe relation of alveolar abscessand pyorrhoea to chorea."In determining the presence or absenceof alveolar abscess the X-ray isinvaluable. Many abscesses dry, leavingcaseous foci containing live bacteriaabout the roots of the teeth.They are in a latent condition and maycause neither pain nor tenderness.Their systemic results may be veryserious and their presence should beinvestigated with the X-ray.In conclusion I desire to report onecase which illustrates more than anypatient I have ever had the conditionsas brought out in this paper.William A. was a seven year old sonof healthy parents. He had been anormal infant at birth and had developednormally. In his childhood hehad had whooping cough, measles,chickenpox, influenza and tonsilitis.His tonsils and adenoids had been removedone year prior to his visit tomy office. At the time of this visitthe chief complaint was a poor appetiteand under weight. There had beenno cough, but had been slight hoarseness.A physical examination showed avery poorly nourished child who seemedquite sick. Examination of themouth showed the gums infected andthe presence of numerous abscessedand decayed teeth, the glands of theneck were enlarged. He was advisedto have the abscessed teeth removedand this advice was followed. Threedays after this operation his weightwas 39 pounds and 10 ounces. Oneweek following this his weight was41 pounds and 7 ounces, a gain ofone pound and 13 ounces. The followingweek he showed a gain of 1 poundand 1 ounce, the following week again of 1 pound and 8 ounces, thenext two weeks he had gained 14ounces, and the next two weeks a gainof 14 ounces, being a total gain of6 pounds and 2 ounces in seven weekstime.In addition to his gain in weight,his change in appearance and hiswhole attitude toward life was equallystriking. He had resumed his schoolwork and was keeping pace with hisfellows.This baby, who lives on a JohnstonCounty farm, is noiv about two yearsold. As you can see, she has startedin early to enjoy the season's outdoorrecreational facilities.

Ma/y, 1930 The Health Bulletin 23MRS. ARMSTRONG GIVES MRS. YOUNG SOMESENSIBLE SUGGESTIONS ON CHILD CAREByJosephineSharkey"Let me have a bottleof bichlorideof mercury tablets, please. That'swhat you get to put in the water youwash diapers in isn't it, Mrs. Armstrong?"The tired, worried motherasked her neighbor at the drug storecounter. "Good gracious, no. Fiveminutes boiling in plain water willkill all the germs from Germany andthe "Mike-robes" from Ireland. Whatis the trouble." "My baby has a rashand is so uncomfortable. Mrs. Jonessaid it might be the cereal makinghim acid and I stopped the cereal buthe isn't any better.Then Mrs. Brownsaid that as he hasn't a rash anywhereelse it might be a good ideato wash the diapers in bichloride ofmercury water because that is thestrongest disinfectant made.""Perhaps it is but I wouldn't bringthose pretty little blue tablets intothe same house with your three yearold Billy for he might do some investigating.What sort of soap do youuse 9""Good strong soap, the kind I usefor the rest of the washing. I have toget them clean and I have such a pileof washing these days.""Perhaps that's the trouble. Ababy's skin is very tender and I neveruse any soap for Jane's clothesthat I wouldn't for my own face. Mywashing doesn't take me more thanten minutes a day because I have acovered white enamel bucket withsoapy water that I drop her I'ttlethings into then once a day I rub themout, then a good rinse, then out in thesunshine to blow dry. My baby isperfectly well, God bless her, and Idon't even boil them on a good sunnyday but if there is no sun I give thema five minute boil. You will be shockedwhen I tell you that I don't eveniron them, just pull them straightwhen they go on the line and whenI take them in they are all fresh andsmelling of the outdoors. That's oneof the ways I save time.""Oh I wish you would tell me whatmakes you look as if you had all thetime in the world. You seem yearsyounger since your baby came and sowell and happy and everyone saysyou have a prize baby. Have you asecret or some trick?""No it isn't a secret or a trick, notone I wouldn't be glad to share withyou. Why don't you come round thisafternoon and we'll have a good talkwhile the babies sleep. That's mypackage, isn't it? You gave me thepint size cod liver oil, didn't you?Thanks."That afternoon Mrs. Young pushedher pale, thin baby, wi-apped upin ever so many clothes, round to theArmstrong's."Let's put the baby round the cornerof the house where Jane is in thesun, then our voices won't botherthem.""But I am afraid to let Georgieout of my sight. He kicks off thecovers so and he's had so many coldsthis winter.""Oh, we'll soon fix that up. Oneof the first things I got in my baby'soutfit was a set of fasteners thatreally hold the bedclothes where theyshould be. They are worth theirweight in gold for they save m.e hoursof time and so much anxiety. WhenI tuck Jane in for the night or hernap I know she can't get uncovereddon't have to keep looking in andso I

24 The Health Bulletin Maif, 1930opening and shutting the door andwaking her up. She knows that I won'tcome back till time for her to get upso she settles down to the seriousbusiness of the moment and is soonfast asleep. I'll get Jane's set for theother bed. I keep one on that andone on her little out-doors bassinette.""You're not going to leave themthere with the sun shining in theireyes?""Yes indeed. It shines on theirfaces but not directly into their eyesand sunshine is one of the most preciousthings a baby can have. Do youknow that right after Jane has hadher seven o'clock bottle in the morningI put her downstairs on the eastporch in the morning sun because thesleeping porch doesn't get the suntill later in the day. She really nevercomes in till time to put her to bedfor the night except when I feed andchange her and now that spring iscoming I even feed her out doors. Ikeep moving her bassinette roundafter the sun. The sides are paddedso she doesn't get the wind, just thefresh air and sunshine.""But everyone says it's bad to havethe sun on a baby's eyes. I have heardthat all my life.""No the government bulletin saysit's all right shining on their closedeyes or from in back of them fortheir brows protect the eyes.""What do you mean by the GovernmentBulletin?""Do you mean you haven't one?Why, I couldn't keep house withoutmine. Here it is look at it all curlyround the edges and the pages turneddown. It really has all the informationanyone needs and has been doneby the best specialists the country canboast of. This is the new edition of'Infant Care' just out and it is rightup to the minute. You see they areDofinding new things out every day.you know the bulletin called ChildManagement? That is also free fromthe government and it is written by adoctor who was awarded a prize twoyears ago for the finest book on childcare. That book would give j'ou lotsof ideas about your young Jack whois beginning to bother you. It willrelieve your mind about some of thethings he does which seem so wild toyou. And perhaps it will call your attentionto little signs of somethingreally needing care.""Oh I do need something for Jack.Some days he almost runs me crazy.He didn't seem to be so naughty tillthe new baby came but some daysnow he seems to be 'possessed.' He hasgone back to so many of the thingshe had been all trained out of andthe more I spank him the worse hegets.""That's it. Read Child Managementand you may see a reason. HereJackie was the baby and had all theattention, perhaps a little too muchand now along comes this baby brotherand Jack has to take a back seat.He has to 'act up' to get attention.Two fine members of their gradegtaduating class in a Thoma-svilleSunday School.

^'lavatory:; myMay, 1930 The Health Bulletin 25Maybe he would rather have a spankingthan be ignored. Here, I'll lendj'ou my copy to use till you get yourown.""But you haven't told me aboutyourself and why you look so muchyounger while most of the rest of usare so tired and nervous.""Well, there is a story about that/'and then Mrs. Armstrong's face becameserious. "You know Jim and Iwanted this baby from the momentwe were married, even before, we talkedof her and when I knew that at lastwe were to have that joy, it came tome in a flash that our baby's inheritancewas all settled then and thatneither of us could do anything aboutit. It made me feel very serious butthen Jim was twenty-five and I wastwenty-three and, after all we wereyoung and strong and weren't givingher such a bad heritage after all. Thenthe thought came that most of theauthorities now say that environmentis four-fifths of the battle and the firstyear or two the most important ofall. They say that no matter whatthe inheritance a child may be madeor broken by the environment an~dwasn't I to be that baby's environmentfor these first few years beforeshe went to school? Then I began totake stock of me and the other youngmothers I knew who seemed to get tiredand nervous. There was plenty oftime to think and plan. I tried to findout what was really important."If I were to be the baby's 'environment'I must keep myself in the bestphysical condition so that I couldserve at my best this little baby wewere bringing into the world. I mustkeep myself from getting overtiredand I looked about me and saw wherejt I could make living a bit easier. Oneof the first things I did was to havethe kitchen sink and the bath roomraised to a height that Icould wash things without bendingmy back. I didn't know how muchback got tired till it stopped. Why,I believe that one thing has made mefeel years younger. Our little homewas very sweet and lovely but I knewthat a little baby coming in would upseta lot of the schedules and thatthere would be times when it couldnot be as tidy as it was without her,still, I believed I could plan a lot ofthings for her comfort and whichwould make things easy for me andI have. We'll have to take a wholeafternoon on them if you want me totell you about them."Then it seemed to me that mostbabies were rather foolishly dressed.They were uncomfortable and thewash was enormous. My baby wasto be an out doors baby so besides thebed on the sleeping porch, I got acheap bassinette on wheels to keep onthe down stairs porch where I couldgive her a glance once in a while asI was working about. If a baby wearsa dress and a petticoat or two theyget wet (unless you use rubber pantswhich are not good for them), thenwhenever they get wet everything hasto be changed and the poor little armspulled in and out of armholes. Orelse the clothes are rolled up and gel;in a hard wad. I saw where I couldmake baby happy and save lots ofwashing, and keep my good humor byhaving her wear shirt, diaper andsweater. You see, the clothes fastenerskeep the clothes well up acrossher chest and still she can sleep withher arms overhead. In very coldweather she had mittens and socksand when she was really tiny I kepta hot water bottle always at her feetand put in fresh water each time Itook her in for a feeding. You knowhow good it feels to have your feetwarm and perhaps that was one ofthe reasons why she did not havecolic."I got a light weight wool bat, fullbed size and made two thin and onedouble weight quilts to fit her bed.They are washable and very light andwarm and with the three the warmth

26 The Health Bulletin May, 1930can be adjusted to almost any temperature.I got enough bottles so thatall her feedings can be prepared atonce and, as they are the kind thatboiling water won't crack I still havethe same number I started with. Shehas her own double boiler never usedfor any other cooking but hers so Iknow I will always find it clean whenI need it. I do enough cereal or sievedvegetables for two days and put themaway in the ice box in little screwtop glass jars and they can be heatedinthe jars when needed.""But is it true that your baby neverhad a cold all winter. How did youmanage it?""Yes. She hasn't even had a sniffle,bless her! Some of it must be luckbut I have been very careful. She hasnever been in an overheated room andI keep her feeding schedule right tothe minute no matter what happensand I am so particular about washingmy hands carefully whenever Ihandle anything to do with her food.I boil the bottles and nipples andstrainers and funnel and everythingbefore using them a second time andeven lift them out of the boiling waterwith a tongs and put them on aclean towel to drain and then put themaway in a clean covered kettle till Ineed them again."You see, little babies pick upgerms so easily and I want to saveher from all the things that can beprevented. My Irish Grandmotherused to say, 'The first rearin' is thebest rearin,' and I want Jane to havesuch a good start that when theyhave the summer roundup the year beforeshe goes to school she will beone of those 100% children. A childneeds to be 100% for that first yearof school for besides the strain shewill be exposed to all sorts of epidemics.If I can make her strong enoughshe willstand a better chance on themeasles, whooping cough, chicken-poxand the rest of them. Of course shewill be inoculated against smallpox,diphtheria and all the preventableones. Isn't it wonderful that we canprevent so much these days? In ourgrandmother's time a woman had tohave twelve children to bring up threeor four, but now with the doctorslearning new ways of prevention everyday and the state trying to helpin every possible way to save thebabies and mothers we all have a betterchance. Oh look at the time. Ihave talked a lot.""But you have told me so much. Iwas sort of down in a hollow witheverything in a muddle all round mebut you've taken me up on a hill withyou where I can look out and forwardfor my babies. I'm going to start rightnow working for that 100% in thesummer roundup for my two and perhapsyou'll let me come again and tellme some of the little things you didin your housekeeping and with yourbaby's things that make life so easyfor you.""Yes, indeed. Come soon and don'tforget the Government Bulletins. Getone called 'Sunlight for Babies' andthen maybe you'll have Georgie outin the sun at half past seven in themorning like Jane."kJEAN'S DREAMByNell CullerWith a long drawn sigh Jean'smother turned away from the bedwhere Jean lay asleep. Asleep, yes,but what a struggle it had been! Becausesleep had come to Jean only aftermuch fretting and scolding on thepart of her mother, and still morefretting and much rebellion on Jean's

May, 1930 The Health Bulletin 27part. And sad to say the same thingwas happening each night with increasedtrouble at every occurrence.Jean's mother, with a troubled expressionin her eyes, took one last fondlook at the tousled head and left theroom. Had she known what was to goon in that little head during the nightshe would have had a smileof satisfactionon her lips instead of thetroubled expression in her eyes.As the hours of the night slippedby Jean's breathing became regular,her slumber deeper, and the goodfairy of sleep said she smiled as ifshe were very happy. But again shefrowned and became very restless,then the happy smile followed. Whatwas happening to Jean Why, she wa,having a dream, of course, and sucha marvelous dream!Jean is in a big wood. Throughthe tall trees the sunlight is flickering:beautiful flowers grow along thebanks of a small creek. What a timeshe does have, romping and playingand the house itself of oatmeal stuccowith a thatched roof of spinach and asquat little tomato chimney. In theyard grew fruit trees of many kindsand they were all hanging with ripefruit.Jean was startled from her wondermentby the opening of the frontdoor which, by the way, was made ofcarrot panels. The loveliest lady Jeanhad ever seenappeared."Who are you?" Jean asked. Thelady laughed. "Can you not guess?I am the fairy of Proper Food.""Oh," said Jean, "I am so hungrycan you not give me something toeat?""With pleasure, my child" the goodfairy replied. "You look as if youneed my care."She held the door open for Jean,and they passed into a large airyroom where Jean was told to sit downata table."I would like some coffee and caketo her heart's content, but she soontires for she has not been sleepingwell. Pangs of hunger have made herconscious of the fact that she is veryhungry—hungrier than she ever remembersbeing before, and she immediatelywishes for candy and cake.You see she has been accustomed toeating such things when she wantedthem so we might venture a guessas to why she slept badly.Finally the pangs of hunger becameso great that she could no longer enjoyher play, so she started up a woodlandpath in search of someone to giveher something to eat. Little Jeantrudged along—almost in tears now—until she came to a clearing andthrough the tears that had gatheredshe saw the queerest house. Shedrew nearer not able to believe hereyes. Why the fence posts were asparagusand the palings were macaroni!Could she believe it? But thehouse was the queerest of all—theporch pests were made of milk bottles.Books have been written which expressedmuch less than the photographertells in this picture of thesetwo fine Rocky Mount children.

28 The Health Bulletin May, 1930if you have it good fairy," said Jean."I am sorry, Jean, but in this housewe do not know what coffee is, buthere is something that I think youwill like better," she said as she placeda steaming bowl of cream soup beforeJean.Jean frowned. "My mother doesn'tmake me eat soup when I don't wantit, and I do not want this now.""My dear child, if you will eatwhat I give you I will show you somethingvery interesting when you havefinished."Jean drank the soup all the whilespeculating on the surprise. The soupwas followed by spinach, a baked Irishpotato, bread, butter and milk. Thiscalled forth many protests from Jean.She wanted meats and pastries, butshe finally gave in and ate what wasgiven her, because she was really hungry.Her dessert was stewed applesand a cookie."My mother gives me pie," shepouted.Finally the lunch was eaten andJean was eager for the surprise. Thefairy led her to a door and openedit. Within were several children seatedat a table eating their lunch."Why," said Jean in wonderment,"they look just like me.""Yes," said the fairy, "they looklike you, and what kind of food arethey eating?""Why, the food that I have athome.""Exactly," said the fairy. "Nowcome with me to another room."In thisroom was another group ofchildren eating lunch."Oh," said Jean, "they look likeme too, but they look so pretty andhappy.""I know," answered the fairy, "andthe reason they look that way, littleJean, is because they have been eatingthe right kinds of food for a very longtime—the kind you had for yourlunch. You could look like this too ifyou would do as they are doing."When the fairy had finishedspeakingJean woke to find her motherbending over her."Oh, mother," she cried, "I've hadthe loveliest dream!""Tell mother."So Jean told her dream from beginningto end."And, mother," she ended, "I wantto be just like those pretty children.""So you shall, dear. We shall startthis very morning at breakfast tomake you that way."DICKY BOY'S VISIT TO THE COUNTRYByLoRiNE DavisDick was six years old and lived inthe city, but he was such a thin, palelittle boy that everybody thought thathe was only four. And his motherand father were very much afraidthat he would not be large enoughto start to school in the fall.Can you guess what was thematterwith Dick? First,he did not likespinach or any other vegetables exceptpickled beets, Irish potatoes andcandied sweet potatoes with marshmallows.When the last was one ofthe dishes served for dinner that wasall that Dick would eat, all except,of course, his dessert, because he wasvery fond of desserts. Worst of allthis little boy did not like milk! Hismother and father drank coffee andtea, so he thought that grown-upsdrank these, and that only babiesdrank milk. Of course, even thoughhe was small Dick was no baby. Nowhis mother knew that milk was goodfor little boys, and at dinner shewould say, "Dicky Boy, drink yourmilk now." But Dick would not, andif his mother made him do so he

May, 19-30 The Health Bulletin 29would be in such a terrible humorall evening that when he went to bedhe couldn't even go to sleep. He alwayswanted to stay up late at night,and when he did go to bed he wouldn'tgo to sleep for a long, long time, andhe often had bad dreams in whichsnakes and bumble bees chased him. Iguess he did have some nice dreamstoo, but he could never rememberthose.You see Dick had no brothers orsisters to play with, and he was toolittle to play on the vacant lot withthe bigger children, so his parents lethim do as he liked most of the timeand he was rather spoiled too.One day Dick's aunt from the countrycame to see them, and she broughtwith her his little cousin Polly. Dickhadn't seen Polly for a long time.They were just exactly the same age,and here Polly was a whole head tallerthan Dick. This made the littleboy feel badly, but he thought her theprettiest little girl that he had everseen with her short curly hair androsy cheeks. They played together allday, and when Polly and her motherwent home they took Dick with themfor a visit to the country.Dick didn't think that he wouldlike the country, and besides he hadnever been away from home by himselfbefore. The very first thing Pollytook him out to the barn to show himthe new calf. He had never seen sucha tiny, wobbly calf before, in fact,he couldn't remember ever havingseen one before, and Polly told himthat milk did not come in bottles, butstraight from the barn in big pails.Dick liked the funny ducks and fatlittle pigs best though.At dinner there was milk at everybody'splace."But I don't like milk," Dick complained,"and my mama says that itisn't nice to make company do things.""Of course, it isn't," said his auntas she gave him a glass of cold water.Polly finished her milk and said,"some more milk, please."Dick just couldn't understand. Didpeople really like milk—grown-upsand pretty little girls?"Now let's go to Nappy's house,"criedPolly hopping up from the dinnertable."But who's Nappy and where's herhouse?" asked Dick."Boy, haven't you ever been to herhouse and played with her children?Why, that's where all good little boysand girls go when they're asleep. I'mnot sure, but I think that Nappy isSanta Claus' wife. Anyway she hasjust as many toys to play with besidesflowers and gardens and boysand girls."For the first time in his life Dickcouldn't wait to go to bed.It was justlike the night before Christmas, buthe was afraid that he hadn't been goodenough that day to be admitted toThese tivo children are brother andsister. The boy is ten and the girl isonly eight. The little boy's dwarfi'ihstature is possibly due to hypothyroidismin which there is a deficiency inthe secretion from the thyroid glandnecessary to normal and healthygrowth. We do not know that such isthe case, as we have not had a reportfrom the family physician.

30 The Health Bulletin May, 19SONappy's house. While he wasthinking about this all of a suddenhere he and Polly were in anotherland. It was like Fairyland and Toylandall mixed up. There were lakeswith boats that would run, trainsjust big enough for children to ride,flowers of all kinds and children toplay with.First they took him into a shining,bright castle to see Nappy. She wasall in white and wore jewels in herhair. She didn't ask the new boy'sname, but said, "Why, Dicky Boy, Ithought that you were never comingto see me. I've watched you peepingover the wall, but here you are and Iam glad to have you. You must comeevery night." Then some more childrencame in, and they were givenmilk to drink from beautiful silvergoblets. Dick tasted his, and it didn'ttaste like milk at all, he liked it. Theyhad other things to eat, too, thatlooked like vegetables, but were betterthan candy.Suddenly someone was shaking himby the shoulder and screeching, "Getup, get up lazy, will you!"Dick never got up this early, butthen he remembered the fat littlepigs, and hurried out to see them havetheir breakfast. When he came in tohis he drank his milk before he rememberedthat he disliked milk, andit didn't taste a bit bad.At lunch he did not like anything,so he asked for his dessert, but hisaunt said, "Dicky Boy, don't youplay the tasting game? We alwaysdo. We don't ever eat things that wedon't like, but we always taste everythingthat we dislike before we canhave our dessert. The one who takesthe biggest taste of the thing hedislikes most without making a facewins."This was a good game for Dick,because there were so many thingsfor him to taste. Polly liked everythingbut okra and carrots, but herfather didn't like lots of things, sohe and Dick got to play most, andsometimes Dick won.It was not long before Dick beganto like vegetables, and he just had tohave his milk and he usually dranktwo glasses. He still went to Nappy'stoo, as soon as dinner was over. Somemornings he could not remember exactlywhat happened at Nappy's thenight before, but he always knew thathe had been there, and had had a goodtime.Dick was having a good time, buthe missed his mother, and Polly wantedto go home with him, so they bothwent to the city.Dick's mother was very pleased thather little boy had become as rosycheeked as Polly, and had grown somuch too. Dick said, "Mumsy, don'tyou want roses in your cheeks too?""Why, yes, Dicky Boy," said hismother."Well, all you have to do," answeredDick, "is to drink milk, play witbNappy's children lots, and win thetasting game.""We'll show you how toplay that,"said Polly, and they did. It was notlong until Dick's mother and fatherwere drinking milk, and enjoying it.And they learned to like vegetablesthat they had never eaten before.When fall came Dick was a big,strong boy, and he started to school.He still does not like carrots andparsnips, but he can taste them ingreat big tastes without making eventhe littlest bit of a face.BIRTHS SHOULD BE REPORTED WITHIN FIVE DAYSAs we may consider this issue ofthe Bulletin somewhat in the natureof our Annual Baby Number, there isno better time or place to call attentionto the importance of properlyreporting and registering all births

—May, 1930 The Health Bulletin 31occurring in the State promptly. Inthis connection we are pleased to presentthe following appeal from Dr.F. M. Register, director of the Bureauof Vital Statistics of the StateBoard of Health, who clearly andconcisely calls attention to this importantquestion."Let me quote a paragraph of theNorth Carolina Vital Statistics Lawof 1913—"'Legitimate or illegitimate: Providedthat in illegitimate births, theword illegitimate shall be writtenacross the face of the certificate, andall items on the certificates whichwould in any way reveal the identityof the father, mother or illegitimatechild itself, shall be omitted."''Now doctor, you can see whatmight happen to a legitimate childwhose birth was not reported. Hemight be tainted with a suspicionbecause his birth certificatecould notbe produced. For instance, you attendan obstetrical case—a child is bornyou are finally laid to rest, and hisparents have also gone on the longjourney 'from whose bourne no travelerreturns' and others who know thefacts have passed away; not beingable to produce a birth certificate,you see how easily he would fall underthe venomous tongue of theneighborhood gossips.Doctor! I beg of you to treat withfairness and honesty, the people whohad such confidence in you and calledyou to attend their obstetrical cases.It is both your moral and legal dutyto report every birth you attend. Thegreat state of North Carolina hassaid that births must be reported, becauseits importance has been clearlydemonstrated.We are glad to say that there areonly a few doctors in North Carolinawho maliciously fail to report births,and we hope that at the end of 1930,there will not be a doctor in NorthCarolina who does not see the fairnessin this law, and will act honestly withhis patrons by reporting 'within fivedays' as the law requires, the birthswhich he has attended."A NEW BOOK ON POSTUREDoctor Frank Howard Richardsonand Dr. Winifred Johnson Hearn haverecently written a most entertainingbook entitled The Pre-School Childand His Posture. The book is publishedby G. P. Putnam's Sons of NewYork and sells for $2.50. It presentsa program of corrective exercisesthrough specially devised games. Inthe columns of the Health Bulletin wehave on numerous occasions duringthe last few years emphasized theease with which postural faults couldbe prevented by simple physical exercises,without costly equipment, carriedout for the children in anyschool. Our readers will rememberthat in the February issue of theHealth Bulletin our front page covertogether with several photographs insideillustrated some of these points.It is gratifying to us to know that thenumerous beautiful illustrations inthis new work of Drs. Richardson andHearn are identically along the lineswe have been promulgating for solong. The book is carefully and accuratelyplanned, the descriptions areentertaining, and the print is largeand easy to read. It is a book whichwe take pleasure in recommendingfor use in the schools as well as forsupplementary reading in the libraries.There is much technical informationof great importance containedin the book. For example, thechapter on flat feet is one of the mostinteresting and instructive we haveever read. In short, the book is goodfrom cover to cover.

-Fom FLIES and FILTHV. ;;-• %, &CONSUMPTIVE V--b FOOD and FEVER.WHERE THEY COMtHKItlFLIESAreDISEASE CARRIERSThey breed in manure andfeed on filth. They carryfilth on their feet and legs,and wipe it off on exposedfood.What To Do About ItScreen and Clean UpScreen every door andwindow up-stairs anddown-stairs.Don't use extensionscreens. Use good niadeto-fitscreens or tack mosquitonetting over thewindows.Swat the few stray fliesthat dodge in at the opendoor.Don't tolerate open-backprivies. When sewerage isnot available use an approvedtype of sanitarytoilet.State Board of HealthRaleigh, N. C.WHERE THEY GO\HOW TO PREVENT FLIESOESTROf BREEDING PLACESSCREEN DOORS AND WINDOWSPRESS OF THE CREATIVE PRINT SHOP, HIGH POINT, N. C.

|mmf^^?uh]i5}^dh^ T/\L.^°KJAG\R9LI/iA 5TATL B9ARD s^AmUTAThi5 Bunelirvwillbe -serxl free to arxg citizen of the State upoix requestEntered as second-class matter at posloffice at Raleigh, N. C, under Act of July 1«,1894. Published monthly at the office of the Secretary' of the Board. Raleigh, N. C.VOL. XLV. JUNE, 1930 NO. 6This six months old daughter of good North Carolina varents now living inan alien land can be described in one word— perfect. Talk about eyes, andteeth, and personality— she simply has everything.

'.MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTHA. J. CROWELL. M.D., President CharlotteCTRUS THOMPSON, M.D JacksonvilleTHOMAS E. ANDERSON, M.D StatesyilleE. J. TUCKER, D.D.S ---. ?°?!"?^°D. A. STANTON, M.D High PointJAMES P. STOWE, Ph.G ^^^}°^^tJOHN B. WRIGHT, M.D RaleighL. E. McDANIEL,, M.D JacksonCHARLES C. ORR, M.D AshevilleEXECUTIVE STAFFCHAS. O'H. LAUGHINGHOUSE, M.D.,Secretary and State Health Officer.RONALD B. WILSON, Assistant to the Secretary.H. A. TAYLOR, M.D., Deputy State Health Officer.C. A. SHORE, M.D., Director State Laboratory of Hygiene.G. M. COOPER, M.D., Director Bureau of Health Education.H. E. MILLER, C.E., Chief of Bureau of Engineering and Inspection.F. M. REGISTER, M.D., Director Bureau of Vital Statistics.A. B. McCREARY, M.D., State Epidemiologist.GEORGE COLLINS, M.D., Director Bureau of Maternity and Infancy.ERNEST A. BRANCH, D.D.S., Director of Oral Hygiene.D. A. DEES, M.D., Field Assistant in County Health Work.FREE HEALTH LITERATUREThe State Board of Health publishes monthly The Health Bulletin,which will be sent free to any citizen requesting it. The Board also hasavailable for distribution without charge special literature on the followingsubjects. Ask for any in which you may be interested.Adenoids and TonsilsCancerCatarrhConstipationColdsClean-up PlacardsChickenpoxDiphtheriaDon't Spit PlacardsEvesFliesFly PlacardsGerman MeaslesHookworm DiseaseInfantileInfluenzaMalariaMeaslesPellagraParalysisPublic Health LawsPrenatal CareSanitary PriviesScarlet FeverSmallpoxTeethTuberculosisTuberculosis PlacardsTyphoid FeverTyphoid PlacardsVeneral DiseasesWater SuppliesWhooping CoughSPECIAL LITERATURE ON MATERNITY AND INFANCYThe following special literature on the subjects listed below will besent free to any citizen of the State on request to the State Board ofHealth, Raleigh, N. C:Prenatal Care (by Mrs. Max West)"Our Babies"Prenatal Letters (series of ninemonthly letters) . ,

VOL. XLV. JUNE, 1930 NO. 6THE JUNE HEALTH PROGRAMAt the beginning of themonth, asusual, every conscientious healthdepartment employee and ofFical willquietly ask himself or herself thequestion. What are the most importantthings for us to do in NorthCarolina during this month? Forourselves the answer to that questionmight be put down about as follows:Every child who is to enterschool this fall, no matter where livingor how far from the centers ofpopulation, and who has not been examinedby a competent person, to seethat he is in good enough physicalcondition to enter school with a minimumof physical handicaps this fall,should be sought out now and this importantlittle service rendered. Suchan enterprise calls for self-denial onthe part of some people. It calls forsome tedious work, and for somerather dreary attention to details, butit is a kind of work that is well worthwhile.Following the examination whereremovable defects are found whichdemand attention, if the child is toreceive the best that the school hasto give, every effort should be madeto have such defects removed. TTiiseffort requires decision on the partof the parent, often self-denial; andfor the children of poor people whoare unable to take the necessary stepsto have this important item attendedto the district and community workersshould see that assistance isforthcoming.Dentists, physicians, and surgeonsand specialists will be found willingto cooperate to the fullest extent,but they cannot be expected to carrythe whole load. They must receivesome compensation for theirservice, and the children must bebrought to them at such times aswill mean a minimum of sacrifice tothose professional workers who areexpected to play the important rolein removing these defects.Follov/ing May, which is alwaysa disastrous month for children undertwo years of age, the month ofJune always registers a high infantmortality. One of the importantmethods of reducing this mortality isto assure every baby that is notbreast fed up to nine months old, andall of those who are above the breastfeeding age, a supply of freshclean,pure, wholesome cow's milk, or cannedmilk where the fresh product ofassured safety is not available. Secondin importance to the pure milksupply, which should be kept cool andfresh and free from contamination byhouse flies, is a pure safe water supplyin abundance. Following thesetwo items, it is important during thismonth to see that every baby is keptfree from annoyance by house fliesand mosquitoes, that the clothing isscant and comfortable, and during thelong days that sleep in the shade andopen air is assured. One of the importantitems for attention, if neglectedin the previous month, is tosee that every home is thoroughlyscreened with a fine wire mesh not

—The Health Bulletin June, 1930less than 16 or 18.be fitThe screen shouldclosely and cover every inch ofopen space for both windows anddoors. This serves to protect againstflies and mosquitoes. It not onlyprotects the health and provides forthe comfort of babies, but for all themembers of the family as well.This is the month that vacationtyphoid should be borne in mind, andwhile the death rate from this diseasehas been decreasing for several yearsin North Carolina, it has not justhappened so. Therefore for everyyoung person or middle aged adultconsidering a vacation where theywill come in contact with visitorsfrom other states one of the firstitems of preparation should be totake typhoid vaccination.Another item for all children undersix years of age during thismonth should be the preventive treatmentagainst diphtheria. Threetreatments of a fresh product oftoxin-antitoxin administered hypodermicallyat periods of one weekapart will protect between eighty andeighty-five per cent of all childrenwho are susceptible to diphtheria.There is little or no reaction from thisvaccination. TTie children are noteven inconvenienced at all, and it isone of the most important thingsthat any parent or health officer canbusy himself with.It should not be necessary to evenmention the necessity for intensegardening activities in this month.However, there may be some peoplein the State who have not yet realizedthe great importance that freshvegetables and fruits are now knownto exercise in promoting good health.For the benefit of these we urgerenewed efforts for every householderwho can to produce these food items.In these months for the residents ofthe cities and towns who do not havegardens—and there are many thousandssuch families in the Stateevery shopping tour should include avisit to the curb market or to thecommission store or grocery wherefresh vegetables and fruits are onsale. This is the month when pellagrabegins to take its greatest tollin lives, and the way to prevent thatdisease is to provide every familywith the necessary variety of foods,including milk and dairy products,vegetables, fruits, and eggs.There are many other things forall of us to consider in protecting ourhealth at this time, but if we all attendto the items mentioned in theforegoing paragraphs, the end resultswill be recorded in a decreaseddeath rate at the end of the year.This fine little Columbus countygirl ivas enjoying her first birthdaycelebration at her home in ChadbournMarch 2nd. Her mother writes thatshe has never been sick and that "Ithink her good health is due to thematerial sent me by the State HealthDepartment both before and after herbirth, and to The Health Bulletin, ofwhich I am a regular reader."

Ju7ie, 1930 The Health BulletinAND PELLAGRA WAS UNKNOWN IN NORTH CAROLINAMany ofour readers, and especiallythose included in what we happilycall "the old-timers," we are surehave been interested in the discussionin the Bulletin during the lastfew years pertaining to gardens andsuch things. As we have stated before,the columns of this journal havefrequently carried exhortations tothe people for the past twenty yearsurging our citizens, when possible, toprovide gardens and orchards, to havepoultry and eggs, in short, a live athome program that is now going overthe State like fire in a broom sedgefield. We consider ourselves pioneersin this activity. Our chief justificationfor so much agitation of thisquestion isthat such a program pertainsto better health.In our morning's mail a shorttime ago we received a letter from oneof these old time friends up in ForsythCounty. We have not askedher permission, but we feel confidentthat she will not object to our publishingher letter. She describes insuch detail the manners and customspracticed on the better class farmsof a half century ago and less, thatwe feel confident all our other oldtime readers, and possibly a largeproportion of the young ones, willread this letter, as we have, withabounding interest.As our critic points out in her concludingparagraph, any farm familycan have these things today just aseasy as they had them forty yearsago. In addition, think of the modernadvantages and improvements to addto these old time supplies. In otherwords, we ought to be living in thegrandest period of the State's historyfrom the standpoint of making a comfortableliving and supplying our ownnecessities, in so far as possible, inaddition to finding a market for ourexcess produce in order to assureourselves of all the necessities andcomforts of modern life.We want to ask you to read herletter and to take note of the factthat it has been less than thirtyyears since pellagara made its appearancein North Carolina. Pellagra,being a deficiency disease and recognizednow as a disease primarilycaused by a faulty diet; that is, adiet in which there is not a sufficiencyof the protective foods andvitamins necessary to the healthymaintenance of life, was unknown inthis section when our forbears werereally living at home. Dr. EdwardJ. Wood, the great North Carolinaauthority on pellagra, argued to theday of his death that pellagra cameinto North Carolina when they beganto send out West for the corn mealand the flour, and to purchase thoseand other food supplies in the storesinstead of raising the stuff at home,as had been the previous custom.The letter follows:"I read so much in the Health Bulletinand the urge from our Governorof the Live at Home plan Ican't helpbut write you the plan my father followed40 years ago and he wasn't remindedthat he should do so by theGovernor, neither was it taught inschools. I suppose it was inheritedfrom a thrifty family. He was nota moneyed man but "my" we didhave something to eat. In March thepeas, onions, beets, lettuce, and saladseeds were planted in the garden. InApril the corn, beans, cabbage, cucumberand tomatoes were put in.Near the fence of that garden waspie plant that furnished us pies inApril. Next came a strawberry bedin the back of the garden, and nexton the fence were black and redraspberries for dessert, and whenthey were gone the May apple wasdropping and we had fruit of everykind for summer use. In August theold dry kiln was fired up, the hired

The Health Bulletin June, 1930man and boys were put to bring upapples and peaches, and about three100 lb. sacks were filled with richdried apples and peaches, and storedin a north room. Both kinds of potatoeswere stored in the cellar forwinter use. There were two kinds ofcabbage raised in the garden, a summerand late kind. The summer varietywas made into kraut; the lateones were turned over on their sidesin October and a few spades of dirtput over them to tender up. Then inDecember, when the hogs were killed,we dug out some of the tender cabbage,cooked with a piece of pork, andwe had a dish that couldn't be beat.Corn was cracked at a nearby watermill (that's still running) to makehominy. TTiat was a splendid dishto serve with the meats in winter.Grain was raised on our farm forbread and feed. With plenty ofchickens for "Sunday dinners," eggsfor breakfast, and for pudding andcakes it required very little money tolive then. Nothing was bought fromthe store except svigar and coffee andthings that could not be raised onthe farm. About four barns of tobaccowere raised for the moneycrop. When the winter winds beganto blow what consolation it was tohave all kinds of food stored away,and at night run from a big log fireand crawl between two home-madeblankets and sleep the sleep thatdoesn't bring indigestion and tiredmuscles.Any healthy man can have thissupply of food today just as it wasmade 40 years ago if he will plan andplan, and it's no "killing" job to doit.""THE FALSE VOICE"In a copyrighted syndicated article,which came to our desk sometimeago, by Dr. Bruce Barton, the authortells one of the finest little storieswe have seen in many a moon. Theidea of the false voice being heededonly by the abnormal or subnormalis so appropriate, when we think ofthe success of some of the nefariousso-called medicines which are advertisedand sold so successfully to thesick and distressed, we cannot refrainfrom quoting Dr. Barton's observations.All of us know individuals wholive normal, satisfactory lives, justlike their neighbors and friends, butwhen overtaken by illness or adversityof various kinds, their judgmentbecomes warped, and they seem to beunable to discriminate between thegenuine and the false, especially inthe realm of healing. Such peopleoften are noted for their balancedjudgment and for their discriminatingpowers, but when ill, from variouschronic ailments which cannot possiblyyield to scientific treatment,they become impatient and distressed,and frequently are exploited tothe limit of their purse by fakers ofvariousstripes.We have in mind as these lines arebeing written the case of a formerhigh official of North Carolina. Hehas been dead for several years andhis identity shall remain anonymous.This man built up a considerablefortune by his thrift, his industry,and his sound judgment. In hisyounger years he was a very successfullawyer. In late middle agehe held one of the important Stateoffices in North Carolina. As he approachedthe years of three scoreand ten his arteries were hardened,the cells in his kidneys could notfunction as formerly, the valves ofhis heart were diseased, and altogetherthe possibility of recoveringnormal and active health was out ofthe question.In the hands of a thoroughlycompetent physician, whorecognized his condition and who told

June, 1930 The Health Bulletinhim the facts fairly and squarely andwho advised a careful daily regime,he could have lived on a great manyyears longer in a fair degree of comfort.But he became impatient withthe restricted diet and with the otherhygienic measures and inhibitionswhich were necessary for him to followin order to live with his troublesinstead of dying of them.About the time he had decided thathis physician was applying too manyrestrictions, and that his progressback to sound health was not asrapid as he thought it ought to be,one of these itinerant traveling fakers,sailing under the sacred name ofdiet specialists, blew into town. Thetemporary headquarters of the fakerimmediately became packed with suchsufferers as our friend. Among theothers, he sought the panacea everoffered by the false voice. The fakerextracted five hundred dollars fromhim in exchange for some "dietslips" stating what he might andmight not eat, all nicely printed,ready-made, and covering the groundthoroughly for any patient, no matterwhat ailed him, from six monthsand up. But unfortunately alongwith the diet slips the faker alsoprescribed "a little harmless drug,to be taken in drop doses, wheneverhe felt the need of pepping up." Laterevents revealed that the drops provedto be a powerful preparation ofdigitalis. The excessive doses buoyedup the victim for a few days. Hethought the false voice was literallythe voice of God.To end the story, the victim diedwithin a few days after beginningthe drops, and after the faker hadpassed on to other pastures; but atleast six or eight years before ourfriend needed to have died.Read Dr. Barton's observations on"Do We Put Too Much EmphasisOn Health""A man who knows Scotland toldme of his experience with a Scotchshepherd."The shepherd seemed to have anuncanny power over the sheep.When he sent out his own peculiarcall every one of them, no matterhow distant, raised his head andstarted straight for home."The visitor begged for a chanceto try his calling powers. He cuppedhis hands over his mouth andemitted a noise which to his ownears sounded exactly like the shepherd'scall."Not a single sheep responded." 'Don't be discouraged,' said theshepherd. 'Try again. Maybe thereis a sick one in the flock and, if so,he will listen to you. When sheepare healthy they wil follow only theirown shepherd, but a sick one may gooff after anybody.'"Every once in a while somebodyrises up to criticize us modernparents for devoting too much timeand attention to our children's physicalwell-being."Says such a critic: 'Of course, thebody is important, but it was givento us not to be exalted but tobe disciplinedand put down. To lay somuch emphasis on the physical ispaganism. Our righteous ancestorsdisregarded the body and paid attentionto their souls.'"This is true, and it might be addedthat our ancestors, by neglectingtheir bodies in the interests of theirsouls, beat us to Heaven by an averageof twenty years. They maturedyoung, worried much, and died inwhat we now regard as early middlelife."Moreover, I have always questionedwhether they were truly religious,whether it is possible to be religiousin the best sense if one is sick andruled by fears."Old Simeon Stylites believed thatit is the business of a saint to mortifythe body. He chained himself to the

8 The Health Bulletin June, 1930top of a pillar, and became so loathsomethat woi'ms lived in his flesh,and he did not attempt to pick themout because he regarded his sufferingsas a means of grace."How such an idea could havebeen born out of the teachings of thehealthy out-doors Jesus is one of themysteries of the ages. He mortifiedno bodies. He healed them, builtthem up, and sent their owners ontheir way rejoicing."St. Paul, the great disciple, lovedgames, races and fights."If it be argued that most of thepholosophers have been men of poorhealth, I venture to contend that theworld has m.ore philosophy than itneeds or can ever use. And that whatis more important is more normal,laughing optimistic women and men.."Health is prophylactic. A healthyboy would much rather go to a ballpark than a saloon."It's the weak, nervous creatureswho demand the stimulus of dissipation.Just as the weak sick sheep gooff when a false voice calls."THE YOUNG MOTHER'S CLUB TALKSABOUT COOKING FOR CHILDRENBy SuDiE E.Pyatt"Girls, at our meeting last weekwe decided to invite Mrs. Ross tomeet with us again this week to talkabout cooking for children, followingup her talk to us last week on feedingthe child from two to six," Mrs.Henry Casteel, president of theYoung Mothers' Club of Crafton,said, opening the regular weeklymeeting of the club, which was beingheld at her own home that afternoon."We will now turn the meeting overto Mrs. Ross."Mrs. Julian Ross, mother, nurseand dietetic specialist, who had writtenseveral excellent books on childcare and feeding, arose with a smile,after Mrs. Casteel's introduction andtook her place behind a kitchen tableon which was arranged an assortmentof cooking utensils."The preparation of food is almostas important as the kind offood," Mrs. Ross began, holding upa standard, eight-ounce measuringcup. "In following recipes measurementsare always to be closely watchedin order to obtain the best results.Use a standard, eight-ounce measuringcup, a set of measuring spoons,tablespoon, teaspoon, one-half teaspoon,and one-quarter teaspoon, andlevel dry materials, and heavy liquids,such as molasses, and honey with aknife.""I have never known just whatcooking utensils were helpful incooking for children," the club presidentsaid, following Mrs. Ross' mentionof measurements."Your measuring cup and yourmeasuring spoon set are two of yourmost helpful utensils," Mrs. Rossanswered, placing the measuring cupand spoons back on the table and takingup two pint size, aluminumdouble boilers. "These are indispensablein cooking for children, as aretwo small aluminum sauce pans, afruit press or ricer, a large mesh,medium mesh and small mesh strainer,custard cups, steamer, small pyrexbaking dish, brush for scrubbingvegetables, and a small baking deviceto be used on top of the stove in summer.Use enamel ware for acidfoods, never tin. Aluminum is bestused for cooking all foods, exceptacid, eggs, and potatoes. For cookingcereals, heating milk, reheating po-

June, 1930 The Health Bulletin 9tatoes and such things use a doubleboiler, or a pan set in hot water.""That is fine, Mrs. Ross, but won'tyou give us some suggestions forsaving time in cooking before you goon to something else?" Mrs. Casteelasked.Mrs. Ross smiled, "Yes, the timeelement is very important for busy,modern mothers. To save time incooking use cooking devices whichdo not need watching and will dolong slow cooking; such as automaticelectric fireless cookers, an asbestoslined oven with a thermostat. Makeyour menus, and do your shoppingonce or twice a week, and when youmake up your shopping lists use yourready-made menus to help make itup quickly.""Are soups and broths really asgood for children as everyone seemsto think they are!" Mrs. Paul Helms,who was the mother of a young sonand daughter, asked."Why, Hermoine, certainly soupsare valuable for children," Mrs. LesterPatterson remonstrated with Mrs.Helms, who was sitting next to her,using Mrs. Patterson's given nameas she did so."You are right, Mrs. Patterson,soups are good for children," Mrs.Ross agreed. "Soups for children canbe made with meat, or without meat,and both, if properly made are equallynutritious and healthful for theyoung folks. There are six mainprinciples in making soup for childrenthat I will touch on brieflywhile we are on the subject of soups.Salt is the only seasoning that isbest used in soups for children. Ifstrong seasonings are used theyblunt the child's taste for naturalmeat and vegetable flavors. A fewclean vegetable peelings, or unpeeledvegetables cooked with meats addflavor, and supply many mineralsalts and vitamines that help littleboys and girls to grow big andstrong. Excess liquid on vegetablesafter cooking may be used in placeof water in making soup. Cook meatsfor soup the day before, and removefat before using the stock in makingsoup. All meats and vegetables forsoup for little folks are to be cookedslowly. The fireless cooker may beused to advantage. Cook all vegetablesused for soup together, andadd them to the broth after the meatand fat have been removed from it.""Vegetables are always a problemfor me," Mrs. Ernest Swarts, sighed."Don't be discouraged, Martha,"Mrs. Ross smiled at Mrs. Swarts."The vitamines and cellulose in vegetablesmake them very valuable forgrowing children. Properly cookedand served children like vegetablesjust as well as they do other foods.There are a few points in cookingThis Chapel Hill baby is sixmonths old and is not worried abouta thing in the world.

10 The Health Bulletin June, 1930vegetables that I will call to yourattention."First, always have your vegetablesas fresh as it is possible to securethem. Slightly wilted vegetablesmay be revived by placingthem in cold water for fifteen minutes.Don't use old, pithy, stringyvegetables, better used canned ones,than these. Always start your vegetablesto cook in hot water. Don'tadd your salt until near the end ofthe cooking, and don't use soda incooking vegetables. A small amountof soda may be added to dried beansor peas that are used for soup, butnot to green vegetables."Underdone, cooked-to-death, overseasoned,scorched or soggy vegetablesserved a child may make himdislike this particular vegetable forlife. In cleaning vegetables userunning water for washing, and abrush for root vegetables. Let as'Thinly as possible' be your guidingrule for peeling vegetables, for invegetables 'It's what's under theskin that counts,' Dr. Lulu H. Peterssays. Use canned vegetables occasionallyfor variety. No matter whatvegetable you cook always try tomake your object in cooking it thebringing out of the natural vegetableflavor. Save the liquid in whichdelicately flavored vegetables havebeen cooked to make soup. If properlycooked practically all vegetablesmay be served children.""I never know just how long vegetablesshould be cooked," Mrs. HenryPatterson said, as Mrs. Ross finishedher discussion of vegetable cooking."I anticipated that, Gladys," Mrs.Ross, said, holding out some typewrittensheets. "Will you distributethese to the girls, and take one foryourself.""You see this is a time table forthe cooking of different kinds ofvegetables, and you will notice thatthe shortest time for cooking vegetablesis given as fifteen minutes totwenty minutes for young cabbage,and the longest time, is one hour forstrong beans."Vegetables that may be cookedfifteen minutes or more are: Asparagus,15-35 minutes; Brussel sprouts,15-30 minutes; Spinach, 15-35 minutes;Summer Squash, 15-30 minutes;Tomatoes, 15-20 minutes. In thetwenty minute group we find cauliflower,peas and potatoes, potatoesand cauliflower may take from twentyto forty minutes for potatoes andfrom twenty to thirty minutes forcauliflower. Cauliflower, like cabbageshould not be over-cooked.Beets, carrots, onions, and stringbeans require longer for cooking thanthe other vegetables, usually fromforty minutes to an hour for all four.""Now, what would you like to haveOne of our nurses sends in thisphotograph of a Columbus countyfamily group. They are tenant farmers,but the type that will soon owntheir otvn farm. The nurse^ says itwas the neatest, the healthiest littlefamily she saw last winter. The picture^vas taken February 28, o warmsunshiny day, while the family wereon the way to grandma's. The oldestchild was a little over five years andthe baby three months at time photographwas taken. We will ask theColumbus county health officer whetheror not they have all been protectedagainst typhoid, diphtheria andsmallpox.

June, 1930 The Health Bulletin 11Ime talk about next?" Mrs. Ross askedthe eager group of young mothers."Bread!" came the simultaneousreply from everyone of the mothers."All right, bread it shall be," Mrs.Ross responded, "and I am going tobegin talking about bread by bringingup one of the child's best breadfriends, whole wheat bread. Use itregularly for the minerals it contains,and help the child to form a goodeating habit that will be an aid tohim all through his life. Bread isnot good for a child on the day it isfirst made. Serve it on the secondand third days, and cut part of theloaf into thin slices and dry it in aslow oven until it is crisp. It is nota good idea to spread butter on toastor hard bread for children, while thetoast or bread is hot."Limit your servings of crackersto the crisp, unsweetened kind, thatthe child will have to chew. Exercisefor the teeth can be secured by givingthe child dry whole wheat bread andcrackers. It is important to rememberthis, too, for many of the foodsfed children do not allow for any exerciseof the teeth. Hot corn breads,muffins, biscuits and pan cakes maybe given to the child over two if theyare well cooked, and served in not toolarge portions. Use any standardrecipe for making bread or toast."Cereals are my main problemwhen it comes to cooking for Richard,"Mrs. Morton Wright, whosename was Clara, said, after the breaddiscussion.Half a dozen other mothers agreedwith Mrs. Wright that cereals werea problem with them, and Mrs. Rosstook up the matter of cereals."Cereals may be divided into threemain classes, whole-grain cereals,such as cracked wheat, steel cutoats, yellow cornmeal, and naturalbrown rice; semi-prepared cereals,wheatena, rolled oats, farina, polishedrice, and entirely prepared cereals,shredded wheat, cornflakes and puffedrice. Of all the cereals the wholegrainones are the best, but the hardestto prepare for children. Mineralsand vitamines so necessary for thegrowth of young bodies are found ingreater proportion in the first groupthan in either of the other twogroups. The semi-prepared groupcontains some of the necessary mineralsand vitamines, the entirely preparedgroup, a smaller amount ofthese minerals and vitamines thaneither of the other two groups."One of the most important thingsto remember in the preparation ofwhole-grain cereals, is that they mustbe cooked for a long time, usuallyfrom one and one-half to two hoursor even more. In cooking this groupof cereals an automatic electric firelesscooker is excellent. It is notnecessary to cook semi-preparedcereals as long as the whole-grainones, but be sure they are well-donewhen served. Prepared cereals maybe made more palatable by crispingthem in the oven a few minutes beforeserving.""What about eggs for young children?"Mrs. Harold Ziegler askednext."Freshness is the first requisite ofan egg, and fresh eggs served inmoderation are a necessary food forchildren. The yolk of the egg containsmore food value for the childthan does the white. When eggs donot appear to agree with a certainchild it is often not the fault of eggsthemselves, but the fault of the particulareggs served to the child, asstale eggs, improperly cooked eggs,or the excessive use of eggs maycause the child to have indigestion."Since it is so important that fresheggs, only, be served to children, Iam going to give you four points fordistinguishing a fresh egg. The shellof a fresh egg is slightly rough tothe touch. A fresh egg will lie onits side in the bottom of a pan ofwater. A bad egg will float to the

12 The Health Bulletin June, 19 SOtop of the water. On opening a freshegg there will be no bad odor. TTieyolk of a fresh egg does not breakeasily, and the white does not scatterwidely. Coddled, poached and scrambledeggs, are good ways for servingeggs to children.""Are fish suitable for serving tochildren!" Mrs. Henry Casteel asked,as Mrs. Ross looked about the room,and asked for queries for discussion."Fish are as suitable as any otherfood for children, but the child shouldeat only lean white fish, such as halibut,haddock, cod, and flounder. Fishfor children may be baked, boiled orbroiled.""How are meats to give to childrenbest cooked?" Mrs. Janet Fisherasked, next."Broiling, roasting and stewing,are three wholesome ways of cookingmeats for children. Only the tenderpieces of beef, chicken or lamb shouldbe given children. Meat that is coatedwith hot fat, as it is when friedis never good for a child. Gravj% andsauces rich with fat or cream are tobe avoided in the child's meat diet.The meat may be seasoned with a littlebuter and salt just as the meatisready for the table, or a milk saucemade with milk, butter, and salt. Agravy which is not greasy is madewith a milk sauce and meat juice."Bacon may be nicely cooked byplacing it on a wire frame over apan and cooking it in a hot oven untilmost of the fat drips out and itbecomes crisp. If cooked in a hotpan over the fire, drain the pieces ofbacon on brown paper before serving.Roasting may be used for cookingbeef, chicken, or lamb for children,using the recipes given in anystandard cook book.""You mentioned fruits quite frequentlyin your talk to us last weekon menus and diets, Mrs. Ross. Whatare the best ways of cooking fruitsfor children?" Mrs. Lester Pattersonasked."Fruit is always best given raw,unless the doctor advises cooking it.If the fruits are served cooked tochildren they are best cooked, eitherby stewing them, or baking. I alwaysprefer serving fruit and fruitjuices to children without sweetening,as ripe raw fruits and dried fruitscontain sweetness of their own. Sometimessugar may be used, but becareful not to make the fruits orfruit juices too sweet, for this hasa tendency to ruin the child'staste for the plain fruit."natural'Are desserts useful in the child'sdiet?" Mrs. Theodore Rudolph, whowas the mother of two growing youngsons, asked."Most assuredly desserts are usefulin the child's diet," Mrs. Rossquickly answered Mrs. Rudoph'squery. "Desserts give the mothermany opportunities of serving foods,particularly milk in guises that arepleasing to the child, and if toomuch sugar, and strong flavoring areavoided, desserts can be made thathave much food value for children.For flavoring I always prefer thenatural flavoring such as, lemonjuice, molasses, brown sugar, honeyand fruit juices. These have severaladvantages. No love is created forexcessively sweet food, the real unadulteratedflavors of fruit juices,molasses and honey are natural flavorsthat it is well to train the childto like, and the child is not temptedto overeat foods excessively flavoredfor artificial stimulation."Any standard recipes for dessertsthat meet the requirements I statedare suitable to use for desserts forchildren.""What do you think of lettingchilren over four have an occasionalpicnic during- the summer months?"Mrs. Henry Casteel questioned."Children enjoy eating in the openair, if it is only in their o%vn backyards.I think an occasional picnic,if it is only in the backyard, or on

June, 1930 The Health Bulletin 13the lawns of their own home, is afine thing for children. The one unfavorablefeature of picnics is thatchildren frequently become excitedand overtired at a picnic. If thechild is taken away from home on atripitof any length for a picnic, watchto see that it does not become overexcitedor fatigued."If you are going on a long automobiletrip and taking the childrenalong, powdered milk may be used.A thermos bo'ttle, or an 'Icy-Hot' willtake care of the problem of hot foods,or these may be prepared over acamp fire. Frozen desserts are ideallykept in a vacuum freezer. Bread,butter, milk and fruit will suffice forthe supper for a child who is off onan auto trip. A nice menu for a picniclunch for young children consistsof egg yolk and lettuce sandwiches,graham bread and butter, honey sandwich,a perfectly ripe pear, gingerbread,gelatin blanc mange or milk.""Mother, before you complete yourtalk this afternoon I wish you wouldtell us how to stock an emergencyshelf for children," Mrs. WilliamBatchelor, Mrs. Ross' daughter, whowas the mother of a two-year-old son,suggested."Certainly, I'll be glad to makesuggestions for the emergency shelf,which every mother should have forher children, as well as for unexpectedcompany, and the other things forwhich good housewives keep emergencyshelves.The vegetables on your emergencyshelf may be used when for any reasonyou can't procure fresh vegetables,or you haven't time to prepareand cook fresh vegetables.""I'd like to know something aboutthe number of calories a healthy boyand girl from two to six years shouldhave each day," Mrs. Paul Helmsspoke quickly, as Mrs. Ross askedthe mothers to tell her of things pertainingto cooking for, or feeding children,on which they wished specialinformation before her talk was over."You all have pencil and paper,"Mrs. Ross looked over the gatheringof interested young mothers. "I havea table there, which was taken from'Chemistry of Food and Nutrition,'writen by Henry G. Sherman, Ph. D.It is short, so you will have little difficultyin following it. The age isgiven first, then the calories per dayfor healthy children, boys first, thengirls."This is the table of calories thatthe young mothers copied in theirnotebooks:Calories Per Day for Healthy"On your emergency shelf for thelittle ones it is a good idea to keepa can of broth, one can of the bestgrade tomatoes, a can of unsweetened,evaporated milk, one jar of powderedor malted milk, one box of grahamcrackers, one box of cookies,one box of shredded wheat, one canof apple sauce or prunes, to be usedwhen fresh fruits are not available,one can of peas, string beans, andspinach, and one can of pea soup.

14 The Health Bulletin June, 1930the chicken were a capon, and ordinarychicken roast, would contain 181calories in a serving of SVi ounces."I think, girls," Mrs. Henry Casteelsaid, as Mrs. Ross completed herexplanaiton of calories, "that beforewe leave this meeting today we allwant to make some new resolutionsfor the feeding of our children, andthat we want to make them in suchform that they may be incorporatedin the minutes of our club.""I move that we ask Mrs, Ross tosuggest some resolutions for us,"Mrs. Ernest Swarts said, while Mrs.Harold Ziegler seconded the motion,and Mrs. Ross graciously met theyoung mothers' requests for somefeeding resolutions by giving themothers the following eight resolutions,which they accepted withoutdiscussion and placed in the minutesof their club meeting for that day.The Resolutions1. I will try to have the mealsattractive and help everyone to becheerful while eating.2. I will serve meals at regularhours and allow no food betweenmeals.3. I will see that the food is wellcooked and that the menus are carefullyplanned.4. I will allow no candy (exceptin place of a sweet dessert at noon).5. I will teach my child to drinkat least a pint of milk a day.6. I will train my child to eateverything served to him as any politeguest at my table should.7. I will teach my child to eatslowly, chew well, and not play atmeals.8. I will teach my child to learn tolike what will make him "grow bigand strong," and not beg for foodsthat will not help.When the resolutions had been readand accepted by the Mothers' Club,the president told the club membersthat they had all secured so muchworthwhile information from Mrs.Ross' talks, that she felt it would bean excellent thing for them to planto have an authority on health orchild care visit their club and talk tothem, or give them a demonstration,along some line dealing with thehealth and care of children, at leastonce every month.The members of the club enthusiasticalyaccepted Mrs. Casteel's suggestion,and they planned to have a physician,if possible, if not a registerednurse, talk to them at their meetingfor the first week in July on firstaid in the home.Note: The account of the meetingof the Mothers' Club of Crafton, whenthey will hear a talk on "First Aidin the Home" will be given in theJuly issue of the Health Bulletin.This is a picture of the five monthsold son of an official of the CarolinaPower and Light Covipany. Startinghis experiments in power developmentat this early age he may equalEdison some day.

June, 1930 The Health Bulletin 15VARICOSE VEINS OF THE LEGSBy Verne S. Caviness, M. D.{Fellow American College of Physicians)Varicose Veins are elongated, permanentlydilated, tortuous veins withthickened walls. The most frequentoccurrence is in the large veins of thelegs, especially the Internal and ExternalSaphenous Veins.OccurrenceThe condition is most frequentlyobserved in women in middle life.Men are much less frequently affectedthan women. The principal differencein involvement lies in that pregnancyis the strongest predisposinginfluence we note. Mode of dressalso is an important factor: gartersor other tight constrictions above theknees have a great tendency to obstructthe return flow of blood in theveins. Persons who are overweightare especially prone to develop varicoseveins.Varicose Veins are frequently presentin youth, but the involvement isusually in the deeper veins and notrecognized until middle life when thesuperficial veins become visibly involved.Frequently other veins arealso involved, but the veins of thelegs are involved with a greater frequencythan any other veins.StructuralChangesThis condition begins as a simpledilatation, extending over a greateror lesser length of the vein. The dilatationis usually uniform at the beginning,but as it progresses, it becomessacculated or fusiform andthese in turn, may contain bloodclots. Infection often follows withthe concomitant increased swelling,redness and pain. The arteries also,at times in the more severe cases,are involved with symptoms similarto the symptoms of varicosities of theveins. Symptoms are much moremarked after the process becomessufficiently extensive to produce aloss of function of the valves in theveins. This results in the weight ofthe entire column of blood up to theheart being placed on the walls of thesmaller veins in the legs.Causes of Varicose VeinsThe first cause of Varicose Veinsis probr.bly at least indirectly aweakness of the vein walls. This maybe either a hereditary tendency or itmay be acquired, as from phlebitis;this latter condition is often termed"Milk Leg," and isespecially likelyto follow pregnancy or some typesof surgical operations. There is aninteresting tendency running throughoutsome families toveins.develop varicoseThe second cause is a retardationof the circulation in the veins. Chronicdiseases of the heart or lungs artfrequentoffenders in this respect.Persons who stand a great part oftheir time, granting the existence ofinherently weak veins, are particularlyliable to develop varicose veins.Another important etiological factorin their development is obstructionto the return flow of blood in theveins from any portion of the body,but especially from the lower extremities.Garters were long consideredto be prime offenders in this respect,especially during pregnancy; now,however, due to changing styles andcustoms, tight garters are not wornso much. Various tumors when situatedso as to obstruct the venousflow produce varicose veins in anypart of the body. A similar blockageof the return flow of venous

16 The Health Bulletin June, 1930blood may be produced in the femaleby the utei-us whenever enlarged bypregnancy or if displaced. Thesymptoms will vary with the degreeof enlargement or displacement.The third cause is compensatorydilatation resulting from blockage ofthe deep veins. There may be manycauses for such a deep blockage, butthe resulting varicose veins areNature's effort to reestablish a disturbedcirculation. Such veins mayproduce severe symptoms, but greatcare must be exercised not to obliteratethem; other more palliativemeasures must be used.The fourth results from aneurysms.Fortunately, such cases are rare, andusually due to injuries.SymptomsIn simple, uncomplicated cases, thesymptoms are rather typical. Theearliest symptom is usually pain inthe leg,often in the back part of theleg, and pain in the sole of the foot.Especially if the involvement is ofthe deep veins only, it may be mistakenfor Sciatica. The next symptomis likely to be heaviness of theleg and foot, with a tendency to letthe foot or heel drag when walking.Next, the reason for the feeling ofheaviness becomes apparent as edemaor swelling ofthe parts involved appears.Muscular cramps are oftenpresent and at times quite severe.We find that both legs are involvedin about seventy per cent of cases, theleft leg alone in twenty per cent ofcases, and the right leg alone in tenper cent of cases. Even when thereis involvement of both legs, the leftis usually worse. This is on accountof the arrangement of the Iliac Veinsin the lower abdomen.ComplicationsThe symptoms of varicose veinsare aggravated by the complications.All simple symptoms remain, butthere are other symptoms that appearwith various complications.Varicose veins often rupture. Suchrupture may be the result of a blow,from coughing or straining, or fromany form of injury to the alreadydamaged vein wall. Often varicoseulcers erode into the wall of the veinand severe hemorrhage is the result.In the event of rupture of a veinhemorrhage is profuse, much moreso than under normal conditions.This is easily understood since thevein walls have lost their tone andare stretched to such an extent thatthey do not collapse; also, bleedingoccurs from both sides of the rupture.Ulceration is undoubtedly the mostunsightly, as well as a very annoyingcomplication of varicose veins. Itis a result of the rupture of a superficialvarix; it may be the result ofa perivenous abscess; or it may startin a scratch; an area of eczema; orbe a result of capillary thrombosis,which is a blocking of the smallestblood vessels. This can occur frommany causes in varicose veins.Thrombophlebitis, blood clotting inthe veins, is an occasional complicationthat is not only painful, but isoften quite serious.Fortunately it isusually localized to a relatively smallsegment of vein.TTirombophlebitis often becomes infected;the infection may spread tosurrounding tissues, involving muscles,nerves, bones or skin, and thusgive inflammation of such of thesetissues as are involved. The resultsare painful and at times fatal; radicalsurgical procedures are necessary insome cases. When there is extensionto the skin, ulcers or eczema arelikely to result. The lymphatics mayalso be involved in severe cases.TreatmentThe treatment of varicose veinsmay be palliative, radical, or by meansofinjections.Palliative: This form of treatmentis definitely indicated in earlymild cases, during pregnancy and

—June, 1930 The Health Bulletin 17also when the deeper veins are involved.The treatment consists first,in the removal of the cause, so faras possible. Tight garters, or otherforms of tight dress constricting theleg or abdomen should be removed.Gentle massage of the skin is beneficialif the skin is healthy; it is contraindicatedif there is eczema, discoloration,or other involvement ofthe skin. The elimination must receivevery careful attention: constipationis a serious foe to good veins,and is far more serious when theveins are below par. Heart or lungdisorders are also quite potent agentsfor increasing the extent of involvementin veins that are varicosed; suchdisorders should receive careful attentionon general principles, but areespecially important in the treatmentof varicose veins.Also, elastic stockings,or elastic bandages, carefullyput on, should be worn constantlywhen out of bed. Either should beremoved at night and the legs rubbedwell with alcohol.With the exception of the elasticstockings and bandages referred toabove, all these measures are indicatedin the treatment of any case ofvaricose veins by any method.Radical: The indications for radicaltreatment are the same as for the injectiontreatment. For many yearsthe radical surgical removal of varicoseveins was the treatment ofchoice in all cases. It is still usedby some surgeons, and quite good resultsare obtained by it. The elementof danger is reasonably small, andwhen the veins have been removed, itwill be impossible for new channelsto be opened along the old varicosecourses.Injection: This is a form of treatmentby which persons who suiferfrom varicose veins may often be relievedalmost without pain, and withoutthe necessity of a prolonged stayin bed. Various solutions are used,chief of which may be mentionedSodium Salicylate, Glucose, SodiumChloride, and Quinine with Urethane.Any one of these preparations willgive satisfactory results in mostcases when used by skilled hands.The solution is injected into the varicosepouches and allowed to remainat the site of injection for a fewminutes; this does not clot the blood,but it produces an inflammatory processin the inner coats of the veinsthat is later replaced by connectivetissue, the walls of the veins aredrawn together, and the channel ispermanently obliterated. Pain is veryslight or absent, almost never so severeas the usual pain from the varicesthemselves.The indications for the injectiontreatment of varicose veins are many.Any case of varicose veins in whichthere is a back flow of blood from theheart, due to failure of function ofthe vein valves, should be treated unlessthere is some definite contraindication.However, there are typesthat demand especial care and thatrepresent unusual indications of thenecessity for treatment. Amongthese may be mentioned thin walledsacs or diverticula that are about toburst; whenever ulcers or eczematouspatches refuse to heal; pain,this is often very severe, and at timesso severe as to prevent much activity;thrombosis,—clotting of the blood inthe veins; whenever a portion of thevarix is situated over the crest ofthe tibia; incompetent valves,—allowingthe blood to flow in the wrong directionin the veins involved.PrognosisThe usual end result of the injectionmethod of treatment is a completecure. The veins become obliterated,they become hard cords whichbecome smaller and smaller as contractiontakes place. These cordsgradually fade from view and becomeless palpable. As veins, theywill no longer exist. The blood flow

18 The Health Bulletin June, 1930willcontinue through the deeper vessels,and through the normal superficialvessels. Unless there be anextensive involvement of the deeperveins, there should rsult a completerelief from symptoms. If due diligencebe exercised in relieving thecauses of the condition, there shouldbe very little or no recurrence.With reference to modes of dress,now that the styles and customs donot decree tight constrictions aboutthe legs and abdomen, there is everyreason to believe that there shouldbe much less occasion for varicoseveins in the people who will be middleaged during the next few years.Also, as more people secure forthemselves an annual health examination,preferably as a birthdaypresent to themselves, such defectscan be detected early, and often relievedby palliative treatment beforethe process becomes so extensive asto necessitate more extensive measures.WHY IWallace F.PLANT A GARDENByMustian, D.D.S.I plant a garden because I believeit is the greatest asset a man canhave, especially a professional manor office worker. A good vegetablegarden means health, money, recreation,and happiness. It gives me theproper amount of fresh food, andvitamins for myself and family theyear round. Vegetables freshly pulledare much easier digested andhealthier than those gathered forseveral days. I have a wife and twochildren, they are healthy and welldeveloped in every way. My littlegirl age 8 and a boy age 4 are perfectspecimens of health includingtheir bone and tooth development. Iattribute this largely to fresh vegetablesgrown in my garden.There are many vegetables that Ican not get living in a small town;for instance, asparagus, rhubarb,carrots, spinach, egg plant, salsify oroyster plant, cauliflower, kohl rabi,endive, parsnips, berries, and grapesof different varieties as well as theregular vegetables; all these andmany more I endeavor to raise myself.Another reason is that I am veryfond of home canned vegetables inthe winter. If vegetables are to keepwell they should be gathered notmore than one hour before canning.My wife always cans an ample supplyof okra, tomatoes, string beans,lima or butter beans, corn, squash,asparagus and berries, etc. for winterconsumption.Perhaps the greatest reason is, Iam in my office all day and get verylittle fresh air, exercise and diversion.A few hours work in the gardenevery morning before I go to workgives my muscles and body the properamount of stimulation and exerciseand fills my lungs full of needed freshair. This puts pep and enthusiasmin my work during the long strenuoushours of the day. On my return inthe afternoon just to take a littlewalk through my garden watchingeach plant very carefully, its natureand how much it has grown relievesmy mind from its nervous tensionand I relax from the trials of the dayperhaps to a greater extent than Icould in any other way. There isnothing more fascinating to a tiredbusiness and professional man than togo out after a hard and trying dayand gather fresh strawberries, rasp-

June, 19 SO The Health Bulletin 19berries, onions, spinach, lettuce, peas,etc. of your own raising.There must be something in everylife to break the monotony—to relievethe nervous tension—to give itrelish and zest and beauty. Everybodymust have a pop-off valve, soto speak—a hobby. The means arealways at hand through a garden.Gardening has no rival as a meansof putting color into life for it hasa quadruple reaction. First, thereNARCOTICSis the joy of making things grow;second, there is the increased healthand vigor that come from that formof labor; third, there is the fun ofbeautifying that part of the world,no matter how small.My garden directly and indirectlysaves me doctors, hospital and dentalbills, increases my income and paysmy taxes. My garden is my golffield for which my game is my gainin health, happiness and prosperity.From School Address of J. W. Ashby, M. D.George Bernard Shaw makes thestatement that it is futile to advocateprohibition to an individual whowishes to drink in order to forgethis misery. But it is a far cry fromthe subject of his remarks to an audiencesuch as we have before ustoday who represent cheerfulness andhappiness and who have the bestyears of their lives before them. Butit is not such a far cry between theeffects of the alcohol which he mentionedand the effects of narcoticdrugs about which we are going tosay a few words. Each is indulgedin for the same reason and becausethe individual is of the introvertedtype and wishes to be extroverted.The normal person does not fall a victimto the drug habit, but it is thepsychopathic individual, who wishesto escape the trials and stress of life.It is the line of least resistance andis frequently entered into without thethought of the dreadful consequences.Morphine heads the list of narcoticdrugs. It cannot be legally obtainedwithout a physician's prescrpitionand the physician who prescribes itand the druggist who furnish it arerequired by the Harrison NarcoticLaw to state for whom it is prescribedand to whom furnished. But like agood many other things there areillegal dealers in morphine who mightbe termed bootleggers. Unfortunatelydoctors are sometimes careless ingiving this drug. A midnight call,a patient in distress, real or imaginary—ahypodermic injection ofmorphine and the patient is soonasleep; also the doctor. If the distressis due to the lowering of consciousnessof the patient or disintegrationof the nervous system theperson realizes the fact and soonlearns to resort to the use of thedrug without the aid and expense ofthe physician, and we must add infairness to the average physician thatthey are careful in such matters butit is the man who isn't careful andthe first dose that does the damage.The continued use of morphine or itsderivatives lowers the vitality of anyperson and alters one's entire personality.They become anemic, havea sallovv complexion and their mentaland moral tone are decidedly lower.They cannot be trusted and prevaricatefrom choice. Luminal and veronalare two other drugs that claimtheir proportion of victims and alsomany of the so called coal tar productswhich are used to allay pain;and unfortunately Luminal, Veronaland the Coal Tar products can be obtainedwithout a prescription. Veronalis exceedingly dangerous andmore than one person has died fromthe effects of an overdose. Only recentlya brilliant young authoress

20 The Health Bulletin June, 1930from Atlanta died in New York fromtaking too much of this drug. Theyare taken to produce sleep—as ahypnotic, but like their ally, morphine,one dose soon does not havethe desired effect and the dose is increasedand increased until borderingon the line that threatens life andalways impairs one's usefulness tosociety.Insomnia and "nervousness" arethe excuse for taking these drugs.Sleeplessness is frequently due to akeyed up condition of the nervoussystem and to hyper-tonia of themuscular system. Many people aretoo tired to sleep due to the increasedtension of the muscles. Drugswill not improve conditions but onlyproduce a habit. Massage will producesleep and is harmless.The nervousness is merely a symptom.Freud defines "a neurosis asa negative for a perversion."As stated before the normal personneeds only a word of caution onthe narcotic subject, but the psychopathicperson will need careful scrutinyand should be warned and watched.It is quite likely that the personof this type will display abnormalpsychological traits early in life andprior to reaching the stage of beingclassed as a Drug Addict.WHEN YOU ARE SICK IN YOUR IMAGINATION"Yes sir," said Mr. Joe Benton,the able philosopher of BentonHeights, "there is a lot in faith healing.I know what it can do for you.It cured me of heart disease."Mr. Benton was giving a confidentialinterview to the Journal andJudge W. 0. Lemmond as the threemet on the corner this morning. Mr.Benton is one of those men who hashis own ideas about everything andin about 99 shots out of a hundredhe is right. He generally has theright sow by the ear."Lots of people are cured by faith.It doesn't cost them anything and ithelps them a lot. When I was in myfifteenth year I became subject topains in the neighborhood of myheart. One of our neighbors, an oldman, had died of heart disease and Iheard a good deal of talk about it.My pains got worse and I was sureI had heart disease. My motherthought so, too. She kept me prettyquiet and I did not work any for ayear.'At last I went to my mother andtold her that I thought I was likelyto drop dead any time and she saidI must go to the doctor. She toldme toget a mule and ride very slowlyto Monroe and see Dr. Ramsey. Inever let the mule get out of a walk.I finally got to town, slopped gentlyoff my mule and hitched him in therear of Dr. Ramsey's office whereSam Hart's store is now."I went in and Dr. Ramsey askedme what I wanted. I told him I hadheart disease and thought I ought tohave some medicine. He wanted toknow wh.0 told me I had heart diseaseand I told him I knew it myself,and described my symptoms and saidIhad not worked in a year." 'You run up those steps just asfast as you can and then down asfast as you can, and then come in hereand I'll look at you,' he said. I toldhim it would kill me but he said goahead anyway, and I did. I thoughtI was going to die anyway and itdidn't make any difference.'After I had run up and down thesteps, he examined my heart and saidthat it was as good a heart as anybodyever had and that the painscame from some nerves across thechest and for me to go on back hom.eand go to work, the harder the better,and the pains would leave."Well, I never felt so good in my

June, 1930 The Health Bulletin 21life.When he told me my heart wasas good as anybody's I was happy. Ifelt like a new person. I got on mymule and cut out for home and Ididn't let him walk any, either. I wasno longer afraid of jolts. I neverhad any more heart disease. Yes, sir,when you are sick in your imagination,faith cure is a fine thing. Itwill cure you."—Monroe Journal,CITY MILK SUPPLY RATINGByBUREAU OF SANITARY ENGINEERINGIn 1924, when the sanitation ofbecame an activitymilk supplies fii'stof the State Board of Health, 21cities of the State had milk ordinancesand were endeavoring to providetheir citizens with a clean product.Since no two of the ordinanceswere identical, it was impossible tojudge whether the quality of milk inone city were better or worse thanthat of another. The minimum requirementsfor the production of milkhad not been definitely settled bythe various health officers, and gradingwas being done in only two orthree cities. Moreover, since therewere no uniform requirements for thegrades, Grade A milk in one city wasquite a different article from Grade Amilk in another, though they mightappear to be the same in the publicmind.In 1924 a Standard Milk Ordinancewas recommended to the cities of theState for their local adoption. Thisordinance was described in detail inThe Health Bulletin, June 1927, P.13, at which time it had been adoptedby 37 cities. At the present writingit is in effect in 64 cities. Amongthe advantages derived by this wideadoption of one ordinance, the mostevident is, of course, the agreementminimum requirements for theon theproduction of milk. Furthermore, itis a grading ordinance, classifyingthe various supplies of any city intoGrades A, B, C, or D, according tothe degree of compliance with theminimum requirements for Grade A.Milk supplies which meet all the requirements,including cooling andbacteria count, are Gi-ade A; supplieswhich fail to meet one or more of afew requirements of construction ofminor importance, or in which thecooling and bacteria counts are notas good, are Grade B; supplies whichfail to meet one or more requirementsof greater sanitary significance areGrade C; and those which fail in themost important requirement of cleanlinessof either equipment or methodsare Grade D. Anyone accustomedto using Grade A milk at homecan accept Grade A milk in any otherStandard Ordinance city with theknowledge that the grade is basedupon compliance with the same requirementsof production.It occasionally happens that a cityexperiences temporary shortage ofmilk, more often now with consumptionof milk increasing than formerly.Such shortages are now takencare of by purchasing the surplusfrom a neighboring Standard Ordinancecity, specifying the grade.Public, producers and officials arethus satisfied, since the importedmilk tests meets their requirements,just as does that which is locallyproduced.A further advantage of the gradingsystem is the result it produces.Under non-grading ordinances, compliancewith each requirement hasgenerally been, made arbitrary, withthe penalty of prosecution and fine,or revocation of license to sell, forviolation. The requirements of thistype of ordinance are almost never

22 The Health Bulletin June, 1930fully complied with. Prosecutions incourt and fines antagonize the producer,and are resorted to as littleas possible by the inspector. Licenserevocation is too drastic for any butthe most serious conditions, since itcuts off a considerable quantity ofmilk and entails a large financial lossto the producer. The result is thatenforcement is lenient, compliance isslack, and condition fail to improve.Contrast this with a grading ordinance.The producer knows what requirementshe must meet in order tosell his milk as Grade A. He is notrequired to produce Grade A, unlesshe wants to, but he must use bottlecaps marked with his grade, be it B,C, or D. Experience has shown thatthe public demand is for Grade A,and the producer of the lower gradesfinds it difficult to dispose of hisproduct. Generally he has to take alower price for it, and since this isunprofitable, he gets his dairy intoGrade A status as quickly as possible.The lower grades of milk aregradually reduced to the vanishingpoint, eventually disappearing fromthe market, and are used as "demotion"or "penalty grades" for thoseproducers who relax the constant vigilancenecessary to maintain a GradeA supply. Conditions are improvedmore rapidly and are better maintainedunder a grading ordinance, becauseof the definite incentive giventhe dairyman by the public demandfor Grade A.Finally, the wide adoption of uniformminimum standards has furnisheda basis for evaluating the relativeexcellence of any city's milksupply, which if desired may be comparedwith the supply of any othercity. ITiis is a valuable advantagewith several applications. Sincemilk sanitation in North Carolina isa matter of local responsibility, itwould be possible for milk suppliesto carry false grades through incorrectinterpretation of the minimumrequirements and, without somemeans of official check or "audit" bythe State Board of Health, mightnever be remedied. Conditions wouldthen vary from city to city, and thegrades would no longer be based onuniform compliance. A copy of thedairy inspection form is shown aslast paragraph in this article precedingthe Public Health Service CityMilk Supply Rating, listing the 25requirements which must be compliedwith for Grade A. The average bacteriacount, which must not exceed50,000, is not shown on this sheet,since it is a laboratory determination,but it enters into the grade determination.These forms are used by themilk insepctors in making their routineinspections, and also by the StateBoard of Health in computing thecondition of the city's milk supplyas a whole—the City Milk SupplyRating. If all the requirements arecomplied with, the right hand columnis clear; opposite each requirementnot complied with is placed a crossmark. Only one mark is necessaryto determine a lower grade than A,and what that grade will be is designatedby the letter to the left of thecross mark. In making the CityMilk Supply Rating, such a form isfilled out for each dairy, togetherwith the number of gallons of milksold. The sum, of course, gives thenumber of gallons of milk sold in thecity per day. Then the number ofgallons of milk which comply withrequirement No. 1 are determined,then No. 2, and so on, until we havethe compliance by gallons of the entiresupply with each requirement.Knowing the total number of gallonssupplied, it is a simple matter tocompute the percentage complianceof the entire supply with each andevery item. From these figures theCity Milk Supply Rating is determined.If all the dairies comply withall the requirements, the rating willbe 100. This, however, is an ideal

June, 1930 The Health Bulletin 23closely approached but seldom attained.Since there are small dairiesand large, it would be unfair to saythat a violation on a small dairy hadas much effect on the total supply asthe same violation on a large one.For this reason, the rating is made onthe "gallons sold" basis.Suppose in some city all the dairieswere labeling their productGrade A. We should expect to findfrom a survey that the rating wouldbe very close to 100. There are, ofcourse, temporary defects liable tooccur on any dairy from time to time,which would be promptly remediedon notice from the inspector, were hemaking his routine rounds, andwould not call for degrading. TheRating Survey, however, records conditionsas found at the time of inspection,and therefore the rating israrely 100. Suppose, however, thatin this same city with all dairiesgraded A, a number of defects arefound, and the final rating is considerablylower than 100, this wouldindicate that the grading was incorrecton some of the dairies at least,and that degrading should be done.It is, therefore, evident that the moremilk a city has which complies withevery item required for Grade A, thehigher will be its milk supply rating.Likewise, in a city where the gradingis found to be correct, but thereare several B, C, or D grade dairies,the city milk sanitation rating will belower. Consequently, the ratingswill improve as the public demand forGrade A milk increases, and the lowergrades are eliminated from themarket.The surveys shown in the followingtabulation were made by differentspecialists of the United StatesPublic Health Service, in companywith the State Board of Health. Itis very important to remember thatall these surveys were made in theperiod between July 1st and October1st of each year and, consequently,the 1929 survey figures are nowsix months old. Since the survey,many conditions have been remedied,and most of the ratings if made todaywould be higher. This appliesparticularly to Concord, Salisbury,Fayetteville and Reidsville, where thesurvey came at a time of reorganization,with new inspectors taking hold,and before they had had sufficienttime to effect marked changes. Undera new arrangement of the State Inspectionpersonnel, we expect to beable to grade dairies and make CityMilk Supply Ratings more frequentlythan the once a year heretofore.When made, such surveys will bepublished in this Bulletin.The order of listing has been thesubject of much question. Obviously,a large city with many dairies and apasteurizing plant to supervise hasWhy not try a swivi in beautifulLake Waccamaw down in Columbuscounty in connection with this summer'svacation?

(24 The Health Bulletin June, 1930a more difficcult pi'oblem to handlethan a small city with but few dairies.It would seem that small cityratings should be higher than thelarge city ratings. However, thelarger city with more money generallyhas a better organized departmentwith full time inspectors. Thesmaller city, as a rule, generally canafford only a part time inspector, andoccasionally he has other duties whichlimit his time for milk sanitation. Itis, therefore, unv/ise to compare therating of one city with another indiscriminately,and consider that thelower rating is a reflection on the inspector.That does not necessarilyapply. The rating is the impersonalmeasurement of the condition of anycity's milk supply, with no regard tothose human factors which might explainthe result, high or low. It isprecisely the same as measuring anyobject supposed to be 36" long v/itha standard yard stick, and findingthat it is actually 34" long. In ourcase our "object" is the City's MilkSupply, our yard stick the "standardNamerequirements." Excuses for failureto measure up to the standard areconditions which should be remedied.City authorities can take the detailedsurvey reports as "audits," see forthemselves the weak spots, and applythe proper remedy. TTiis is thelegitimate use of the Rating figures.The stimulus of competition is desirable,but the differences should notbe carried tothe point of "hair splitting."Such comparisons would attacha fictitious accuracy to the ratings.In general, the milk sanitation ratingis an expression of the extentto which the public understands, appreciates,and demands the highestquality of milk. As an economicmatter, the dairy industry will respondto the consumer's demand forthe highest quality of milk, as representedby the highest grade. Whenall milk consumers demand Grade"A" milk, and Grade "A" only, citymilk sanitation ratings generally maybe expected to reach or closely approach100.,NORTH CAROLINA STATE BOARD OF HEALTHDAIRY INSPECTION FORM(Dairy) (Manager) (Owner)LocationP. O. AddressA duly authorized officer of the City ofmade aninspectiV" this day of your dairy and you are respectfully notified of the defectsmarked below with a cross (x).Cows milking; Cows dry Total production (gals.) Sold as milk(sweet and butter) (gals.) Grade, CrossCOWS If markdefec- meansItem No. tive defect(1) Tuberculin testing' and physical examination C ( )DAIRY BARN(2) Lighting (3 sq. feet per stanchion) B ( )(3) Air space (500 cu. feet per stanchion) B ( )(4a) Floor construction (concrete or other impervious material;graded) B ( )(4b) Floor cleanliness (no accumulations bevond one milking) D ( )(5) Walls and ceiling (painted; whitewashed; clean; ceiling(6a)(6b)tight if feedstuffs over) ( )Barnyard (graded; drained) B ( )Barnyard (cleanliness) D ( )(7) Manure (no fly breeding) CMILK ROOM(8a) Floor

June, 1930 The Health Bulletin 25Grade,ifdefec-Crossmarkmeans•Item No. tive defectTOILET(10) Location, construction, and operation (N. C. Standard) D ( )WATER SUPPLY(11) Accessibility, adequacy, quality D ( )UTENSILS(12) Construction (easily cleaned; good repair; seams solderedflush; narrow mouth pails) C ( )(13) Cleaning (rinsing, scrubbing alkaline solution, rinsing) D ( )(14) Sterilization with steam (steam jet or steam chamber) B ( )(15) Storage (no recontamination) D ( )(16) Handling (no handling of surfaces to which milk is exposed^D ( )MILKING(17) Udders and teats (clean; disinfected) D ( )(18) Flanks (free from visible dirt) D ( )(19) Hands (clean; disinfected, dry) D ( )(20) Clothing (clean) D ( )(21) Milk stools (clean) D C )(22) Immediate removal of milk to milk house (no straining inbarn D ( )COOLINGAND STORAGE(23a) Within one hour to 50° F; temperature maintained B ( >(23b) Within one hour to 51° to 60° F; or delivery to plant within2 hours C ( )BOTTLING AND CAPPING(24) Method (full credit given if milk delivered in cans; capsdisinfected) C ( )EMPLOYEES(25) Health certificates (once each year) C ( )DateInspector.*The item numbers correspond to the item numbers for grade "A" milk in theordinance, to which please refer,NORTH CAROLINA CITY MILK SUPPLY RATINGS MADE BY THEU. S. PUBLIC HEALTH SERVICE

'26 The Health Bulletin June, 19SORATINGSb o o c « 2* ^ - - g g *-Burlington1929 14,250 34 705 240 465 66.0% 87% 84% 63% Ql%1928 13,063 544 369 175 32.0% 84% 80% 71%1926 5,952 356 356 0.0 81% .-_Hendersonville1929 8,000 30 634 484 150 23.6% 99.5% 97% 91% 94%1928 7,500 648 648 0.0 92% _..1926 3,720 584 479 105 18.0% 92% 75% 71%Concord1929 11,000 21 528 328 200 38.0% 89% 99% 85% 59%1928 10,854 371 213 158 42.0% 85% 68% 48%1926 9,903 559 284 275 49.2% 50% 50% 27%Salisbury1929 14,000 16 750 730 20 2.7% 78% 55% 64% 34%1928 19,265 820 770 50 6.0% 78% .... 28%1926 13,884 746 746 0.0 61% __ _Rocky Mount1929 16,964 15 647 647 0.0 80% .._ _.. 48%1928 16,432 15 603 603 0.0 90% _1926 12,742 525 525 _ 0.0 92% ._ _Fay6tt6villc1929 15,000 15 549 549 0.0 69% .... _.. 34%1928 10,342 10 449 449 0.0 92% _ _1926 8,877 466 466 0.0 78% __Hickory1929 7,500 14 438 438 0.0 89% _. __ 77%1928 6,164 12 416 416 0.0 84% ._..1926 5,076 333 333 0.0 81% _ _Chapel Hill1929 3,500 13 515 305 210 40.7% 89% 98% 82% 81%1928 4,250 9 420 300 120 29.0% 97% 82% 76%1926 1,483 298 298 0.0 92% _ _Halifax County1929 16,400 12 491 491 0.0 83% __ _ 73%1928 12 403 403 0.0 84% __ElizabethCity1929 12,000 12 389 389 0.0 90% 80%1928 9,336 16 456 456 0.0 82% _ _New Bern1929 14,211 11 400 350 50 12.5% 87% 85% 70% 82%1928 13,988 13 569 419 150 26.0% 88% 61% 68%1926 12,198 421 421 0.0 73.5% __Lexington1929 10,000 11 455 345 110 24.0% 83% 90% 66% 56%1928 6,127 11 466 466 0.0 90% _1926 5,254 307 307 0.0 73% .._ _.Statesville1929 14,500 10 453 453 0.0 97% __ 92%1928 10,533 15 505 505 0.0 85% _ 1926 7,895 355 355 0.0 69% __ _14,117 10 462 342 120 26.0% 66% 63% 55% 55%-I r^r.r^WllSOn.X??1928 13,802 15 540 540 0.0 78% 1926 10,612 427 427 0.0 72% _ _, ^^^ Goldsboro1929 16,000 9 387 387 0.0 69% _ „ 78%1928 15,451 11 483 483 0.0 83% __ 1926 11,296 418 418 0.0 98% _ _i

June, 1930 THE HEALTH BULLETIN 27RATINGS^e '^s "ia "5o O O -om • c•> A H ^4 ^

28The Health Bulletin June, 1930RATINGSgo01903a.23aoCM^dommooEhoo•aa)N'u3®mOh

June, 1930 The Health Bulletin 29shown by Mr. A. E. Akers, Superintendent.I The homes of Mrs. Quentin Gregory,Mrs. S. S. Norman, Mrs. EdwinCoppedge, Mrs. Ed Travis, Jr., andMrs. J. W. Tillery, the garden of Mrs.Frank Musscleman, and the floweryard of Mrs. J. W. Tillery of Halifaxwere visited and much enjoyed. Thedemonstrations set forth many valuablesuggestions for making homesmore attractive, more convenient,more homelike, and a better place forthe manufacturing of citizens.DANGER!R. W. Haywood, Jr.Asst. Eng., Bureau of Sanitary Engineering"A traffic death every seventeenminutes!" "Terrible!" you cry. Butstop! That statement is hicorrect,because traffic is not responsible forthese eighty-four deaths each twentyfourhours. It is directly responsiblefor more than twice that number!The rapid development of the automobileas a means of transportationwithin the past decade hasbrought to the forefront a problemthat is not limited to the numbers ofdeaths caused by wrecks, overturnedcars, hit-and-run drivers, or thelike. Each tourist, camper, joy rider,or traveler of any kind is a potentialmenace to public health, and far moregrave than any intoxicated, careless,or reckless driver.A familiar sight to those travelingthe highways, for which North Carolinais so justly praised, is the scoresof "hot dog" stands and other eatingplaces. A modern convenience thatis necessitated by the incessant flowof traffic from point to point withinand without the State is the fillingstation, and those advertising "restrooms" are ever popular. A long,hot drive develops a thirst to bequenched with a glass of water, comingfrom some roadside well or spring,and carrying no one knows how manykinds of bacteria capable of causingdiseases that time and again provefatal.These three sources menace publichealth to an extent little realized byus of the every day world who takeno time to stop and think of thedangers we encounter along the highways.True, we have a wonderfulsystem of protection for ourselveswhen we are at home. Forever watchingover us is the Board of Healthwith its numbers of trained and efficientmen and women who are alwaysat work making North Carolinaa better and more healthy place tolive. Hundreds of thousands of dollarsare spent yearly by our municipalitiesto secure and maintain adequateand safe supplies of drinkingwater, to turn sewage from a nuisanceand threat to public health intovaluable fertilizing materials, to makesure that milk served on our tables,or used in our kitchens, is producedby healthy cows in clean dairies, tokeep our cafes and hotels clean andsanitary so that we may eat and sleepaway from home, knowing that thefood placed before us is prepared withthe greatest cleanliness and our bedsare supplied with clean linen andfurnished with inspected matresses,and to keep up a constant warfare inmany other ways against disease andill health. And yet, we ignorantlyor wilfully, expose ourselves to moredanger and take more chances on onetrip in one day than we will come incontact with in a life time at home.A drastic statement, say you? Notat all. Let us stop to think a minute.That wiener you bought back

30 The Health Bulletin June, 1930yonder that tasted so good. Wheredid it come from? When was thepan in which it was cooked lastthoroughly cleaned? How muchdust had settled on it to add to itsflavor? In what physical conditionDidwas the man who prepared it?he have any infectious disease ?Washe clean or did his hands look astho' they'd never seen water? What?Of course you didn't think about allthat. You were hungry. But doesthat make those dangers less grave?And that delicious drink of waterfrom that "quaint old well," did younotice that the ground surroundingitdrained toward the well, or stop tothink that the water you spilled pouredthrough the cracks in the platformcover back into the well to be drawnup and drunk by someone else ? Didyou notice that the pig pen was onthe hill back of this well, or that theprivy was just a little way up thehill to the left from that picturesquewell? How disgusting, you say.And yet, how true."Oh, what a nice filling station!And a restroom! We must stop here!"But who used that restroom beforeyou did? Were they clean andhealthy? Or were they filthy withsome communicable disease ? Wheredoes this restroom sewage empty?Are you sure it isn't near a wellwhere you must get a drink?And that attractive tourist campwith such cunning litle cabins. Ifyou were just too tired to unfastenall your bedding that took so long topack last night, and used that furnishedso cheaply, do you know whoused it last, or whether it has beenlaundered since then? Is it youridea of "roughing it" to keep slappingat those bothersome flies thatpersist in annoying you while you'reeating breakfast the next morning?What caused so many? Perhaps itwas that garbage heap or some insanitaryprivies when they've coveredthemselves in filth and carry millionsof disease germs just ready toput them on your ham and eggs.The presence of such places is necessitatedby the vast stream of touristtraffic in and through the State.The dangers are seldom realized byHere is a group of children who will enter Aycock school in Orange countythis fall for the first time. They were examined on March 6th in a preschoolround-up. The little rebel down front says he is positively not going to schoolthis year and wants to know why they are picking on him unless they aregoing to give him toxin-antitoxin, which he wants and needs.

isenseincreasies,,cationists'byways.'goingIcafeIJune, 1930 The Health Bulletin 31the hundreds of travelers that areconstantly passing over the highwaysand, of those that do, a great numberare inclined to disregard the commonprecautions and to "rough it"or "live off the country."As the number of touristsso do the dangers. Traffic withinthe State is heaviest during thespring and summer months when vathrongthe highways andTraffic through the Statenorth is heaviest in the springwhen those who have wintered inFlorida and other southern resortsare returning home, and south boundtraffic increases as cold weatherdraws on. So it is easily seen thatthere is only a small period duringthe twelve months when there is theleast let up in this tide, and at notime does it stop flowing entirely.Not only is the health of the travelingpublic in danger, but those whostay at home are also exposed by thediseases brought back by these campersand tourists. To spend moneyfor the prevention of diseases of typhoid,diphtheria, smallpox, and thelike at home is to throw it away, ifbreeding places are allowed to dot thelength and breadth of the State,furnishing an inexhaustible supply ofbacteria with the most efficient meansof transmission, the automobile andits occupants.The realizationIof these dangers isno recent thing by those in authority.Numerous letters and editorials havebeen written bewailing their presence,and the State Board of Healthhas been severely criticized for allowingthem to exist. Just recently aletter was received asking why theeating places did not come under thelaw governing hotels and restaurants.The State agencies have done littleto eradicate these conditions, becausethey have no power to act. Theand hotel law does not affecteating stands that accommodate lessthan twelve people, and it is easilyseen how the chief offenders remainunaffected by this statute. Werethere laws governing such establishmentsnow in existence, there are nofunds appropriated to provide sufficientpersonnel of the proper kindand with the proper training to undertaketheir enforcement.Let it be said now, and emphasized,that to clean up the highways in theState of North Carolina is a taskthat can only be satisfactorily accomplishedby the enactment of lawsmaking sanitary conditions in all instancesobligatory to anyone servingthe public in any way, and in placingthe responsibility for enforcementof these laws upon a departmentequipped with MEN COMPETENTTO DO SO—men WHO HAVE BEENTRAINED specifically in this line ofwork. It will be a hopeless task toeffect such a cleanup, even whenlaws are passed, by utilizing untrainedmen, or those who are alreadyoverburdened with other tasks.Let us consider what has been doneelsewhere to control this ever-increasingwave of danger. Alreadyseveral states—Ohio, Maine, Pennsylvania,Minnesota, Wisconsin, andWest Virginia have developed programsof roadside sanitation in attemptsto cope with this problem.The systems adopted by Maine andOhio are particularly complete andinclusive and, if properly enforced,should make highways equally as safeas the towns and cities they connect.In Ohio supplies of drinking wateralong the roadside that furnish waterat any time to the public are inspectedby a representative of the StateHealth Department, or the districthealth officer, samples of the wateranalyzed for its bacterial content,thesurroundings carefully gone overto make sure that there is no sourceof possible pollution near and, ifjustifiable, the "Seal of Safety" isawarded. In case the nature of the

32 The Health Bulletin June, 1930well, pump, or whatever may be thetype of supply, does not permit theawarding of this seal, suggestionsare made whereby it may be attainedby cleaning up and developing asafe supply. If, after a reasonablelength of time, the proposed improvementsare not made, the supply isordered discontinued, the well filled,or pump dismantled.The "Seals of Safety" are numberedand a careful recordof each sealis kept so that a list of all certifiedwater supplies is available at alltimes. The surroundings of thesesupplies are watched to prevent subsequentcontamination and additionaltests are run from time to time onthe water to ascertain whether or notsuch contamination has taken place.Signs are erected along the highwaysadvising the motorist of a supplyof safe drinking water, guaranteedby the State of Ohio, is to befound just ahead.Maine is equally as careful withher roadside water supplies and isconcerned also with the eating placesalong her highways, being aided inthis program by most comprehensiveand conclusive laws and statutes. Itis obligatory that every eating, drinking,or lodging place of any size belicensed once a year, and that suchplaces shall be maintained in accordancewith the rules and regulationsset forth by the State Board ofHealth. Each employee must, uponapplication for a position, no matterhow small the establishment, furnisha certificate from a reputablephysician stating that he, or she, isfree from any communicable diseaseand this certificate must be availablefor inspection at any time. Carriersof diseases such as typhoid fever,diphtheria, septic sore throat, and thelike, may not serve as employees afterthe proprietor has been notified inwriting that such a person is a carrier.Pennsylvania, during the warmweather months of 1929, had a forceof over fifty workers patrolling herhighways to enforce laws similar tothose of Ohio and Maine, with particularattention being given to the"hot dog" and cold drink standsfound scattered everywhere. Thisemphasis was due to the fact that aprogram to maintain safe roadsidewater supplies had previously beeninaugurated and was functioningsmoothly at that time.All the states mentioned have realizedthe importance of summer campsin the life and health of its children,and the problem presented in providingadequate sanitary facilities forsuch camps. The tourist camps thatare now found adjacent to the mainarterial routes in profusion presentanother phase of this problem that hasbeen adequately cared for.All camps in these states must belicensed each year and licenses areissued only upon the recommendationof a sanitary inspector whose dutyit is to thoroughly inspect the campand its surroundings, paying attentionto the water supply, garbage,and sewage disposal, and many otheritems vital in the maintenance of asafe and healthful camp. The lawsgoverning public eating and drinkingplaces are applicable here, as wellas elsewhere, and must be adheredto.So have other states gone abouttaking care of themselves and curinga necessary ill. Are we to lag behind?North Carolina ranks v/ell tothe front in all fields of sanitationsave this alone, and, indeed, is servingas a model for some other statesto be guided by in their developmentalong these lines. As has been said,the State Board of Health is ready,willing, and anxious to act, if onlygiven the authority and personnel todo so. Are we to stay behind and delayin protecting ourselves in the faceof such a crying need for protection?

Published bn TAZ.^?RmC^\K9LI/iA 5TATL D^ARD s^AmLTA1 This Du]lelir\willbe 5er\t free to ar\g citizen of the 5tateupor\ request.!Entered as second-class matter at postoffice at Raleigh, N. C, under Act of July 16,1894. Published monthly at the office of the Secretary of the Board, Raleigh, N. C.VOL. XLV. JULY, 1930 NO. 7VACCINATION WOULD HAVE PREVENTED THISThis Trmn is a respected citizen of his co7nmunity. He had simplyfailed to go to the trouble to get himself vaccinated. He is advisinghis friends noiv that one big ivay to prevent sure enough troublesooner or later is to be vaccinated until it "takes."

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTHA. J. CROWELL, M.D., President CharlotteCYRUS THOMPSON, M.D JacksonvilleTHOMAS E. ANDERSON, M.D StatesvilleE. J. TUCKER, D.D.S RoxboroD. A. STANTON, M.D High PointJAMES P. STOWE, Ph.G CharlotteJOHN B. WRIGHT, M.D RaleighL. E. McDANIEL, M.D JacksonCHARLES C. ORR, M.D AshevilleEXECUTIVE STAFFLAUGHINGHOUSE, M.D., Secretary and State Health Officer.CHAS. O'H.RONALD B. WILSON, Assistant to the Secretary.H. A. TAYLOR, M.D., Deputy State Health Officer.C. A. SHORE, M.D., Director State Laboratory of Hygiene.G. M. COOPER, M.D., Director Bureau of Health Education.H. E. MILLER, C.E., Chief of Bureau of Engineering and Inspection.P. M. REGISTER, M.D., Director Bureau of Vital Statistics.A. B. McCREARY, M.D., State Epidemiologist.ERNEST A. BRANCH, D.D.S., Director of Oral Hygiene.D. A. DEES, M.D., Field Assistant in County Health Work.FREE HEALTH LITERATUREThe State Board of Health publishes monthly The Health Bulletin,which will be sent free to any citizen requesting it. The Board also hasavailable for distribution without charge special literature on the followingsubjects. Ask for any in which you may be interested.Adenoids and TonsilsCancerConstipationColdsClean-up PlacardsChickenpoxDiphtheriaDon't Spit PlacardsEyesFliesFly PlacardsGerman MeaslesHookworm DiseaseInfantile ParalysisInfluenzaMalariaMeaslesPellagraPublic Health LawsPrenatal CareSanitary PriviesScarlet FeverSmallpoxTeethTuberculosisTuberculosis PlacardsTyphoid FeverTyphoid PlacardsVenereal DiseasesWater SuppliesWhooping CoughSPECIAL LITERATURE ON MATERNITY AND INFANCYThe following special literature on the subjects listed below will besent free to any citizen of the State on request to the State Board ofHealth, Raleigh, N. C:Prenatal Care (by Mrs. Max West)"Our Babies"Prenatal Letters (series of ninemonthly letters)Minimum Standards of Prenatal CareWhat Builds Babies?Breast FeedingSunlight for BabiesHints to North Carolina Mothers WhoWant Better BabiesTable of Heiglits and WeightsThe Runabouts in the House of Health(pamphlet for children from 2 to 6years of age).Baby's daily Time Cards: Under 5months; 5 to 6 months; 7, 8, and 9months; 10, 11, and 12 months; 1year to 19 months; 19 months to 2year's.Diet Lists: 9 to 12 months; 12 to 15months; 15 to 24 months; 2 to 3years; 3 to 6 years.Announcement _ 3Disgrace of Smallpox Still Upon us_ 3United States Chainber of CommerceHealth Conservation Contest5Another Side to the TenantFarmer Problem 6CONTENTSPAGEButter Vs. ~Butter"'SubstTtutesIIII"l3The County's Medical Bill 14Oral Hygiene 14PAGEMilk Diets Favor Long Lives 15Letter to Parents of Babies SixMonths Old 15The Public Health Laboratory AsAn Asset 16Physician Talks on First AidMethods to the Young Mothers'Club of Crafton 18No Old Age Dead Line Here 24Health Activities in Industry 24"Sanitation Approved" 28

aMb

The Health Bulletin July, 1030condition or infection when used ona person to prevent smallpox. Underthe leadership of the United StatesHygienic Laboratory at Washingtonstandard measures have been perfectedand adopted until today it is justas safe from the standpoint of infectionto have vaccine virus injectedinto one's skin as it would be to haveplain sterile water rubbed in. It hasbeen proved during the past hundredyears by its use on millions and millionsof people that no one can sufferany unfavorable consequences followingthe vaccination against smallpoxif even ordinary care is exercised.Since the adoption of smallpox vaccinationas a prevention of that scourgethe mortality has been reduced toalmost nothing; that is, very few peoplenow dying of the disease whenhaving it, although an occasionaldeath occurs, and in some epidemicsthe disease is still virulent andcauses the deaths of quite a numberof people. However, speaking of theworld at large, the universal use inall countries of smallpox vaccine hasreduced the mortality to a very lowfigure. People now have very mild attacksas a rule compared to virulentattacks of former days. It is, however,the same disease it has alwaysbeen—one of the most contagious inthe world, one of the most filthy andloathsome diseases, and one in whichthe patient suffers untold agonieswhen the disease is contracted inanything like severe form. Any relaxationof the laws requiring vaccinationor any suspicion of its use andits recommended use by physiciansover the world would result in a fewyears time in the same terrible conditionsreturning that were presentin the eighteenth century.In spite of all the foregoing facts,in the full face of knowledge so simplethat any child can understand asto what vaccination has done andwhat smallpox meant before vaccinationwas discovered, we find in thisfree and liberty-loving United Statesof America today more people havingsmallpox per thousand population thanany country in the world exceptamong the benighted population oftropical India; and we also find flourishingas never before anti-vaccinationsocieties and organizations whoflaunt in the face of the public thefact that they are in existence for thepurpose of opposing this humanitarianand life and health saving measuresponsored by scientists for morethan a hundred years and proved asno other single scientific measure hasever been supported.In order to remind our readers thatsmallpox is still present in NorthCarolina; that it is still the same kindAs this photograph indicates, it wasnot all flowers that bloomed lastspring for this citizen of North Carolina.He was so anxious to warn hisfriends that he had his photographpublished on some post cards to mailto them, showing just what any unvaccinatedperson may expect anytime.

July, 1930 The Health Bulletinof disease it has always been; thatit is still dangerous to play with, weare publishing in this issue of theBulletin two photographs of respectedwhite men who have had the diseasethis year in one of the counties ofNorth Carolina. We will ask our readersto look at these photographs andthink of what it meant to these twofellow citizens, and then be vaccinated,unless it has been done within thepast three years.UNITED STATES CHAMBER OF COMMERCE HEALTHCONSERVATION CONTESTThe State Board of Health is inreceipt of a letter from Dr. W. F.Walker, secretary of the Committeeon Administrative Practice of theAmerican Public Health Association,notifying the Board that the citiesGreensboro and Durham have wonhonorable mention in the ConservationHealth Contest inauguratedearly in 1929 by the Chamber ofCommerce of the United States. Inofthis contest the American PublicHealth Association cooperated in everyway with the commerce associationin creating interest in this enterprisein the cities of the UnitedStates. In this contest held last yearthere were seven cities in North Carolinawhich entered thecontest.We are publishing in full belowDr. Walker's letter. We would likeespecially to call attention to the paragraphof his letter which remindsthe health officers in the differentcities and towns of this State thatthe contest is again being held thisyear. The object of this annual competition"is to assist in reducingeconomic losses in the United Statesdue to unnecessary illness and death,by means of activities carried onthrough the organization and thencethe leadership of health committeesof local chambers of commerce orsimilar associations, in cooperationwith the official health agencies." Allchambers of commerce, or similar associationswhich are organizationmembers of the chamber of commerceof the United States, are eligible toenter this contest this year. Full detailsof the plan and the requirementsfor entry may be obtained bywriting the Insurance Department,Chamber of Commerce of the UnitedStates, Washington, D. C.The letter of Dr. Walker followsin full, in which he commends thecities of Greensboro and Durham forwinning honorable mention."The cities of Greensboro and Durhamhave won Honorable Mention inClasses III and IV, respectively, ofthe Health Conservation Contest inauguratedby the Chamber of Commerceof the United States. On behalfof the Association and of theCommittee on Administrative PracticeI congratulate you, as the StateHealth Officer, for the schedules submittedare a manifestation of thehigh plane public health has reachedin your state."To the American Public HealthAssociation which must consider thenation as a whole, as well as its integralparts, the broadening of interestson the part of authoritativebusiness organizations so as to includehealth and its economic valueis particularly gratifying. With suchenlightened cooperation the financialburden from preventable sickness andearly death may be lowered not onlylocally, but soon will be reflected inthe vital statistics of the nation."In addition to Greensboro andDurham, five other cities in NorthCarolina entered the Contest. Theyare: Burlington, Raleigh, Winston-Salem, Lexington and Statesville. The

The Health Bulletin July, 1930last two, however, did not submit them over again with a view to interschedules,esting the Health Officers and Cham-"I am attaching a copy of the An- bers of Commerce of the above citiesnouncement and Fact-finding Schedule and other North Carolina cities in theas you will no doubt want to look 1930 Contest."ANOTHER SIDE TO THE TENANT FARMER PROBLEMIt is a well known fact that thereare always in North Carolina twoclasses of tenant farmers. One classmiay be said to be the shiftless, thriftless,no account moving type thatwill not work, will not stick to a cropuntil it is harvested, if it is possibleto avoid it, and who are constantlymoving around, unable tomake a livinganywhere. This type, of course,should be pitied, and every effortshould be made to help their children,because more frequently than notmental competence, through heredityand bad training, is lacking.There is another class, however, oftenant farmers which comprises someof the best citizens in this state. Innearly every instance when a youngcouple of this class marries and setsup housekeeping, unless disease orother misfortune overtakes them, itis not long before they are able,through their thrift and industry, toacquire a farm of their own. Many ofthe State's staunchest middle classcitizens emerge from this class. Itis natural to expect that from nowon increasing numbers of people ofthis character will become landownersand independent farmers, makingfor a finer citizenship for the State.This may be expected on account ofbetter educational facilities, betterhealth advantages, and better economicopportunities.As an illustration of some of theproblems which this better class oftenant farmers has to meet, and alsoas an indication of the vision for betterconditions promised to them, weare herewith publishing a letter froman intelligent young wife and mother,received sometime ago from oneof the eastern North Carolina counties.Read the letter and ponder itcarefully."I am writing you in regard towhat I term a serious problem. I willstate the facts as brief and plain asIpossibly can."I am a tenant farmer's wife, livingon a farm owned and controlledby (Name of absentee landlord).There are five tenants, including us,living in a radius of one mile, threeof whom are white, and respectablefamilies, the other two are Negrofamilies. There is no sign of a privyof any kind on our premises, let alonea sanitary one. This same landlordhas been kindly asked to provide suchfor these white tenants, and to theserequests replies in a careless manner.We have been living here since thefirst of the year. He is able not onlyto provide such but has plenty ofold and new lumber to build them,also the tenants have offered to buildthem, although he has not given hisconsent."With the approach of summer, wethink there could be some measuretaken whereby we might induce himto build sanitai-y privies, or providelumber and material so our men folkscould build and thus safeguard ourhealth and that of our children. Isthere a way that you people couldtell us how to begin to bring thisabout?"

—July, 1930 The Health BulletinDIABETESByFrederick R. Taylor, B. S., M. D.Diabetes is a name that is appliedto three different diseases: diabetesinsipidus, renal diabetes, and diabetesmellitus or ordinary diabetes.Diabetes insipidus is a rare conditiondue to a particular type of diseaseaffecting a special part of thebrain. Sugar is not found in the urine(hence the name "insipidus"), and thedisease is rather a medical curiosity,of no practical importance to anylarge number of persons, so it willnot be discussed further here.Renal diabetes, or more properly,renal glycosui'ia, is a rather uncommonkidney condition due to the factthat the sugar normally present in theblood, "leaks" through the kidney, asit were, and appears in the urine,though there is no excess of sugarin the blood. It is practically harmless,but is of importance where itoccurs because of the ease of confusingit with true diabetes mellitus.Where doubt or confusion exists, anexamination of the blood, testing itfor the amount of sugar it contains,will clear up the diagnosis.Ordinary diabetes, i. e., true diabetesmellitus, is not a kidney diseaseat all, despite much public beliefto the contrary, but a disease of thepancreas. Dr. Joslin of Boston estimatesthat there are about one millionpersons affected with this disease inthe United States alone, so it is importantthat every intelligent personshould have some general knowledgeof it. Hereafter, in this article, whereverthe term "diabetes" is used itwill refer to the ordinary diabetesmellitus, unless otherwise stated. TTieterm "diabetes" comes from theGreek and means literally a syphon.It is applied to the disease becauseadvanced cases show great thirst,drink immense quantities of water,and void equally immense quantitiesof urine. "Mellitus" means literally"honeyed," or, more freely translated,"sweet," or "sugar bearing," and refersto the sugar content of the urine."Glj'^cosuria" means having glucose inthe urine, and occurs in true diabetesmellitus, in renal diabetes, and in certainother conditions where it is oflittle or no practical importancee. g. it is said to be produced in hydrophobia.The pancreas is a vital organ locatedin the upper abdomen behindthe stomach. It has a double function:it supplies the most powerful digestivejuice in the body, known as thepancreatic juice, which it pours intothe intestine through special ductsdeveloped for the purpose; and itmakes another substance, which wecall insulin, which goes directly intothe blood, which is essential for theutilization of sugar in the body. Onlycertain special cells of the pancreasprepare this insulin. Under the microscopethey can be seen grouped inlittle "islands" in the pancreatic tissue.The Latin word for "island" is"insula,"hence the secretion of these"islands of Langerhans," as they areknown after their discoverer, iscalled "insulin."Diabetes mellitus may be defined asa disease of the pancreas in whichthere is deficient production of insulin.Sugar is essential to life. Thatdoes not mean that we have to eatsugar to live, for starch of all formsis broken down in the process of digestionwith the formation of sugar.Some sugars are very complex, but

8 The Health Bulletin July, 1930these are broken down until glucose,one of the simplest sugars known, isformed, and practically all sugar thatis utilized in the body is utilized asglucose. Without insulin, however,glucose cannot be utilized.Normally the blood of a fastingperson should contain from 0.09 to0.12% glucose. After a meal, especiallyif sugar or starchy foods are eaten,the amount will be somewhatgreater. However, unless an enormousamount of sugar is eaten, the glucosecontent of the blood of a normalperson never gets very high, for if amoderate excess be present, it isquickly disposed of with the help ofinsulin, in one of two ways—transformed,into heat or other energy, ors'ored in the body as glycogen, or asfat. If. however, the supply of insulinis deacient, glucose tends to accumulatein the blood. If the kidneys arenormal, when the blood glucose, orblood sugar, as it is usually called,reaches a concentration of about0.16%, sugar begins to appear in theurine, and the more there is in theblood, the more there will be in theurin".UNDERWEIGHT GROUP OF SOUTHPORT SCHOOL CHILDRENMiss Parsons, Brunswick County Public Health Nurse, sends us this pictureof a group of 32 children in the Southport Schools tvho were provided withmilk^ regidarly each day for three months. The milk was donated by the Wovian'sClub of Southport from money secured from the sale of Christmas Seals.At the beginning of the period all the children ivere underweight. After threemonths the gain in weight ^vas considerable.

July, 1930 The Health Bulletin 9We do not know the cause of thisdeficiency in insulin formation. We doknow, however, that fat people tendto develop it much oftener than personsof normal weight, and thosewho have a diabetic tendency aremade much worse by a diet containingan excess of sugars and starches.Inability to utilize sugar oftencauses difficulty in utilizing fattyfoods in the body. If fats are notproperly used, dangerous acid poisonscalled "ketone bodies" may be formedin the blood, and these substances^may cause unconsciousness and death—indeed they are responsible forimost deaths from diabetes. A personsuffering from such acidpoisoning issaid to have a "ketosis," or "diabeticacidosis." When this is severe enoughIto produce unconsciousness, the patientis said to suffer from "diabeticcoma," a very dangerous condition.Diabetes can kill in other ways thanby causing coma, however. When thereLis an excess of sugar in the blood,many disease germs grow more luxuriantlythan they do in normalbodies—the sugar laden tissues supplythem with rich food. This is especiallytrue of the ordinary pusformingorganisms—a tiny pustule ina diabetic may spread and develop afatal carbuncle or abscess. Slightabrasions about the toes from ill-fittingshoes, ingrowing nails, etc. arepeculiarly liable to result in a fatalblood-poisoning. A severe diabetic isalso peculiarly liable to develop gangreneof the toes or feet.The Symptoms ofDiabetesAt its onset diabetes does not usuallycause any characteristic symptomsthat can be felt by its victims.Many a case of diabetes is discoveredin its early stages merely in thecourse of a routine medical examination—e.g. sugar is found in the urineduring an examination for life insurance,or in the course of a periodichealth examination, in a person whobelieves himself quite healthy. Or,again, it is often discovered when theurine is examined as a routine procedureduring the medical examinationof a patient who is sick withsome other condition, such as an attackof tonsillitis or influenza thathappens to be coincidentally associatedwith the diabetes. Such attacksvery often start up a case of diabetesin a person with a tendency to thedisease, or make a preexisting diabetesmuch worse. Even in mild casesof diabetes, however, while the patientsfeel no characteristic symptomsthat point to the disease, many ofthem recognize that they feel a littlebelow par when sugar is in the urine.Advanced cases of diabetes mayhave highly characteristic symptoms.The very high content of sugar inthe blood produces an intense thirst,presumably as an eff^ort of Nature todilute the blood with water and solower the sugar concentration. Thepatient drinks increasingly largeamounts of water—perhaps two,three or four times the ordinaryamount for him, or even more. As thewater that goes into the body has tocome out again, he voids proportionatelylarge amounts of urine. If thedisease progresses unchecked, theurine contains more and more sugar,and becomes irritating, and severeitching of the genitals, may be noted.The body tissues in general, too, beingloaded with sugar from the blood,often are irritated, and generalizeditching of the whole body, may occurand be not only very distressing, butdangerous, for it causes scratchingwith resultant abrasions of the skinthat may develop into fatal infections.In advanced diabetes there may bealmost complete inability on the partof the body to utilize sugar andstarch, so that the patient gets nobenefit whatever from the sugars andstai'ches he eats—they all pass out of

10 The Health Bulletin July, 1930the body unused, as sugar in theurine. It is astonishing how muchsugar may be lost from the body intwenty-four hours in an advanceddiabetic. Yet if we recall that allstarches are broken down with theformation of sugar, so that sugar isformed from our bread, potatoes, cereals,macaroni, etc., as well as fromthe sweets we eat and from milk sugar,it will not seem quite so strangeto be told that a severe case of diabetesmay eliminate in twenty-fourhours time the equivalent of one hundredlumps of sugar or more. This,however, means foods wasted. Thepatient ate it, but really didn't getit after all! Therefore the severe diabeticis often starving in the midstof plenty—he doesn't get what heeats, and this causes another greatsymptom of advanced diabetes—inordinateappetite.While the fat person is peculiarlylikely to develop diabetes, the advanceddiabetic is cften underweight becauseof his inability to utilize a largeproportion of thefood he eats.Another symptom, and an ominousone, in advanced diabetes is abnormaldrowsiness. ITiis is often due to acidpoisoning, and when it is, the patientis threatened with coma. Vigoroustreatment is essential in suchcases.Extreme susceptibility to boils oftenoccurs without diabetes, but it isso frequent in advanced diabetes thatthe urine should be examined in allsuch cases.Certain disturbances of vision, includingcataract, are not infrequentin advanced diabetes.Impotence also has often been noted.Other symptoms occur which arenot characteristic.It cannot be too strongly insistedupon, however, that the so-called"characteristic symptoms" of diabetesrarely occur until the diseaseA baby, like a kitten, will oftencrawl up on the running board of acar standing still and fall asleep inthe warm sunshine. In such cases,when the driver hurriedly enters thecar from the opposite side and drivesoff without looking, the newspapersand the death certificate often tell thestory of another "unavoidable accident."has progressed to an advanced andserious stage. The diagnosis shouldbe made from the laboratory findingsbefore symptoms occur. These findingsconsist cf two or three things:(a) the finding of sugar in the urine,(b) the finding of an excess of sugarin the blood, and (c) in severe casesthe finding of ketone bodies in theurine.In a very mild case,sugar may appearin the urine only after the patienthas eaten unusually freely ofcarbohydrate foods (sugars andstai'ches). A slight excess of bloodsugar may be detected when no sugarcan be found in the urine. Theappearance of ketone bodies in theurine is an urgent danger signal, andthe patient should go to bed and placehimself under the close watch of aphysician, and follow his directionsimplicitly.The diagnosis of the existence andseverity of a case of diabetes, therefore,must depend on a well-trainedphysician. Other things being equal,the earlier the diagnosis, the moresuccessful the treatment. There beingno early symptoms, the widespreaddevelopment of the custom ofannual health examinations, offers the

July, 1930 The Health Bulletin 11best method at our command todayfor the early detection and adequatecontrol of diabetes.The Treatment of DiabetesNearly twenty years ago, Dr. AlfredStengel, Professor of Medicinein the University of Pennsylvania,remarked that he knew of no betterway to distinguish a well-educatedphysician from a poorly educated onethan to watch the way he treateddiabetes. That was of course beforethe days of insulin treatment, butthe advent of that remarkable preparationhas in no wise changed thetruth of Dr. Stengel's statement. Thephysician who properly manages diabetesmust be a real student of medicine.The treatment consists of a properlyarranged diet in all cases—a dietlow in sugars and starches, yet sufficientto keep up bodily strength.Insulin must be used in severe cases,and is indispensable in certain diabeticemergencies, notably coma. Inaddition special care must be takenI[ of the skin and feet, and small abrasions,ingrowing toenails, little pustules,etc., treated energetically totry to prevent serious complications.The diabetic should also be especiallycareful to avoid so far as possible,all kinds of other infections, such ascolds, influenza, etc., as they frequentlychange a mild diabetes intoa severe one, or a severe one into afatal one.As a carefully arranged diet is essentialin all cases, the diabetic mustput himself under the care of a competentphysician who is a student ofdiabetes, and follow his directions,but this is not all. Dr. Elliott P. Joslin,one of the greatest authorities inthe world on diabetes, writes, " — thepatients who know the most, conditionsbeing equal, can live the longest.TTiere is no disease in which anunderstanding by the patient of themethods of treatment avails as much.Brains count. But knowledge alonewill not save the diabetic. This is adisease w^hich tests the character ofthe patient, and for success in withstandingit, in addition to wisdom,he must possess honesty, self-control,and courage. These qualities are asessential with as without insulin.Many of my patients have actuallylived longer than would have been expectedof them had they been normalhealthy people, and far longer thantheir similar fat friends whose obesityled to their death by way of theheart or kidneys. For the diabeticthis is a demonstration and a challenge."The above isquoted from the thirdedition of "A Diabetic Manual forthe Mutual Use of Doctor and Patient,"by Elliott P. Joslin, M. D., publishedby Lea and Febiger, Philadelphia.It is an excellent book for thediabetic to study. One of the mostfrequent prescriptions which the authorof this article writes for his diabetiapatients is filled at the bookstorerather than the drugstore, and is forthis invaluable little book. Drugs,other than insulin for severe cases,have very little place in the treatmentof diabetes. Insulin must be givenhypodermically—if taken by mouthit is destroyed by the digestive juices.Researches are going on to try to developa satisfactory substitute for insulinthat can be taken by mouth,but as yet success has not beenachieved. However, insulin is an almostmiraculous life-saver in manysevere cases of diabetes, though itcannot save all case's. It is a greatboon to many who would otherwisebe constantly threatened with death,and has added years of active usefulcomfortable life to thousands whowould otherwise be hopeless invalidstottering on the brink of the grave.No wonder Drs. Banting and Best,the discoverers of it, were given theNoble Prize in Medicine! It is one ofthe greatest discoveries of the cen-

12 The Health Bulletin July, 1930tury. However, this discovery doesnot do away with the absolutenecessityfor a properly restricted diet. Theskilled physician will direct his patient'sdiet but the patient must learnhow to apply his dietary instructions,and apply them. In other words,to boil down the quotation from Joslingiven above, he must first knowwhat to do, and then do it. Here iswhere character comes in. If he kicksover the traces and refuses to stickto his diet, he cannot expect to holdhis disease in check. Advice of themost expert sort is useless if it isnot followed. I recall an interestinganecdote illustrating this point toldby Dr. William H. Smith of Bostonin one of his postgraduate clinics inthe Massachusetts General Hospital.The story ran something like this:"A wealthy society woman oncecame into my office, and a preliminaryexamination showed that shewould require a careful regulation ofher diet. Before going to too muchtrouble in working out details, it issometimes a good idea to see whetheryour patient will benefit by yourwork or not, so I remarked to thewoman, 'Madam, do you like goodfood?' She replied, 'Oh, I just lovegood food, Dr. Smith.' Then I said,'Madam, do you have a good cook?'She answered, 'Oh, Dr. Smith, I havethe best cook in Boston.' I saw howthings were, so I sorrowfully remarked,'Madam, I can do nothing for you.Good-day'."This does not mean that the diabeticcannot eat good food—he canand should, but he will have to limithis diet to a greater or less extentaccording to the severity of his disease.If he has not the character todo this, and lives to eat instead ofeating to live, nothing can save him.Look at this picture and then if you feel that you are going to be ill soon,hurry to Currituck. This is the Moyock class in home nursing. They range inage from seventeen to seventy and they all know their stuff.

July, 19^30 The Health Bulletin13BUTTER VS. BUTTER SUBSTITUTESOur present knowledge of nutritionand nutritional diseases is full of informationconcerning the effects ofvitmains on growth and in the preventionof diseases of diei:ary deficiency.Of particular interest is the effectof Vitamin A, the growth promotingvitamin, on growth and nutrition andthat its absence in the diet causes apathological condition of the eyesknown as xerophthalmia, which ifneglected will lead to blindness.Vitamin A is associated with cer.tain fats, and is especially abundantin milk, butter, egg yolk, the fat ofglandular organs, and also in theleaves of plants. The seeds of plantscontain less and it is practically absentfrom lard and the fats and oilsof vegetable origin.In the American and European dietthe fats of milk are the most importantsource of Vitamin A. Since thisis true it can easily be seen the importantplace that butter holds in thediet. In the investigation of xerophthalmiaof dietary origin in rats andin children, cures were effected by>( MJMJSr 1 ii iL 'JtJLm

14 The Health Bulletin July, 1930THE COUNTY'S MEDICAL BILLFigures indicating that ForsythCounty's medical bill for one yearamounts to $3,360,000, or an averageof $140 per family, are importantparticularly because of their bearingon the project of preventive medicine.Nearly half of this sum is paid outin doctors' bills. Hospital service, operations,nurses' attendance and medicinesconsume most of the rest ofIhe bill.Any doctor v/ill readily agree thatmost of the illness which he is calledto rei.-.edy could have been preventedif the patients would have consultedhim in time to correct conditions thatultimately resulted in disease.Any doctor knows that he wouldbe better off financially practicingpreventive medicine than trying tocombat disease once it had obtained afoothold. People kept well are in muchbetter position to pay than people depletedby sickness.A medical bill of more than threemillion dollars for Forsyth County isan imposing item. But the cost ofsickness in terms of lost time, impairedearning capacity, loss of time torelatives and other factors is probablymuch greater than the medicalbill. Preventive medicine is makingprogress. People are coming to knowthat the best time to see the doctoris in health and not in sickness, formaintained health keeps sicknessawav-—Winston-Salem Journal.ORAL HYIENEEvery parent in Tarboro and thistownship should have heard the ableand educational address last night byDr. Branch of the State Departmentof Health at the Monday evening sessionof the Parerst-Teachers Association.Dr. Branch is a dentist and heknows whereof he speaks. In his talkhe stressed the great importance ofthe care of the teeth of children inour public schools. Not only did hetell of the many children who weresuffering from the effects of badteeth and diseased gums, but he toldhow these troubles could be remediedand after all his remedy was a mostsimple one that could be taken advantageof by all parents with asmall cost.One thing that struck us was thatin many cases the child was sick andno one seemed to know the reason.He spoke of one child, a girl, whohad been in the first grade for fouryears, at a great cost to the taxpayersof the county where she lived. Anexamination of the teeth and mouthdisclosed that she had been intoxicatedby pus flovv'ing from her gumsinto her stomach, causing a sluggishnessin mind and body. But he did notstep here, for, said he, after this girlhad received treatment she wentahead with her studies and was thereafterone of the brightest pupils inherclass.Dr. Branch did not deal as much intheory as he did in actual facts andfigures and this he did with slides,showing the actual conditions foundin many cases. He called upon peopleof the county to continue these dentalclinics from year to year, stating thatif the county people would raise thesum of |900 the state would furnisheach year a term of another fourweeks free of charge to the taxpayers.—TarboroSoutherner.

July, 1930 The Health Bulletin16MILK DIETS FAVOR LONG LIVESMost of the persons who have livedto be more than one hundred years ofage seem to have subsisted largelyon milk and dairy products, accordingto Dr. James A. Tobey, writing on"Some Famous Centenarians" in theScientific American for April 1930.Dr. Tobey mentions numerous instancesof real centenarians, amongthem Marie Prion, who died in 1838at the reputed age of 158, after livingfor most of her life on goat'smilk and cheese. Nicole Marco reachedthe age of 110 on a diet of breadand milk and the same fare helpedEphraim Pratt of Massachusetts tolive to be 100. As in many other instances,Mr. Pratt's age was claimedto be much greater than that, and Dr.Tobey points out that many instancesof alleged great ages have been foundon investigation to be unwarranted.There have been numerous real centenarians,but only a few have attainedto many years beyond the centurymark.TTiat a milk diet can actually contributeto longevity has been shownby scientific experiments on animals,according to Dr. Tobey, who cites investigationsby Professor Henry C.Sherman of Columbia University inNew York. After ten years of studieson more than 400 white rats. ProfessorSherman found that by doublingthe proportion of milk in a diet comprisedoriginally of one sixth wholemilk powder and five sixths wholewheat powder, a gain of exactly tenpercent in the span of life resulted.This indicates, according to Dr. Tobey,that six years might be addedto the span of human life in this countryby means of optimum nutrition,with milk playing a leading part.LETTER TO PARENTS OF BABIES SIX MONTHS OLDDoctor C. C. Hudson, health officerof Greensboro, has adopted the followingplan, effective in the city ofGreensboro when every baby born inthat town reaches the age of sixmonths. The plan, as will be noted, isto send a letter to the parents suggestingthat they have their familyphysician give the baby toxin-antitoxinwithin the following sixty daysin order to protect it against diphtheria,also urging them to have theirphysician vaccinate the baby againstsmallpox before it is three years old,and also advising typhoid vaccine beforethe child is four years old. It isan interesting letter, and it is aplan which could be adopted withsatisfaction by all other health departmentsnot already carrying outsome such arrangement."Dear Father and Mother:"Your baby is six months old."Have your family physician giveyour baby three doses of toxin-antitoxinto protect it against diphtheriabefore it is eight months old."Have your physician vaccinateyour baby for smallpox before it isthree years old."Have your physician give yourchild typhoid vaccine before it is fouryears old."Measles is Preventable. Call yourphysician as soon as your child is exposedto measles."WTiooping cough is dangerous,especially for children under threeyears of age. Call a physician atonce if your baby shows any symptomsof whooping cough, or is exposedto it."Have your physician give yourchild a thorough physical examination

16 The Health Bulletin July, 19 SOduring its fourth year. Have him correctall physical defects which hemay find at this examination."Your Child is your most valuablepossession. You should care for it assuch."THE PUBLIC HEALTH LABORATORY AS AN ASSETByC. C. Hudson, Health Officer, Greensboro, N. C.The public health laboratory haslong been recognized as one of themost valuable parts of the publichealth program. If a health departmentis to control communicable diseases,it is necessary that it know^where danger lurks. The informationfurnished by the laboratory is ofmuch assistance in finding out thesedangers. It gives information as tothe condition of the water supply,milk supply, ice cream and certainother foods, and is of great importancein detecting communicable diseasecarriers. To the physician it isinvaluable in assisting in the diagnosisof certain infections which aredangerous to the public. The work ofthe public health laboratory is madeup of certain definite divisions:First, Research Work—Most of ourlaboratories in smaller cities andtowns do not have sufficient funds forcarrying on research work, but insome of our larger cities this phaseof the work is proving of enormousbenefit to the public in general. Thework of the New York City healthlaboratory is an outstanding exampleof research work in a public healthorganization.A second function of the publichealth laboratory is the productionof vaccines and serums for use byphysicians in the treatment and controlof various diseases. Our ownState laboratory is an excellent exampleof the good that may come fromhaving such an organization. Eventhough our State laboratory did notprepare a single dose of vaccine itwould be worth the cost of the entirelaboratory just to have our manufacturersknow that we have such a laboratorywhich could do so from thestandpoint of the decreased cost ofsuch materials to the public.The third function of the publichealth laboratory is that concernedwith routine examinations which aremade for physicians and for thehealth department. The work of thehealth department consists mainly insuch examinations as testing milk forbacteria and butter fat, solids—notfat, examination of milk for dirt andother pollution; examination of watersamples from wells or the public supplyfor pollution; examination ofspecimens of ice, ice cream and otherfoods; and certain specimens of variouskinds which may be submitted fordiagnosis by physicians and the examinationof cultures for release ofcases from quarantine. As an exampleof the work of a public healthlaboratory, during the last year ourown laboratory made the followingexaminations: Wassermann tests, 5,-688; Diphtheria examinations fordiagnosis and release, 1,775; sputumexaminations for tuberculosis, 74;examinations for gonorrhea, 462;Widal tests for typhoid, 302; bloodcultures for typhoid, 26;blood counts,93; Malaria, 125; intestinal parasites,53; other diagnostic examinations,1,187; water examinations, 118; examinationsof milk, 922, total 10,825.Even at a low estimate, the value ofthis work was almost equivalent to

—July, 1930 The Health Bulletin 17the cost of conducting our entirepublic health program.The public health laboratory to beof most assistance to physicians mustbe so located as to be readily accessibleto them from the standpoint ofgetting specimens to the laboratory ingood condition and securing promptreports.While public health laboratorywork, like all laboratory work, isexceedingly valuable, there are certainthings about this work which wemust remember. There are varioussources of trouble in connection withlaboratory work. Let us take diphtheriafor example. At times a physicianwill depend for treatment uponthe results of a diphtheria culturewhich he has submitted to a laboratory.There are various sources oftrouble in connection with diphtheriacultures. The mop used in taking the•culture may not have been rubbedover the membrane sufficiently to getthe diphtheria germs on it so thatthey will be transferred to the culturemedia. Occasionally the swabwill not be rubbed on the culturemedia sufficiently to inoculate it. Ifthe culture has been allowed to dryout for several hours the diphtheriagerms may die. We have long ago decidedthat where a case is possiblydiphtheria it is best to give diphtheriaantitoxin and then take a culture tofind out whether or not the disease isdiphtheria. If one culture is negative,a second should be taken. No oneshould depend upon a culture for adiagnosis of laryngeal diphtheria, asmany of these cultures will be negative.In the diagnosis of typhoid feverwe have many difficulties, but witha blood culture for the early cases,a Widal test for the late cases andboth in most instances, and also witha white cell count, we can usuallyarrive at a fairly satisfactory diagnosis.The Widal test, however, mustbe carefully watched and unless afresh culture is used a partial agglutinationmay be secured where thereis no typhoid.The Wassermann test, as a diagnosticmeasure for syphilis, is asource of considerable trouble. Intaking the specimen we find that occasionallyphysicians use tubes whichhave not been properly cleaned withdistilled water and then sterilized. Ifthe blood is not immediately put onice it may haemolyze in spite of havingused a sterile syringe and steriletubes. It is necessary that the bloodbe centrifuged and the serum withdrawnat a very early date if hemolysisdoes not take place in warmweather. While a Wassermann test isperhaps the best laboratory test wehave for the diagnosis of syphilis,we cannot consider it an absolutelypositive test for the diagnosis ofsyphilis or as a means of ruling outthat disease. Drs. Mary C. Mclntyreand Robert L. Gilmer, of Philadelphia,have compiled the results from1394 serums from cases of provedsyphilis, as reported in the Journalof the American Medical Association,August 23, 1929, using two teststhe Kolmer test and the Kahn test.They were only able to secure a positivetest of 62.4% with the Kolmertest and 53.3% with the Kahn test.There was very little variation in thepercentage of positives in the typesof syphilis examined with the exceptionof visceral syphilis, which showed100% positive. Recently a seriesof examinations of the same bloodswere conducted by different physiciansunder the auspices of the HealthSection of the League of Nations. Theblood was taken from persons whowere proved to have syphilis and personswho did not have the disease. Ina number of instances positive examinationswere secured from personswho were apparently free fromsyphilis. At times we secure Wasser-

18 The Health Bulletin July, 1930mann tests which do not agree withour physical findings. In such casesit is best to recheck the test, and ifthere is any doubt to give provocativedoses of Neo and then retest.In taking a specimen of blood forexamination for malaria it is alwayswell to find out about when the patientexpects a chill and take the specimenan hour or two before the chillisexpected.It is always well in taking a specimenfor examination of gonococci infemales to secure this specimen directlyfrom the urethra. Smears takenfrom other locations are usuallyso overgrown by other organismsthat it is impossible to find the gonoccccisexcepting in the very earlystages of the disease. If a small cottonmop is made on an applicator andthis inserted directly into the urethrathe examination is more reliable.In conclusion I would suggest thatthe public health laboratory is ofenormous value to the local physicianand to the public health work in anycommunity but, like all laboratorywork, we must remember that it hascertain weaknesses and that it is frequentlynecessary for us to check resultswhich we have obtained whenthese results do not seem to be in accordwith our clinical observations,and also that we should always treatcases suspected of being diphtheriaas such until we are certain that thisdisease is not present.PHYSICIAN TALKS ON FIRST AID METHODS TO THEYOUNG MOTHERS' CLUB OF CRAFTONBySuDiE E. PyattThis is the two-column, front pageheadline the Crafton Herald gave itsreporter's account of the third HealthMeeting of the Young Mothers' Clubof Crafton.Here is the complete account of themeeting as the reporter wrote it forthe Crafton Herald:Ten, wide-awake, earnest youngwomen, mothers of future citizens ofCrafton, and members of the YoungMothers' Club, met at the home ofMrs. William Batchelor, seci-etary ofthe club, at 114 Spruce Street, yesterdayafternoon and listened to amost interesting, informative discussionby Dr. Morton Wright on "FirstAid in the Home.""In household remedies be sure youhave only high grade remedies, carefullylabeled and kept in a medicinecabinet, that are real household aidsthat may be given by any member ofthe family in an emergency, and nota useless collection of bottles filledwith patent medicines, and medicinesleft over from doctors' prescriptionsused in treating former illnesses," Dr.Wright began his talk."I'he quality of the first aid remediesyou have in your home, yourknowledge of how to use them, andthe immediate calling of your physician,and if he is not available the bestdoctor nearest your home, willmanytimes save the lives of those you love,and much suffering and pain."Many women of the 'home-doctor'type think it necessary to keep onhand an odd collection of all kinds ofmedicines, the properties and uses ofwhich they know practically nothing,"the doctor continued. "The things thatare really necessary for a well-equippedfirst aid cabinet in the home arecomparatively few, simple to use andnot expensive. There are only fourteenarticles that are necessary at all

July, 1930 The Health Bulletin 19times in the home medicine cabinet."A clinical thermometer for takingtemperature, is an indispensable partof the equipment of the home medicinecabinet, and one which manywomen, even with small children,senFijIessly neglect to provide. In allcases of illness it is necessary toknow whether there is any fever presentor not. The clinical thermometeris the only tool we have for determiningthe presence or absence of fever,so you see why I mentioned a clinicalthermometer first in my list ofnecessities for the home medicine cabinet."First aid dressings for the medicinecabinet include sterilized gauzefor v/ound dressings, gauze bandagesused to hold dressings in place, a rollof adhesive plaster, and a number ofindividual first aid dressings, willtake care of emergency dressings forwounds."Six ounces or more of rubbingalcohol, used externally to relievepains of sprains, strains, bruises, andto refresh the skin during illness, is 'necessary for the medicine cabinet."xAromatic spirits of ammonia,about two ounces, used one-half teaspoonfulin water for faintness, isuseful."A good eye wash is one and onehalfteaspoonfuls of boracic acid dissolvedin a glass of hot water. Keepabout four ounces in the medicinecabinet."One tube of sterilized carbolatedvaseline for external use in the treatmentof slight burns will save muchunnecessary suffering from pains ofburns."Tincture of iodine, three and onehalfper cent solutionfor wounds, isindispensable. Keep on hand a bottleof syrup of epicac to cause vomiting,especially in cases of poison. The ipecacis taken according to directionswritten on the bottle label."In the case of these simple remediesit is well to remember the dosagein each case, and to place on thebottle a plain label on which the namewrittenof the contents of the bottle isand typed, together with instructionsfor its use.The doctor should be called immediately.Dr. Wright said, in the case ofany serious accident, when a personis unconscious, or suffering from convulsions,severe pain in head or abdomen,especially after" an injury, severesere throat, which may be diphtheria,and a rash with fever. Therash with fever, he said, might besome contagious disease.Headache, earache, nosebleed,toothache, colds, upset stomach, diarrhea,constipation, heartburn anddysmenorrhoea, are all common illnesses,the doctor stated, for whichmost people treat themselves withoutbothering to consult a doctor.Headache, not a disease itself, buta symptom that some other part ofthe body is not functioning properly,the doctor said, might be treated athome with rest, an ice-cap on theforehead, or a cloth kept cold by frequentlybeing wrung out of ice water.Repeated headaches ai'e a sign thatsomething is wrong somewhere, andyour doctor should be consulted. Dr.Wright advised his hearers."Take an earache ora dischargingear immediately to your physician,or deafness might result from neglect,or half measures used in hometreatment," the doctor stated emphatically.Go to your dentist as soon as possiblein the case of toothache, andvisit him once every year, even ifyour teeth seem all right, was whatDr. Wright told the members of theYoung Mothers' Club."For colds," the doctor said, "takea hot bath and a hot drink, such aslemonade, and go immediately to bed,rest, eat light food and drink plentyof water. .

,20 The Health Bulletin July, 1930"If the cold doesn't clear up intwenty-four hours, and there is anyfever, sore throat, severe cough, ordiscomfort in the chest, see your doctorimmediately."Repeated attacks of upset stomach,particularly if accompanied bysevere pain, are indications that aphysician is. needed," the doctor saidin speaking of stomach disorders,which so many people are inclined totreat themselves. "The person whoisn't a physician does not know howto prescribe for a sick stomach, andthe medicine taken is likely to makea serious condition more so. Eat nofood,or only very light food in casesof upset stomach, and do not eatheartily when overtired or nervous,or just before going to bed. Diarrhea,caused by irritation of the intestines,is treated just as you wouldan upset stomach, and if it persists,see your doctor."Dr. Wright gave the members ofthe Young Mothers' Club some valuablesuggestions for the cure of constipation.He advised, first of all, notto get into the habit of taking catharticsor enemas, and to have aregular time for the bowel movementevery day. A glass of cold water onarising, followed by five or six glassesduring the day, together with the restrictionof the use of tea, boiledmilk, cocoa and cheese, until the constipatedcondition has passed, wasadvised by the physician.The foods to aid in the cure of constipation,the physician said, werefoods with bulk, coarse cereals, wholewheat or rye bread, green vegetablesand fruits, and foods that act somewhatas lubricants, such as cream,olive oil; or those having considerableindigestible fibre, such as figs anddates. Sufficient sleep and exercisewere suggested as an aid to constipation,and the members of the clubwere advised to consult their physicians,if after using these suggestionsthe constipated condition continued.Heartburn, caused by a disturbancein the digestive juices of the stomach,and having nothing to do withthe heart. Dr. Wright said, was easilyrelieved by taking a half teaspoonfulof soda bicarbonate in water. Tea,coffee and spices aggrevate this condition,and as in the case of othercommon illnesses, heartburn is a matterfor consultation with your doctorif you have it frequently."It is not normal, as many peoplesuppose, for women to have severepain at the menstrual period," Dr.Wright stated to his interested audience,speaking of dysmenorrhea."Considerable pain at that time is acause for consulting your doctor, andno drugs are to be taken at that timewithout his advice. Heat applied tothe abdomen by the use of hot waterbottles, or an electric pad is the besthome remedy for this trouble. Anydischarge, or bleeding between periodsmay be an indication of someserious trouble, such as cancer, andnews of such a condition is best conveyedto your doctor at an earlydate."After Dr. Wright had discussed thecommon illnesses, given their symptoms,and suggestions for treatmenthe told the members of the YoungMothers' Club how to treat emergenciesuntil the doctor could be secured."There are three questions whichare wise to keep in mind when youare suddenly called upon to treat emergencies,"Dr. Wright said. "Thefirst thing you want to ascertain iswhether or not the patient is breathing.If the patient is not breathingeverything else must be disregardeduntil the breathing is brought back,or until the doctor pronounces thepatientdead."Artificial respiration, which I willtake up in detail later, is the meansused for restoring breathing ina livingperson. T'he most common causes

July, 1930 The Health Bulletin 21for the stoppage of breathing in aliving person are: drowning, gas poisoningand electricshock."Is the patient bleeding dangerously?is the second question you wantto keep in mind when a person is seriouslysick or injured. If the patient isbleeding, the hemorrhage must bestopped before any other treatmentis given, or he may bleed to death."Sometimes in cases of serious injurythe patient may still be in aplace where his life is still being endangered,if so move the patient immediately,otherwise it is best not toattempt the moving of the patientyourself, but to wait until the doctorarrives and orders his removal."Cut off clothing if it stands inthe way of an examination to discoverthe extent of injuries. Don't let theskin become chilled. If there is stoppageof breath immediately begin usingartificial respiration. If there isserious bleeding, check the flow ofblood before doing anything else.Dr. Wright then took up an interestingexplanation of artificial respiration,which is the means of restoringbreathing to a living body. Whateverthe cause for the stoppage ofbreathing, usually drowning, gas poisoning,or electric shock, Dr. Wrightsaid, the treatment was essentiallythe same. Artificial respiration consistsin forcing the patient's chest toimitate the movements of ordinarybreathing, and is known as the PronePressure Method of Dr. Schaefer."Feel in the patient's mouth," thedoctor said, "and remove any obstruction,such as tobacco, or falseteeth. If the mouth is closed make noeffort to pry it loose. This can beattended to later. The main object isto begin artificial respiration movementsas early as possible."The position in which the patientis placed to begin receiving the artificialrespiration treatment is important.Lay the patient on his belly, onearm extended directly overhead, hisother arm bent at the elbow, and handand forearm well away from face.The face is turned outward and restingflat on floor or ground, so thathis nose and mouth are free forbreathing."The patient in position, the personwho is to do the work of restoringnatural breathing, kneels, straddlingthe patient's thighs with the kneesplaced about midway between thepatient's hip-bones and his kneejoints. Next, place the palms of thehands on the small of the patient'sback with the fingers resting on hisribs, the littlefinger just touching thelowest rib, with the thumb and fingersin a natural position, and the tipsof the fingers just out of sight."With arms held straight, swingthe body forward slowly from thewaist so that its weight is graduallybrought to bear upon the patient. Theshoulder should be directly over theheel of the hand at the end of thethe forward swing. The operatorshould not bend the elbows. This operationtakes about two seconds."Now immediately swing the bodybackward so as to remove the pressureupon the patient completely."Wait two seconds, then repeat theswing forward. In this way the doublemovement of compression and releaseare to be repeated deliberately twelveto fifteen times a minute, a completerespiration in four or five seconds."Artificial respiration is to be continuedwithout interruption, untilnatural breathing is restored, if necessaryfour hours or longer, or untila physician declares the patient isdead."Any tight clothing about the patient'sneck, chest or waist is to beloosened as soon as the artificialrespiration is started, but the personwho isdoing the work of restoringthe patient's breathing is not tostop to do this. Another person looses

22 The Health Bulletin Juhj, 1930the clothing. It is especially importantto keep the patient warm, anddon't give any liquids by mouth untilthe patient is fully conscious."When the patient revives keep himlying down to avoid strain on theheart. If by the time the patient hasrevived the doctor has not arrivedgive some stimulant, such as a teaspoonfulof aromatic spirits of ammoniain a small glass of water or adrink of hot coffee or tea, and I wantto repeat again, keep the patientwarm."It is best to carry resuscitation onin a safe place as near as possible tothe place where the patient was overcome.Don't move him until he isbreathing naturally, and them movehim, if possible, only in a prone condition.If weather conditions, or anyother conditions make necessary themoving of the patient before he isbreathing normally, carry the resuscitationoperations on while he is beingmoved."Brief returns of natural respirationare not a sufficient reason forstopping the resuscitation work. Aftera temporary recovei'y of respirationthe patient will frequently stopbreathing again. The patient is to bewatched carefully after normalbreathing has returned, and if hestops breathing artificial respirationis to be again resorted to at once."Before normal breathing has beenestablished it may be necessary tochange the operator. Make thischange without losing the rhythm ofrespiration, which is a double movementof compression and release repeateddeliberately twelve to fifteentimes a minute, and a complete respirationin four or five seconds."Oxygen-carbon dioxide inhalersare sometimes available. Municipalfire departments, safety departmentsof big corporations, and hospitals usuallyare equipped with inhalers toaid insecuring the return of respira-This fine little fourteen months oldGuilford County girl lives on RouteNo. 1 from Greensboro. Her mothersays she is a "Fresh air, sunshine,balanced, diet baby who has neverbeen sick." She had toxin-antitoxin ateight months, vaccination againstsmallpox and typhoid fever later.tion to a living body. If an inhaler issent for do not wait for it to arrive,but begin artificial respiration bythe method I have just described toyou, immediately. When it arrives donot stop artificial respiration. Havean assistant apply the mask of theinhaler, fitting it closely over the patient'snose with the lower part placedwell down over his chin, takingcare to avoid leakage."Keep the inhaler on the patientfor about half an hour or until he isfully conscious or can speak and whenspoken to, can answer intelligently.The inhaler doesn't make the patientbreathe. Use artificial respiration withthe inhaler in place on the patient untilhe breathes naturally; then lethim continue to bi'eathe naturallythrough the inhaler some minutes. Hemay stop breathing, so observe himclosely."After his explanation of the methodof artificial respiration, Dr. Wrightnext told the members of the Mothers'Club what the signs of shock are:Dr. Wright said that in most seriousaccidents and even in trivial ones acertain degree of what is known as"surgical shock" was likely to bepresent. "Surgical shock," he explain-|

July, 1930 The Health Bulletin 23ed, was due to a depression of thenervous system, which results directlyin failure of the blood vesselsto maintain proper distribution ofthe blood supply.He gave as the signs of shock: paleskin, blue lips and nails; cold moistbody; a weak and rapid pulse; stuporand possible unconsciousness; andpossible vomiting or hiccoughs.Unless there is serious bleeding,shock is the first thing to be treatedin an emergency, Dr. Wright said. Intreating shock the first thing to dois to refrain from talking of thewound, and keep the patient fromlooking at his wound. Send for thedoctor, and proceed to give emergencyrelief by placing the injured personflat upon his back with the headsomwhat lower than the body, if possible.Next, keep the patient warm.Blankets, heavy clothing, hot waterbottles, hot bricks or stones are allmeans of keeping the patient warm,but hot water bottles, bricks andstones are not to be placed too nearthe patient, or they might burn theskin. Under the covers massage thelegs and arms, working toward thebody.Aromatic spirits of ammonia arean aid in recovery, and the patientmay be given half a teaspoonful ofaromatic spirits of ammonia in hotwater when he is able to swallow.Such hot drinks as tea, coffee, milkor bi-oth are also aids to recovery.Unconsciousness, or fainting, Dr.Wright stated, might be caused byany number of things. If possible, hesaid, it was best to try to discoverthe cause of the unconsciousness, andthen give the special treatment required.If the cause of the fainting isnot easy to determine, place the unconsciousperson in a reclining positionwith nothing under his head ifpale, and with a pillow under his headif his face should happen to be red.In fits, or convulsions the patientis to be kept as quiet as possible,and protected from injuring himself.It is also wise to place something inhis mouth, possibly a stick, to preventtongue biting, and send for adoctor."A badly injured person," Dr.Wright said, "is to be moved onlywhen it is absolutely necessary, andwhen he is carried do it with thegreatest gentleness without jarring.Carry severely sick or injured personslying down on some kind of a stretcher.One way of carrying a patient athome, when no stretcher is available,is to place the patient in a strongkitchen chair. One person takes holdof the front legs of the chair, theother of its back, then tilt the chairback so the patient is partly lyingdown, and carry him in that way."At this point the doctor stated thathe had talked as long as his allottedtime upon the subject of "First Aidin the Home." He said he would stilllike to take up the subject of injuries,both those where the skin wasand was not broken, foreign bodies inthe eyes, ears, nose and throat, injuriesfrom fire, heat exhaustion andheat-stroke, electric shocks and burns,poisons and some cautions for preventinghome accidents, but that hewas afraid that if he did so at thismeeting he would unnecessarily tirethe club members.A motion was then passed by themembers of the Young Mothers' Clubto invite Dr. Wright to be presentat their first August meeting, tocomplete his talk on first aid subjectsthat he had not covered duringhis talk at the July meeting.The reporter from the Crafton Heraldvolunteered to be present at thismeeting also, and report the doctor'stalk fully for her paper, as she saidshe felt the doctor's talks were ofvalue and interest to all of the mothersin Crafton, and that her paper

24 The Health Bulletin July, 1930was glad to print complete reportsof the doctor's talks.The Crafton Herald reporter's accountof Dr. Wright's talk to themembers of the Young Mothers' Clubof Crafton, at their August meetingwill appear in the August number ofThe Health Bulletin.NO OLD AGE DEAD LINE HEREByEdward J.WickerFrank Glenn, veteran linotypeoperator with the News and Observer,is celebrating his 65th birthday, andfellow workers say that his "string"is as long as the best of them, despitehis age. Frank is evidently tryingto explode the theory that a man isthrough when he reaches the age of40. He has been a faithful workeron this paper ever since the firstpaper was published with JosephusDaniels as editor and publisher. Contraryto all rules, Frank Glenn wastold last week that as long as he livedhe had a job, and that from now onhe was only to work when he felt likeit, the only requirement being that hemust see that a sub covered hismachine during his absence, and thatthe pay envelope would remain thesame— work or no work. It isgratifying to make this report, whenso many men much younger are beingthrown into the discard. If therewere more employers of labor of thistype this old world would be a muchbetter place in which to live, and themen would always render the bestsei'vice of which they are capable.Having worked with Frank in the oldhand-set days, when the oil lamp wasthe best possible light for 12 to 15hour day on a morning newspaper, weknow his many good qualities, and extendto him congratulations and bestwishes for many more years of usefulness.^—TheUnion Herald.HEALTH ACTIVITIES IN INDUSTRY*ByE. S. Thompson, M. D.Industrialmedicine and surgery isa new specialty in this state. It dealswith the human maintenance problemin industry. For many years our modernindustrial concerns have regulai-lyemployed experts to study their expensiveand complicated machines, inorder to preserve their mechanismand obtain their maximum efficiency.The human machine, the most complicatedof all, has been sadly neglected.Company surgeons have been employedfor a long time but their dutiesrarely extended beyond the repair ofinjuries for which the company wasliable under the old common law, orthe workman's compensation law. Thenew specialty of industrial medicinenot only furnishes adequate medicaland surgical care when necessary, butincludes all measures bearing upon thehealth, welfare and working abilityof employees; so that now medicalsupervision of the employee's healthhas become an essential part of theorganization of many of our progressiveindustries. The modern employeriIhis paper was read at the Health Officers Meeting at Pinehurst, April 281930. Dr. Thompson is a member of the medical staff of the R. J. ReynoldsTobacco Company of Winston-Salem.

JuUj, 1930 The Health Bulletin 25has come to realize that the humanmachine pays a large return on theinvestment in its upkeep, and the efficiencyof its whole organization isin exact proportion to the health ofitsemployees.Physical health is man's greatestasset; and as this is true individually,it must be true collectively, thereforethe capitalizing of it should becomea real factor in all industries. The resultof a well organized industrialmedical department should be asbeneficial to the employer as to theemployee.To the employee it means morehealthful and better working conditions,which stimulate production andincrease wages. It helps prevent discontentand labor unrest. It meansbetter home conditions, for whichthe plant furnishes a stimulus, andsets an example. It prevents causesof disease, accidents, and loss ofworking power. It discovers diseasein itsearly stages and makes possibleits rapid and certain cure. It treatsaccidents early and prevents infectionsand consequent loss of time andsuffering. It prevents overwork, controlscontagious diseases, and reducesthe hazards of occupation.To the employer it means a largerfinancial return, the extent of whichit is hard to estimate. It increasesthe efficiency of the human machine,cuts down absenteeism, decreases laborturn-over and tends to build agood will between employer and employee.The amount of illness in any organizationdepends to a large extent uponthe type of industry and efficiencyof its medical department. In spiteof the remarkable development ofmedical science in the last few decades,illness and defectiveness stillpersist, caused in part, at least bypreventable and avoidable conditions.Most of the misfortunes of life, ofpoverty, of broken homes, etc., arecaused by disease—thecommon misfortuneof all. Sickness and the costof it, a problem so large as to touchevery individual life and so importantin our industrial as well as our politicallife, to be a matter of real concernto every one who has risen tothe level of citizenship. Those of youwho have read the reports of the"Committee on the cost of medicalcare" in the United States will seethat the fields are still white unto theharvest. The average individual betweenthe cradle and the grave spendsone-foi-tieth of his time in bed becauseof some incapacitating illness. Theaverage worker loses two per cent ofhis time, or a fraction over sevendays per year, due to some disablingdisease. Hence approximately onefortiethof our population is continuallyincapacitated to earn a livelihood.Eeliable studies indicate thatwhere there is one person sick thereare at least two physically impairedto the extent of from tenper cent tofifty per cent of their efficiency. Estimatingthat there are about thirtysixmillion wage earners in the UnitedStates, you can easily see the bignessof this problem.The cost of sickness, doctors,nurses, hospitals, loss of income, lossof production, etc., plays a vital partin the economic status of our wholepopulation. The annual expense tothe people of the United States formedical services is estimated to be inexcess of two and one-half billiondollars, or about twenty dollars percapita, or approximately one hundreddollars per family. The average wageearner's family, according to studiesconducted by the United States Bureauof Labor Statistics, pays $60.39per year for medical service. If weconsider the loss from decreased wageearning due to sickness and accidents,plus the expense of medicalservice, you will easily see how theentire program of sickness is one that

26 The Health Bulletin July, 1930the industries must reckon with; becausethe two major problems thatare facing them today are: (1) Costof production, (2) Purchasing powerof the people. Just what part eachorganization would play in helpingsolve this tremendous problem of sicknessand associated misfoi-tunes, isone that must be worked out to fillthe needs of its own environment.Each separate industry has its ownpeculiar hazards, and yet all have acommon problem^that of a wageearner sick and unable to produce.As a further proof of the need of"Health Activities In Industry," anact of our last legislature made it obligatoryon industries that they takeinto consideration the accidents whichtheir employees sustain while in theperformance of their duties, as practicallyevery other state in the unionhas done. For every accident sustainedsufficient to cause lossof time forover seven days must be paid for inpart by the employer plus all medicalexpense. Hence all modern industriesshould be continually takingstockof their human machines, sothat they may function as nearly onehundred per cent as possible.The R. J. Reynolds Tobacco Companyhas maintained an organizedmedical department since 1919 and itswork has justified its existence, untiltoday it is almost an indispensablepart of this large and efficient organization.Our equipment includes ageneral dispensary or plant hospitalin connection with the employmentdepartment, located on the groundfloor of our new nineteen story officebuilding. In here we have dressingrooms for applicants, examiningroom, accident room, operating room,x-ray department, two wards, and afully equipped dental department withone doctor, one dentist, and twonurses, all on duty all working hoursof the factories. In each factory wehave a first aid station with a grad-This little piece of humanity atfour months of age and weighing lessthan seven pounds, and in bad physicalcondition, was found by a DurhamHealth Department nurse. Thebaby ivas brought to one of the severalexcellent baby clinics sponsoredby the Durham Health Department.The child was placed on a definitediet of dry lactic acid milk, furnishedby one of the big commercial _companies.Orange and tomato juice ofcourse tvas added. Five months laterthis photograph was made. H indicatesa yiormal healthy baby.uate nurse in each. We have tensuch stations.The examination of applicants forwork includes first an interview bythe employment department, then aroutine physical examination. Thedoctor here has a double duty; (1)that of weeding out the unfit, (2)classifying the others according tothe work they are able to do. Hereit is essential that the doctor knowthe kind of work each applicant isexpected to do. We divide all applicantsinto three classes: Class A,those able to work anywhere they areneeded; Class B, those able to do limitedwork, due to some physical con-

July, 1930 The Health Bulletin 27Pdition; Class C, those rejected forwork, due to some contagious or infectiousdisease, or some deformitywhich incapacitates from work. Eachapplicant employed is required to bevaccinated for smallpox unless heshows evidence of immunity. Afterexamination applicants are returnedto the employment department andsent to the different factories.If an employee gets hurt whileworking, he or she is required tovisit the first aid station immediatelyand receive treatment for the injury,however trivial. If the injury is ofa more serious nature, the patient issent at once to the plant dispensary.No patient is kept over night, so thatif the patient is not able to return fortreatment, he or she is sent to one ofthe hospitals in the city. One of themost important points in keeping injuredpeople from losing time is totreat the injury immediately. Thisprevents infection and makes the injuredbetter satisfied. TTie fact thatyou have medical service availablenear the injured's place of work stimulatesa wholesome relationship betweenemployer and employee.Medical cases go through the sameroutine as accident cases. If an employeegets sick while on the job, heis sent to the first aid station and thenurse in turn sends him to the doctorif necessary. Our examination isas nearly complete as we are ablegive in an office visit, including laboratorywork, x-ray, dental, etc. If theemployee is too sick to return towork, he is advised of his conditionand sent home with the instructionsto get his family doctor, if the conditiondoes not clear up as it should.Before any sick employee is allowedto go home he is required to visit themedical department and is excusedby that department, with a note totohis or her foreman stating why andprobable time he will be out. Any employeewho is out from work on accountof sickness for more than threedays is required to visit the medicaldepartment before returning to work.In this way we prevent many sickcases from coming back to work beforethey are well. Any employee whois a member of our group insuranceplan and is out sick more than sevendays is eligible to draw compensationfor lost time. The amount receivedwill be in proportion to the salarysick employee made while at work.If he dies, the beneficiary will be paidimmediately upon proof of death asum in proportion to the income ofthe insured during his last year ofwork.The dental department is open allday during working hours and anyone in need of dental work gets apermit from his or her foreman andis then sent to the dental office byappointment. Here we do prophylaxis,extractions, and a moderate amountof filling. This department does itsmost good in the education of thepeople as to the needs of dental care,and is looked upon very favorably bythe dental profession in our city.The follovi'ing from last year's reportwill give you some idea of theamount of work done:No. of patients for extractions..^ 2,538No. of patients for prophylaxis.... 427No. of patients for fillings 363Total number of patients 3,328A record is kept of each employeefrom the time he enters our employ.In this folder is the record of his physicalexamination on entrance, the accidentshe has had, times he visitedthe medical department and causeany any other information that weknow that pertains to his health.These folders are filed in the medicaloffice and are worked each week intoa live and dead file, so that we haveat all time easy access to as completea medical record as we are ableto get on each employee.

28 The Health Bulletin July, 1930The magnitude of the work we aredoing in the industry of R. J. ReynoldsTobacco Company will be seenfrom the following summary of ourlast year's report:No. of medical cases treated-.-32,836No. of accident and surgicalcases ....31,530Total number of cases 64,366This is an average of about sixvisits per employee during the year.exclusive of return visits for dressingsin surgical cases.In addition we gave complete immunizingtreatment for:1. Typhoid to 3,102 people2. Smallpox to 1,119Industrial leaders today have cometo realize that the greatness of theirindustries is not measured by thenumber of their machines nor the sizeof their buildings but by the humanrelationship that exists therein."SANITATION APPROVED"A NEW SIGN ALONG THE HIGHWAYS TOINSURE HEALTH PROTECTIONWATCH FOR ITBy H. E. Miller, Chief EngineerNorth Carolina State Board of HealthA general public exasperation hasbeen expressed in speech and in printon the subject of the desecration ofthe landscape by unsightly billboardsand signs along thehighways. NorthCarolina's budding consciousness of"things beautiful," that has been sotenderly fostered and nourished bythe patrons of art, has been enragedand well nigh blighted by the growingspectacle.Reprehensible as this tendency maybe, in it's most ghastly aspect, itcannot compare as a spectre of hideousnesswith the dragon that rearshimself in the path of the thousandsof our citizens diligently burning gasat five cents per. to help the highwaycommission build more good roads.This new dragon was conceived whenthe first service station operatorbrought in a bucket of water fromhis polluted open dug well in thedays of clincher tires when "crankytin lizzies" were cranked, to enticethe perspiring motorist to stop fora drink of water and incidently afew gallons of gasoline. The slimypup (if baby dragons be called pups)liked the prospects, and so when itdawned on a neighboring service stationoperator that comfort station facilitiesmight attract more customers,the dragon winked his eye in fondanticipation. True enough, the comfortstation toilets soon became foul,illkept, and a model in the abuse ofsanitation. Our dragon winked hisother eye and reflected "life heresurely looks promising."Now that the ribbons of concretehave rapidly penetrated the "lostprovinces," climbed the mountainsand straddled the swamps, therehave blossomed out countless servicestations seeking by every possible deviceto attract the passing traveler.Many of these stations are a creditto themselves and the community,but sad to relate, among the attractionsoffered by many are drinkingwater from hundreds of open wellsteeming with germs of disease. Socalledcomfort stations, that generallyshould be more appropriatelytermed "incubators of disease guaranteedto transmit infection to the

July, 1930 The Health Bulletin 29traveler and the community alike,"which compete with one another inrepulsiveness. Eating establishmentsand lunch counters reeking w ith filth,teeming with flies and presided overby persons incapacitated for a moreactive life because of venereal diseaseor the last stages of tuberculosisare not unusual delicacies with whichthe traveler is tempted. Who knowswhich are safe and which are unsafeunless some public agency separatesthe "sheep from the goats." This iswhat the "SANITATION APPROV-ED" sign is designed to do.Meanwhile our dragon has waxedfat and strong in his slimy grandeur,and has burst forth in all his glorywith blazing eyes and fire shootingfrom his mighty nostrils to the skies,and behold his name—VACATIONTYPHOID!The principles of sanitation in thecontrol of the environment are sowell established and their significanceso well recognized that every selfrespectingmunicipality has long agoprovided a safe water supply, and inmost instances rigid sanitary controlof the milk supply and food handlingare practiced. Up to ten or fifteenyears ago these measures provided areasonably safe sanitary control ofthe environment of persons living inmunicipalities, whose environmentwas then bounded by the corporatelimits. In the past few years, however,the limits of environment havebeen extended beyond the corporatelimits beyond the mile zone of policejurisdiction, even unto the most distantpoint on every highway in everydirection, bounded only by the distancethe family pocket book will permitthe family flivver to travel.When Mr. Average Citizen used totake his vacation he took a train. TTiedrinking water and the food servedon the train are regulated by theFederal government under the interstatequarantine regulations. His des-This young gentleman is four yearsold and a valued citizen of the goodtown of Wilson. He is evidently heginninghis summer vacation withoutphysical handicaps.tination was perhaps some mountaincity or town or some accessible seasideresort, where again there wassome measure of protection affordedthrough the sanitary regulation andcontrol of the environment by the CityGovernments having jurisdiction. Ordinarilyhe took his trunk along andstayed at his selected destination untilreturning home again by train.Thus the traveler or vacationist lived,traveled, sojourned and returned,always in surroundings and undercircumstances where he enjoyed theprotection of the ever watchful healthagencies of City, State and Nation.What happens today? T'he sameMr. Average Citizen loads mammaand the children in the flivver andoff they go for a vacation. They stopnowhere longer than over night. To

30 The Health Bulletin July, 1930save time they get their lunch atsome lunch counter along the roadwhile the tank is being filled with gasor the crank case is being drained.They drink water obtained from allmanner of sources and surroundings,some good and some bad. They eatfood in all kinds of places served byany and every body, supervised byno piiblic agency. They give the babymilk, often produced and handled infilth, by persons reeking with disease.Wliat happens ? What promi^^ to bea happy lark, turns out to lie a'ieatastrophe.First the baby nearly dieswith diarrhea, then about a week afterreturning home papa and Johnnydevelop typhoid fever. Papa finallypulls through after a serious illness,and the loss of three months timefrom his work or business. Johnny,poor boy! has passed on to his reward.Mamma is broken physicallyand in spirit from the ordeal andpapa has to mortgage the old homeplace to pay off the doctor, the undertaker,and to keep the wolf fi'omthe door due to his loss of earningsduring sickness. VACATION TY-PHOID! — See how our dragonthrives!Through effectively administeredmeasures of water supply and foodcontrol, and the sanitary disposal ofexcreta and sewage, by means ofsanitary privies and modern plumbing,epidemics of typhoid fever havevirtually become a thing of the past,and the occurrence of typhoid feverin our municipalities has become exceedinglyrare.Health officers investigating suchcases as do occur, however, usuallyfind themselves up against a stonewall in the midst of the investigationbecause it usually develops that thepatient was away on a vacation orhad returned from a trip about 10days or two weeks before being takensick. TTie determination of probablecause is thus impossible, becausewho can recall what he ate or when,where he stopped for a drink of wateror where he drank a glass of milk.The investigator can only repoi'tVA-CATION TYPHOID. How many otherpersons have been exposed to diseaseat the same source ? The riddle willnever be solved.Our older readers may recall sometwenty years or more ago that itwas not a rare occurrence for one orboth of the bridal couple returningfrom a honeymoon to develop typhoidfever shortly thereafter. The NiagaraFalls City water supply w^as at thattime heavily polluted, and is estimatedby health authorities to have beenthe specific cause of thousands ofdeaths from typhoid fever in cities,hamlets, and farm homes all over theUnited States. The actual havoc thatwas wrought, is another riddle thatnever will be solved. We have herein North Carolina "Little Niagaras"all along our highways.The State Board of Health is andhas been fully avi'are of the menacethat exists, but it has neither the authoritynor the facilities to regulate,or to require improvements. It has,therefore, undertaken a voluntaryprogram^me of improved, roadside |sanitation. It is believed that therears enough conscientious personsmanaging these roadside accommodationsto secure a response that willcause a material improvement. It isbelieved further that the travelingpublic will sufficiently appreciate theprotection afforded, so that enterprisingservice station operators willfind it a paying proposition to respondto and further this voluntaryclean up."SANITATION APPROVED"As a partial measure of correctionthe following programme is outlined:A.ny establishment, located on astate highway, and off"ering any orall the following accommodations,drinking water, comfort station,

July, 1930 The Health Bulletin 31meals, or lodging will be permittedto display a sign "SANITATIONAPPROVED by the STATE BOARDOF HEALTH" after having compliedwith certain conditions. The signs, ofmetal, will be issued in pairs andmay be displayed in conspicuousplaces visible from both directions.Each pair of signs have a serial number.Before receiving the signs themanagement must first have compliedwith the detailed sanitary requirementsfor each of the above accommodationsoffered.Letters have been sent to all ofthe fifteen thousand service stationsin the state explaining the "SANITA-TION APPROVED" programme, andforwarding copies of the sanitaryregulations, and a blank form formaking application for a sanitary inspectionwhich will be made free ofcharge. Upon receipt of an applicationfor inspection, a state or countysanitary inspector will make the inspectionas promptly possible.When upon inspection the stationis found to be in FULL compliancewith the sanitary regulations uhemanagement may be authorized todisplay "SANITATION APPROVED"sign upon signing three copies of th**"SANITATION APPROVED" signcontract and upon payment of onedollar to defray the cost of makingthe signs.The inspector forwards three signedcopies of the contract and the dollar,along with his report recommendingthe station for display of thesign. The State Board of Health completesthe execution of the contractand returns two copies together witha pair of "SANITATION APPROVed"signs bearing serial number. Eachof the two contracts are required tobe posted in conspicuous places designatedby the State Board of Health,(see "SANITATION APPROVED"sign contract on page 32).TTiis contract is required to be postedin conspicuous places in order thatthe traveler may know what "SANI-TATION APPROVED" stands for.will be observed also that the publicis invited to notify the State Boardof Health of any violations observed.This is an undertaking "for the people"and it is hoped that the publicwill show sufficient interest make italso "of the people and BY the people."All that is necessary in makinga report is to address a post cardor letter to the State Board of Healthstating the serial number of "SAN-ITATION APPROVED" sign, andthe condition observed. All reportsare considered confidential.Local health agencies are showinga keen interest and a ready cooperation,which is essential to the successof this undertaking. The CarolinaMotor Club has extended the fullestcooperation and is aiding the programmein every possible way. Manycomplaints as to existing conditionshave been made by motorists to theState Board of Health. That agencyis now prosecuting a programme ofcorrection. It's success depends largelyon the interest you, Mr. Motorist,demonstrate, both as to helping desciplinethe careless stations, and givingyour patronage as a recognitionand to encourage those who seek toprotect you.If you will look for the "SANITA-TION APPROVED" sign when seekinga service station and report violations,our dragon VACATION TY-PHOID will find the atmosphere andthe environment not so much to hisliking and will finally slink off andmake his slimy ghastly way to somemore auspicious clime, removing hisshameful presence from our midst.If you have a romantic urge, if youever aspired to be a "dragon killer"look for and patronize those servicestations that display the "SANITA-TION APPROVED" sign, and yourambition will be gratified.It

!32 The Health Bulletin July, 1930"SANITATION APPROVED"SIGN AGREEMENTFOR THE PERIOD JULY 1, 1930 to JUNE 30, 1931In consideration for the privilege to display "SANITATION APPROVED"Sign Noupon the following described premises,wherein the following service and accommodations to the traveling publicwhich have been approved by the State Board of Health, are offeredhas paid the North Carolina State Board ofHealth $1.00 (one dollar) to defray cost of making sign hereby acknowledged,and agrees:1. To comply at all times with all the sanitary requirements of the StateBoard of Health pertaining to the above cited services.2. To notify the State Board of Health of any changes in conditions orsurroundings affecting or likely to impair the sanitary status of the aboveenumerated services.3. To notify the State Board of Health of any contemplated additionalservices, either comfort station, drinking water, meals, or lodging.4. To refrain from the inauguration of any such additional service nothereinbefore cited and approved.as the5. To keep this contract posted at all times in such conspicuous placesState Board of Health shall designate.6. That this contract and the "Sanitation Approved" sign shall not betransferred, either as to management or premises.7. That upon failure to correct any violations of the sanitary requirementscited in Item 1, upon the repeated violation of such requirements, orupon the violation of provisions of Item 5 or 6, he surrenders his right to thepossession and privilege of display of the "Sanitation Approved" sign, andagrees to deliver the same to any official representative of the State Board ofHdalth upon request, or to mail said sign to the State Board of Health wilhin24 hours after receipt of written instructions from the State Board of Healthto that effect.8. That said sign is and shall remain the property of the North CarolinaState Board of Health and that upon failure to surrender or mail the sameas specified in Item 7 any right to again display a "Sanitation Approved" signis hereby forfeited for a period of 6 months.Signed Signed ._._ .._Health Officer of . __ North Carolina State Board of Health— _Bureau of Sanitary Engineering and InspectionDate _ _. Signed ByThe public is requested to report to the State Board of Health with "SAN-ITATION APPROVED" sign number, any insanitary conditions observedupon these premises. All reports are considered entirely confidential and willbe promptly investigated.

.m.PutlisKedbn TAn.^°KJ/\CAK9LI/iA STATE. E)

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTHA. J. CROWELL, M.D., President CharlotteCYRUS THOMPSON, M.D JacksonvilleTHOMAS E. ANDERSON, M.D StatesvilleE. J. TUCKER, D.D.S RoxboroD. A. STANTON, M.D High PointJAMES P. STOWE, Ph.G CharlotteJOHN B. WRIGHT, M.D RaleighL. E. McDANIEL, M.D JacksonCHARLES C. ORR. M.D ^ AshevilleEXECUTIVE STAFFCHAS. O'H. LAUGHINGHOUSE, M.D.,Secretary and State Health Officer.RONALD B. WILSON, Assistant to the Secretary.H. A. TAYLOR, M.D., Deputy State Health Officer.C. A. SHORE, M.D., Director State Laboratory of Hygiene.G. M. COOPER, M.D., Director Bureau of Health Education.H. E. MILLER, C.E., Chief of Bureau of Engineering and Inspection.ERNEST A. BRANCH, D.D.S. , Director of Oral Hygiene.D. A. DEES, M.D., Field Assistant in County Health Work.FREE HEALTH LITERATUREThe State Board of Health publishes monthly The Health Bulletin,which will be sent free to any citizen requesting it. The Board also hasavailable for distribution without charge special literature on the followingsubjects. Ask for any in which you may be interested.Adenoids and TonsilsCancerConstipationCo'dsClean-up PlacardsChickenpoxDiphtheriaDon't Spit PlacardsEyesFliesFly PlacardsGerman MeaslesHookworm DiseaseInfantile ParalysisInfluenzaMalariaMeaslesPellagraPublic Health LawsPrenatal CareSanitary PriviesScarlet FeverSmallpoxTeethTuberculosisTuberculosis PlacardsTyphoid FeverTyphoid PlacardsVenereal DiseasesWater SuppliesWhooping CoughSPECIAL LITERATURE ON MATERNITY AND INFANCYThe following special literature on the subjects listed below will besent free to any citizen of the State on request to the State Board ofHealth, Raleigh, N. C:Prenatal Care (by Mrs. Max West)"Our Babies"Prenatal Letters (series of ninemonthly letters)Minimum Standards of Prenatal CareWhat Builds Babies?Breast FeedingSunlight for BabiesHints to North Carolina Mothers WhoWant Better BabiesTable of Heij/hts and WeightsThe Runabouts in the House of Health(pamphlet for children from 2 to 6years of age).Baby's daily Time Cards: Under 5months; 5 to 6 months; 7, 8, and 9months; 10, 11, and 12 months; 1year to 19 montlis; 19 months to 2years.Diet Lists: 9 to 12 months; 12 to 15months; 15 to 24 months; 2 to 3years; 3 to 6 years.Board's Budget Reduced 3Pellagra: Eradication from ItsHome in Italy Now Spreadingover North (^aroUina 4CONTENTSPAGEPAGE'First Aid" in the Home againInterests Members of theYoung Mother's Club 11

-II.!-J .J- ' ^ IVOL. XLV. AUGUST, 1930 NO. 8M ! IL. J X 1 ' '' II-- .L I IBOARD'S BUDGET REDUCEDt V • . •TTie State Board of Health is put- inspection to Schools to basis of suptinginto effect reductions in its bud- ervising dentist and six field dentistsget equivalent to thirty per cent for and seven field nurses for school inthebiennium of 1929-31 in accordance spection work required by law; dropwithdirections from the Director of ping the director of the Bureau ofthe Budget. The executive committee Vital Statistics, Dr. F. M. Register,of the Board, Dr. A. J. Crowell of and two clerks in that division, andCharlotte, Dr. Cyrus Thompson of temporarily discontinuing the BureauJacksonville, and Dr. Thos. E. Ander- of Health Education as a separateson of Statesville, in special session unit, combining Vital Statistics andon Saturday, June 28, approved the Health Education under the directionproposed budget cuts for the several of Dr. G. M. Cooper and reducingdivisions of the Board and ordered the Health Bulletin from 32 to 16that they be made immediately effec- pages monthly; abolishing the Lifelive. Extension division; reducing the Lab-The reductions to be made are dras- oratory of Hygiene appropriation bytic and will require considerable 20%; reducing State Aid to countiesdoubling-up on the part of the per- by a total of $16,715; reducing apsonnelretained to carry on what is propriation for Orthopedic clinics andconsidered absolute minimum essen- Cancer Control by 20% each; effecttialsof the Board's program for the ing a net saving of $5,000 in Miscelprotectionand promotion of the laneous Items allotted to the severalState's public health. The reductions divisions of the Board.affect every division of the Board and^j^^ program of reductions by diinclude:reduction in field personnelvisions consists of the following items:of Bureau of Sanitary Engineeringand Inspection totaling S13,967; drop- Administration $10,840ping the director. Dr. A. B. McCrearj% Engineering and Inspection.- 13,967and one clerk in Bureau of Epidem- Epidemiology 7,420iology with duty of field epidemiolog- Maternity and Infancy 21,563ical investigations transferred to Medical Inspection of Schools., 11,331other personnel; discontinuing all Vital Statistics 7,700field activities of Bureau of Maternity Health Education 700and Infancy by not replacing the di- Life Extension 9,100rector, Dr. George Collins, deceased, Laboratory of Hygiene 13,600and by dropping the supervising nurse State Aid to Counties 16,715and four field nurses, retaining two Orthopedic Clinics 2,000office clerks to maintain correspond- Cancer Control 500ence course with expectant mothers Miscellaneous Items 5,000and other essential duties; i-educingfield personnel of Bureau of Medical $120,433

that every possible service will be,rendered within our budgetary limijThe Health BulletinAugust, 19SO"The executive committee of theBoard considered most carefully thereductions necessary to be made inthe Board's budget," says Dr. CharlesO'H. Laughinghouse. "We were facedwith the problem of finding 20% ofthe appropriation to the Board forthe fiscal year 1930-31, amounting to199,294. In addition the Board forthe fiscal year 1929-30 had failed inthe sum of ?21,000 to effect a savingof 10 9

August, 1930The Health Bulletintuberculosis in this country. It is understoodthat the Italians do not nowregard hospitalization as having hadany great bentficial effect towardthe eradication of the disease.Some thirty years ago the diseasewas of such extent in Italy that thegovernment appropriated a certainamount of money to go to each patientsuffering from the disease. Thedisease at that time was almost exclusivelyamong the poverty strickenpopulation of the Italian empire. Theappropriation of money for the patientsserved two purposes. It first enabledthe Italian health authoritiesto obtain accurate reports of the extentof the disease, and, second, itenabled the people to provide themselveswith better food, housing, andmedical care. The experience of theRoumanian government has been similarto that of Italy.Following the appearance of pellagrain North Carolina in 1907, thedisease soon became very widespreadin certain sections of the State. Althoughit was long before the vitalstatistics law of the State was enacted,it is thought now that the diseasewas numerous, and known to havecaused a great number of deaths, inmany sections of the piedmont regionof North Carolina and of what mightbe called the western part of thecoastal plain section. The disease neverhas been as prevalent in the extremecoastal counties where the peoplehave always lived largely onfresh vegetables of their own raising,including both kinds of potatoes, andwhere they have consumed the yearround an abundance of sea food. Untilrecently the mountain sections ofNorth Carolina have hardly knownthe presence of the disease. However,during the last four or five yearsthere has been an increasing spreadthroughout some of the mountaincounties which had never hithertoknown the presence of the disease.Even today some of the more prosperousdairying counties like Wataugaand Catawba are reporting asmall number of cases of the disease,as compared with many of the othermountain counties.Experience In ItalyAs already stated, Italy has beenregarded as the endemic home of pellagra,although its incidence at itshighest peak was not as widespreadand as serious as the situation whichexists in North Carolina today. Asthe people of this State are rightnow confronted with the problem asnever before, and as intelligent action,cooperaiton, organization, andlevel-headed, common sense effortsmust be effected, if the disease is tobe controlled, there can be no moreimportant study for the people ofNorth Carolina than a considerationright here of the methods that haveproved successful in Italy.Sonietime last March the writervvTote a friend of his who has beenspending the past year in the LondonSchool of Tropical Medicine and whowas sent to Italy for a six weeksstudy of tropical diseases in thatcountx-y as a part of his course, andasked him for any first hand informationwhich he could get on the ground,and v/hich would be of benefit to themedical pi-ofession and to the peopleof North Carolina in dealing with thisfearful disease. Dr. B. E. Washbuili,the name of our friend, respondedwith some first hand information ofinterest and importance to us. Underdate of March 28, Dr. Washburnwrote to us as follows: "I have justreturned from a trip into Sicily andfind that a summary of the Reportof the Pellagra Commission has beenmade and translation mailed to you."This report was summarized andtranslated by Dr. L. W. Hackett, directorof the Rockefeller Foundationof the International Health Boardfor Italy. We feel greatly indebted toDr. Hackett and to Dr. Washburn for

The Health Bulletin August, 1930this interesting translation, whichwe publish below. The first summarywe quote is contained in a letter fromDr. Hackett at Rome to a SouthernState health officer who had writtenhim for information a short timeearlier. Dr. Hackett's letter follows:"The only official measure ever takenin Italy with the specific intentionof preventing pellagra was the passageof a law appointing committeesof experts in the ports of entry(especially Venice and Genoa) to examinethe state of preservation ofcorn arriving from abroad. The cornmust be examined twice—first whenit is unloaded and secondly when itis discharged from the silos or elevatorsin which it is stored at the port.Spoiled or unripe corn can be usedonly for fermentation. Examinationof the corn produced in the countryis compulsory only in localities inwhich pellagra cases exist, but hasnever been carried out in practice.However this corn bears only a smallproportion to the total quantity consumed."The disease has diminished veryrapidly in Italy since 1881, in whichyear there were reported 104.067cases. In 1926 there were 1,446 cases.The figures may be relied upon sincethe families of pellagra cases receivecertain benefits from Government.In 1926 there were only 103new cases reported during the year.The deaths from pellagra per millionpopulation are shown for certainyears in the following tables.Year Deaths perMillion1898 125 1908 491899 119 1909 421900 117 1910 381901 94 1911 351902 73 1914 201903 81 1918 181904 72 1923 41905 71 1925 31906 61"It is evident that some constantlyacting and very efficient cause hasbeen extinguishing pellagra at an everaccelerated rate in Italy, just asis occurring with tuberculosis in theUnited States. There is no authoritativePublic Health official or scientistin Italy who believes that this hasbeen due to the condemnation ofmouldy corn at the ports of entry. Astanding commission appointed tostudy pellagra (abolished a few yearsago) supported the theory that somedietary deficiency was the predominatingfactor in the etiology of thedisease, and this is in accord withscientific opinion in general in Italy.Lustig and Franchetti, reporting atthe request of the above commissionon the eff'ect of the World War on theepidemiology of pellagra, came to theconclusion that in localities where thewar produced a deterioration in thediet there was an aggravation in thepellagra situation, and where on theother hand the war improved the nutritionof the people there was adiminution in the number and severityof the cases."In Italy pellagra is confined tothe northernmost region including thevalley of the Po and the sub-Alpineprovinces. Here the introduction ofscienitfic agriculture in the last thirtyyears, with rotation of crops andincrease in cattle and in dairying industries,together with the cultivationof rice on a large scale, hasgi'eatly improved the economic conditionsand standard of living and thediversification of diet of the inhabitants.The prohibition of the sale ofspoiled or unripe corn has thus beenonly one factor in a very complicatedsituation."Finally it may be mentioned thatwhereas the law went into effect onthe 5th of November, 1903, the deathrate from pellagra had begun to fallrapidly as early as 1898. From 125deaths per million inhabitants in 1918,the mortality had fallen to 73 in1902—a decrease of 42%. In the five

August, 1930The Health Bulletinyears following the passage of thelaw the deaths diminished from 73to 49 per million population—a decreaseof 33 9f. Pellagra has been decreasingat about the same rate eversince."The opinion of the Commission(as expressed by Lustig) was thatthe law of 1903 went into effect whenpellagra was in its period of maximumdecrease, and that it has probablyhad little to do with the subsequentdisappearance of the disease asa factor in the public health of Italy."In conclusion I might say thatItalian opinion cannot be said evenremotely to support the theory thatthe etiological factor in pellagra isconnected with the spoiling of Indiancorn, since even the Public HealthDepartment which caused the passageof the law of 1903 has never claimedany credit for the subsequent regressionof the disease."The significant and serious considerationstothe people of North Carolinain the statement of the foregoingfigures by Dr. Hackett is the factthat in 1898 the highest figures reportedto the government of Italywas 125 deaths per 1,000,000 of population.The seriousness of our situationis that in 1929, according to ourpopulation, we had more than threetimes as many deaths in an equalpopulation.As the reader may have just notedin Dr. Hackett's letter, the spoiledcorn theory as the cause of pellagrawas exploded.A letter from Dr. Washburn latersets forth the following pertinent commentsfor our consideration here inNorth Carolina:"None seems to know exactly whathas been the cause of the disappearanceof pellagra from Italy. Theyare all agreed, I think, that hospitalizationhad nothing to do with it. Thefacts of the disappearance of the diseaseare about as follows. It beganto lessen about 1900 when the numberof deaths per million was 117, andthere has been a rapid decreasesinceuntil at present it is not an importantcause of death—in 1925 the numberof deaths per million was only 3.Pellagra is found only in the northernpart of the country—this is the districtwhich formerly imported agreat deal of com and this formed thechief diet of the people. About 1895to 1900 a movement was started toinduce the people to raise rice; it wasthought that this would largely takethe place of corn as an article of foodand would enable the country to getalong without importing so muchcorn. The purpose of this movementwas economic as, at that time, thecountry was not too prosperous andmuch money had to be sent away annuallyto purchase corn."This movement was successful andrice is now grown in most parts ofnorthern Italy. A number of importantand unforseen things also happenedin connection with the movement.It was found that rice not only proveda good substitute for corn, but alsothat it was a highly profitable -crop.More than this, rice is hard on thesoil and in order to grow rice profitablyit became necessary to practicecrop rotation—plant rice one year andpeas and beans the next. This led tocattle raising in order to use up thepea crop profitably. And cattle raisingincreased the dairy industries andled to the use of milk, butter, andcheese;as well as beans and peas, asregular articles of diet. And with thechange of diet brought about in thisway, pellagra has decreased steadily."It will be noted from the foregoingthat many theories of pellagra haveheld sway for the past two hundredyears, many theories of origin ofcause and concerning treatment. Itwill be noted from Dr. Washburn'sletter that the rotation of 'crops, thespread of the dairying industry, togetherwith the incident prosperitybrought about in that way, and espe-

'The Health Bulletin August, 1930cially with the radical change in thediet of the Italian population affected,have been the chief causes of eradicatingpellagra from the Italian empire.It might be well for the readerto stop here and compare the nearlyone thousand deaths which we had inNorth Carolina in 1929 in a populationof three million people with thefewer than forty deaths occurring inItaly in the same year in a populationof forty million people.I may conclude that opinion is byno means unanimous in Italy as to justwhat are the agencies which have operatedtoward such a radical declinein the number of people having pellagrain that country, but we wouldlike to especially call attention to onesignificant statement in Dr. Hackett'ssummary, to-wit, where the war produceda deterioration in the diet,there was an aggravation in the pellagrasituation, and where, on theother hand, the war improved the nutritionof the people, there was a diminutionin the number and the severityof the cases. That observationcould be literally applied to the experienceof North Carolina in the warand in the painful years of deflationalong about 1920 and '22 followingthe war, as well as to the presentperiod of economic depression in thisState.What Causes PellagraITie most frequent question aboutthis disease is, What causes it? Thereare many things about the diseaseand its prevalence which have notyet been satisfactorily explained. Wecan safely repeat what has almostbecome a trite saying, that the UnitedStates Public Health Service, and possiblya majority of the practicing physiciansof the South, agrees that itis a deficiency disease, and that it iscaused by 'the eating of a one-sideddiet. Dr. Edward Wood used to urgeeverj'^ physician in dealing with suspectedcases of pellagra to make theutmost endeavor to trace the completepersonal dietary history of sueh a pa-tient back as far as it was possible togo. A lai'ge number of physicians believethat there is some special parasiticentity responsible for the disease.A large number of physiciansbelieve that it is caused by a fungoidgrowth. This coincides with theold Italian theory of spoiled corn.Today any physician would be afool to conclude that the last chapterabout pellagra has been written.There are too many things which areas yet not satisfactorily explained toencourage a dogmatic opinion aboutthe cause of pellagra. All the agenciesin the world, however, seem to be inentire agreement on the point thata general balanced diet consumed everyday from early childhood on tothe end of life acts as a definite preventiveof pellagra. It cannot be saidin this country to be strictly a diseaseof poverty, but it is generallyassociated with poverty. One reasonfor that is that there are so manymore poor people than any otherclass that almost any disease is foundto be more prevalent among the poorerclasses than others. The diseasecan be said to be associated with aone-sided diet, be it in the homes ofthe wealthy or of the extremely poor.Some one has cited the case of a verywealthj' old lady who insisted oneating nothing except biscuit in sweetenedcoffee, and in about one yearcontracted pellagra and died. Naturallyevery person confining themselvesto such an eccentric diet would notdevelop pellagra every time, nor doesevery person exposed to tuberculosisinfection contract that disease everytime on exposure to it. There is probablyless known about genuine immunityto disease than about any otherfactor having a vital part in medicalscience.Having made the foregoing declaration,let it be repeated again that allauthorities, so-called authorities, andwould-be authorities in the world

August, 1930The Health Bulletinagree that a well balanced diet preventspellagra. It not only will preventit this year, but next year, andthe year after, and on throughoutlife. But the diet must be eaten. Itmust comprise the necessary vitaminelements. The food must be preparedproperly, and sufficient attentionmust be devoted to such matters asrest, sleep, and freedom from worry.The Governor's Live-At-HomeProgramOne of the most pertinent moves toobtain popular acceptation inauguratedin the State is Governor Gardner'slive-at-home program. Basically, thisprogram is that every family in theState who can possibly have a gardenshould possess one. If any person isinclined to doubt that this programhas been honestly attempted in NorthCarolina this year, let such a personsimply step out of his back door andlook around his neighborhood. Wehave never seen such evidence of attentionto gardens, and such successaccompanying the efforts, as we haveobserved wherever we have been inNorth Carolina this year. Naturallythere are hundreds and thousands ofpeople who do not have thefacilitiesfor a garden, but a majority of thepeople can have and do have a vegetablegarden this year. Vegetablesalone will not prevent pellagra, andwill not support any family, but vegetablescontribute a large proportionof the food necessary to maintainhealth.The Dairying IndustryIt is coming to be more and morerealized that the prevention of pelnlagra is dependent upon a larger percapita consumption of milk and dairyproducts. There could be no more importantobjective for the people ofNorth Carolina than to undertake todouble the per capita production cfmilk and butter, and to double theper capita consumption of the same»in Noz-th Carolina for 1931. It is essentialthat production cost be loweredas far as possible in order to affordthe dairy producer a reasonableliving profit and at the same timemake for a reduction of the prices ofmilk and butter to the consumers inthe cities and smaller towns. Thisespecially applies to the nearly halfmillion industrial workers in thisState.From a splendid paper presentedto the North Carolina Medical Societyat its Pinehurst meeting by Dr. FrederickR. I'aylor of High Point, wequote the following paragraph:"The purpose of this paper is not toadvance any positive and final theoryof the etiology of pellagra, but toemphasize the importance of facingthe fact that we have much yet tolearn about this very complex subject.I am fully convinced that any theorieswe may hold at present should beheld only tentatively, and that furtherresearch is urgently needed beforewe can consider the etiology of pellagraas finally established."Whatever may be the flaws inGoldberger's theory that make manyof us unable to accept it in toto, hehas made a very important step inthe development of the prophylaxisand treatment of the disease. The importanceof an adequate diet cani.otbe overestimated at this time, even ifit will not cure all cases. Goldbergerhas outlined what he considers anadequate menu for the pellagrin whichconsists of foods readily obtained inthe southern United States."Some Recommendations for Meetingthe Existing Situation1st. To repeat again, there is unanimousagreement that food of theright sort, in abundance, properlyprepared and consumed every day byevery person, will prevent pellagra.2nd. For the many thousands ofcases of pellagra in existence in theState at the present time, medicalsupervision is essentially important,as it is absolutely necessary for themorale of the patient to have the

'10 The Health Bulletin August, 1930stimulating advice and encouragementof a physician.3rd. In what way may those twoprovisions be carried out in order toreach every individual vitally concernedat present in the State?4th. To repeat again, a first classyear round garden is essential whereit is possible to achieve, meaning anabundance of fresh vegetables everyday in the year. To this vegetablediet milk and butter in abundance,fresh eggs, lean meat and fruitsshould be added—fruits either driedor canned when fresh fruit is notavailable. Yet many people cannothave a garden and are not financiallyable to purchase the necessary foodsand to secure the necessary medicaltreatment. Therefore this writer recommendsthe following methods:1st. The organization of a specialpellagra commission in every county,this commission to be composed of acommittee from the County MedicalSociety, a member of which shouldact as chairman; a committee fromthe women's clubs acting with thecounty health officer, the county physician,the home demonstration agent,the county welfare officer, and thecounty superintendent of schools; thiscommittee to endeavor in every possiblemanner to immediately ascertainthe name and residence of everyperson in the county suffering fromthe disease in any stage, but makingan especial effort to locate those inthe incipient stages, and who have notyet consulted a physician; this pellagracommission to undertake tofollow methods already under way inat least two or three counties in makingan effort to provide and distributevegetables and milk to all the pellagrinsin the county where such patientsare net already in position tosecure the necessary food.2nd. A reliable product of driedbrewers' yeast, in tablespoonful dosesthree times a day, to be made availableto every person suspected ofhaving pellagra, this in addition tothe essential foods outlined3rd.above.The commission should make avaliant effort to see that every suchpatient, as soon as the diagnosis ofpellagra is made, has the personalcare of a physician. There are manyassociated conditions and many symptomswhich arise, which can only bedealt with by a competent physician.Precious time should not be lost inrelying on advertised quack remediesfor this serious condition.4th. The plan already under way inone county, of providing a temporaryor emergency hospital utilizing tents,somewhat on the plan of the boyscouts and the campfire girls camps,in which expert supervision of cookingis to be carried on by the homedemonstration agent, the medical careassumed by the county physician, orthe county health officer, and propernursing care by a responsible nursingagency, for a period of about sixweeks at a time, so that indigent patientsand the family attendant whenpossible may have the opportunity oflearning first hand how to cook, feed,nurse, and care for a pellagrous patient,especially in the early stages, sothat this information can be put intopractical effect when returning homefrom the instruction course at thecamp is practical and should be triedwherever possible. Such facilities, ofcourse, are only practicable to carryout in the spring and summer months,but at least three or four diff'erentgroups of patients may be taught duringthis time how to combat the disease.We simply issue the foregoing as asuggestion, and we hope that it willbe undertaken in many counties, ifnot this year, then early next spring,and continue until such time as pellagrashall be found in North Carolinano more.

August, 1930 The Health Bulletin 11"FIRST AID" IN THE HOME AGAIN INTERESTSMEMBERS OF THE YOUNG MOTHER'S CLUBBySUDIE E.PYATTThere was a pleasant hum of voicesL in the sitting-room of Mrs. Paul* Helms' home, as the ten members ofthe Young Mothers Club of Ci'aftonwith the young woman reporter fromthe Grafton Herald sat talking of thehappenings of the community whilethey were waiting for Dr. MortonWright to come to continue his addresson "First Aid in the Home" tothe members of the club, that he hadstarted when he had talked to theyoung mothers at their July meeting."I tried to remember everything Dr.Wright told us last month, about theonly safe way to use household remedies,when to call the doctor, treatmentsfor common illnesses, treatingemergencies until the doctor comesand how to restore respiration," Mrs.Ernest Swarts said."Yes, I certainly needed what hesaid about the medicine cabinet," putin Mrs. Kenneth Hill, the wife of theleading druggist of Grafton. "I wenthome after Dr. Wright's talk, andhad a medicine cabinet cleaning. WhenI finished Kenneth said it looked asif I had been trying to set up a rivaldrug store. My medicine cabinet is amodel now. Just the articles the docfttor recommended for the medicinecabinet, and a few others that wem have found indispensable."If I had not heard Dr. Wright'stalk I suppose I would have faintedmyself the day that Theodore's sisterfainted, when she received the newsof her sweetheart's death," Mrs. TheodoreRudolph gravely asserted: "Butremembering what Dr. Wright said,I was not afraid at all. Eliza, my goodcolored maid, and I, lifted her, andplaced her on the couch in the sitting-room.Her face was pale, so Iplaced her head flat on the couch, andtold Eliza to telephone for Dr. Wright.Luckily he was in and in a few minutesafter he arrived Marian was allright."The pleasant buzz of conversationin the living-room died down as thedoor-bell rang, and Mrs. Helms welcomedthe doctor of whom they hadall been speaking."Good afternoon, everybody," thedoctor greeted the room full of youngwomen who had been waiting for hisarrival. "And now, young ladies, as Iam a bit late, I am going to plungeimmediately into my talk. Last monthI told you that for this meeting Iwould touch on the subject of injurieswhere the skin was and was notbroken, foreign bodies in the eyes,ears, nose and throat, injuries fromfire,heat exhaustion and heat stroke,electric shocks and burns, poisons,and some precautions the housewifecan use to prevent home accidents."I have just returned from thehome of a farmer out in Hopewelltownship, whose young son suffereda fracture of one of the bones in hisforearm this morning. A fracture,which means broken bones, is usuallyspoken of as an injury where the skinis not broken. Dislocations, sprains,and strains are all injuries where theskin is not as a general rule broken.If the skin should be broken thereisa wound as well as a fracture, dislocation,strain, sprain, or bruise tobe dealt with."In cases where an injured personhas had a blow or a fall, and complainsof severe pain at the point,and there is tenderness, swelling anddeformity present, a broken bone ispractically always indicated."If any or all of the indications of

12 The Health Bulletin August, 1930a broken bone are present do not attemptto set the bone yourself, butsend for the doctor. While you arewaiting for the doctor you may, however,make every effort to keep thebroken bone from moving, for if thelimb is allowed to move the sharpknife-like edges of the broken bonewill do further injury to the softtissue surrounding it, and cause greatpain."If you are expecting the doctorsoon place the injui'ed limb in a comfortableposition on a pillow andleave it there."Only as a last resort should a personwho is not a physician attempt toset a broken bone. The broken boneis set by putting it in the same positionit had before the break occurred,and holding it in that position bythe aid of splints. Any rigid thing mayserve as a splint, such as a flat board.Wide splints are better than narrowones, and they should extend wellabove and below the point of injury."In fractures of the skull the patientusually seems stunned and is unconscious.T'here is nothing that thelayman should attempt to do for aperson suffering from a fracture ofthe skull. Send for a doctor at once."A dislocated bone is out of placeat a joint, and it looks out of placewhen compared with the same jointon the other side of the body. Theaverage person should not attempt totreat a dislocation any more than afracture. The best thing to do is putthe patient in a comfortable position,treat shock if it is present, and makethe patient comfortable."Doctor, is a sprain similar to adislocation?" Mrs. Harold Zieglerquestioned."In one respect, and that is it issometimes quite as painful as a dislocation,but it is dissimilar to the dislocationin that no bones are brokenor out of place. A sprain is generallydue to a sudden turn or pull, whichtears the cords that attach the musclesto the bones. Even if the sprainis only a slight one it is best to sendfor the doctor. If the pain is considerable,by all means have the doctor.It may be a fracture."The simplest treatment for sprainsis to place the injured joint at rest,and apply cloths wrung out of verycold water for sometime. Prevent motionof the joint, and if the injury isto be a lower limb do not allow thepatient towalk."Strains are similar tosprains, butthe muscles are the parts injured.Rest and light massage will give relief.'Everyone knows how a bruiselooks. Cloths wrung out of cold waterand applied to the bruise will bringrelief. Treat a black eye with coldwater applications as you would abruise on any other part of the body.A black eye may become serious, soit is best to take it to a doctor fortreatment."Injuries when the skin is brokenwe call wounds. The greatest dangersfrom wounds are homorrhage andinfection. Hemorrhage in mostwounds is slight, the danger of infectionfrom wounds, even in the smallestpin pricks, is always present."If infection develops from a woundthe patient may be very seriouslysick."In preventing infection from awound nothing but a piece of cleanwhite cloth, which has been sterilized,should be allowed to touch the wound.You should have on hand in yourmedicine cabinet dressings of sterilizedgauze. If not boil a piece of cleancloth in water for 10 minutes to sterilizeit."Use pure soap and clean waterthat has been boiled and allowed tocool to a comfortable temperature tocleanse the wound. After cleansingthe wound paint the surrounding fleshwith tincture of iodine and apply a

August, 1930 The Health Bulletin 13Ifew drops to wound if the wound issmall. Mercurochrome is less irrritatingthan iodine and may be used insteadof iodine. After cleansing andplacing the antiseptic on the woundcover it with a sterilized dressingthat has come in contact with no otherobject and secure the dressing withadhesive tape. If the wound is morethan a very small flesh wound, consulta doctor at the earliest possiblemoment."The danger of tetanus poisoning,or lockpaw, is greatest in small, deepwounds caused by rusty nails, wireand splinters. Do not try to sucksuch a wound, and poke iodine downin the wound. It will only make itworse. Take the person sufferingfrom the wound to the doctor as soonas possible to prevent the developmentof tetanus."In hemorrhage from wounds thereare three kinds of bleeding: Fromthe fine capillaries blood comes slowly,and is usually stopped by pressureof dressings. Blood comes slowly frommost of the veins. If the arteries remainopen, much blood may be lost ina short time. It is most difficult tostop bleeding in the veins of the neckand legs. Put the fingers on the bleedingpoint, and press vein to stopbleeding. Keep the fingers on thebleeding point until the doctor arrives."Send for a doctor at once in caseof bleeding from varicose veins. Beforethe doctor comes lay the patientflat on his back and raise the leg sokleg,git is at right angles with the body.Remove all bands from around theand place a dressing of sterilizedgauze firmly in place over the bleedingpart."Bleeding from the arteries is mostserious. If the stream of blood is asmall one the pressure of the dressing* may stop it. If a great deal of bloodis being lost a tourniquet will stopthe bleeding. Pressure on a small arhtery from which blood is being lostwillstop the flow of blood. The pressureis first made with the fingers,then with a tourniquet. The tourniquetshould be quickly and tightlyapplied. It should be placed betweenthe wound and the body and appliedtight enough to stop all hemorrhage.Any kind of strong cord or strip willmake a tourniquet."In cases of bleeding from the arteries,just as in cases of bleedingfrom other wounds, send for a doctorimmediately, but do all that you cansafely do to stop, or check the bleedingbefore the doctor arrives.""Oliver and Harry cause me moreconcern getting foreign bodies intheir eyes, ears, nose and throat thanany other one thing," Mrs. TheodoreRudolph gave Dr. Wright an openingfor the next part of his talk, whichwas on foreign bodies becoming insome way lodged in the four organsof the body that were most likely tobecome the lodging place of such objects."Splinters, pieces of clothing andgravel, which are most likely to becomelodged in the orifices of thebody, carry germs with them whichcause infection. If foreign bodies getinto the eyes do not rub them. Closethe eyes and the tears may be sufficientto wash out the object. A washwith clean water, or with boracicacid solution will sometimes removethe object when the tears fail."Next, you may pull the upper liddown over the lower, seizing the uppereyelid as you do so. If the objectis on the lower lid, pull the liddown gently, and remove the speckwith a clean handkerchief. If the objectis on the lower lid, pull the lidto remove the object yourself, but goto the doctor, and take the personwho is suffering with the foreignbody to the doctor. A soft cloth, soakedin cold water and placed on theeye will aid in lessening the pain. If

14 The Health Bulletin August, 1930there is any injury to the eyeball sendfor the doctor."When children place objects, asthey sometimes do, in their ears, donot attempt to remove them yourself.You may do serious permanent injuryto the delicate ear drum. Send for adoctor, or take the child to a doctor,and have the doctor remove the object.Should an insect get into theear place a few drops of sweet oilthe ear, but do not attempt to removethe insect yourself. When thedoctor comes he can remove the insectand wash out the ear to remove theoil."Do not try to remove wax fromthe ears by the use of sharp instruments.This practice is likely to resultin making: a hole in the ear drum,and causing partial or total deafness.A wash with warm water used in asmall rubber ear syringe is a goodway to remove accumulations of wax."Should foreign bodies becomelodged in the throat of a child, or anadult, it is best to send for a doctor.You may safely hold the childinupsidedown by the heels and slap him vigorouslyon the back in the hope thatthe object may fall out. In doing thisbe careful that the child is not heldby the heels too long, and that theslaps are not too vigorous. If thismethod fails better wait for the doctorbefore making any more effortsto remove the object."A child who has swallowed somearticle like a coin or a safety pinshould be fed mashed potatoes, andbread or bananas as much as possiblefor a day or two, and the stools shouldbe watched until the object has passedfrom the body. If not passed thedoctor will advise an X-ray examination."Objects inthe nose of a child maybe removed by the mother, or nurse,if the object can be seen, and only alittle force is necessary to remove it."How to handle a fire and how totreat burns and scalds and sunburnare the most important things toknow in first aid measures about fire.When fire starts in a room promptlyclose all windows and doors to preventa draft. Give the alarm at once.A rug or a blanket will often smothera fire. If a person catches on fire layhim on the floor and smother theflames with a heavy coat, blanket, orrug, if no water is handy."All burns, covering more than aminute surface of the body, requirea physician. Until the physiciancomes, stop the pain by protecting theburn from the air, A paste made ofbaking soda and water may be usedto keep the air away from the burn.Put this substance on the burned part,and cover with a piece of cloth, orbandage. All burns should be consideredas infected wounds."Sunburn is like any other mildburn and should be treated accordingly,baking soda and water, andcold cream are all good helps to lessenthe discomfort."Heat exhaustion,and heat stroke,or sunstroke are two separate conditionsand requii'e different treatment.In both cases it is better to send for \a doctor at once, particularly in heatstroke, or sun stroke, which is generallymore severe than heat exhaustion."For heat exhaustion, usually restin a cool place is sufficient. For sun- istroke loosen tight clothing, and removeto a cool place is sufficient. Toreduce the temperature, which is alwayshigh in sunstroke, cool sponges,cool sprays, ice-water packs and icemay be necessary."The first problem to handle intreating a person suffering fromelectric shock is to remove the personfrom contact with the live wire,and to do this without the personaiding the one already shocked, frombecoming shocked. If near the powei*house the current may be turned off

'heaters,August, 1930 The Health Bulletin 15Pand the person safely removed fromcontact with the wire. If there is noway to have the current turned offthe rescuer may grasp the shockedperson's coat if it is dry and drag himaway from the wire in that way, or adry wooden stick may be used to removethe wire. While doing thesethings the rescuer should stand on adry board, or a folded dry coat ornewspapers, and should wrap hishands in several thicknesses of drycloth or newspapers."Treat electric burns as any otherburns would be treated, when the patienthas recovered from shock. Inany electric burn send for a doctor."Doctor, what are the most frequentcauses of poisoning?" Mrs.Lester Patterson questioned the doctor,after the members of the clubhad made comments on shock andburns."Gas poisoning, chemical poisonsfrom foods and drugs, poisoning fromanimals, snakebite, dog bites, insectstings, and ivy poisoning are themost frequent sources of poisoning,which are dangerous to the averagechild or adult," the doctor answeredMrs. Patterson's query."The most common cause of gaspoisoning is illuminating gas," hewent on. "Carbon monoxide gas,present in illuminating gas, and inthe exhaust from automobiles is oneof the most serious causes of fatalitiesfrom gas poisoning. An automobilein a small closed garage willsoon fill the air with enough carbonmonoxide to kill a man, if the engineis running. An engine of an automobileshould never be run in a smallgarage without as many windowsand doors as possible being open inthe garage."Gas cook stoves, leaky gas tubes,loose gas fixtures and valves, furnacegas, gas heating stoves, and watershould all be properly adjusted,and connected to flues."Treatment of the person sufferingfrom gas poisoning consists in gettinghim into the open air, and sendingfor a doctor."Very sudden and severe illnesseswith vomiting and bad crampingpains, are indications of poisoning.Send for the doctor at once, and ifyou can let him know what poisonhas been taken so he may bring theproper antidote. In cases of poisoningvomiting is the best means ofridding the system of the poison,Mustai'd and water, salt and water,or syrup of ipecac are all good emetics.Do not worry about the dose,but give it promptly."Do not delay in cases of snakebite.Get at the wound by cutting theclothing if necessary, and immediatelytie the limb between the wound andthe heart with a tourniquet made of ahandkerchief, piece of cloth, or anythingavailable. Send for a doctor. Asmall, clean pen-knife, which hasbeen held in a flame may be usedto enlarge the wound causing it tobleed freely. After the tourniquet hasbeen on for fifteen or twenty minutesit must be loosened gradually. Afterloosening for a minute tie the tourniquetfor a few minutes, and againloosen and so on. In the meantime getthedoctor."Dog bitesin which hydrophobia issuspected, should be cauterized deeplywith fuming nitric acid as soon aspossible. The Pasteur treatmentshould later be given the patient. Theservices of a good physician shouldbe procured at once."Many people kill a dog as soon asit bites a person. It is best not to dothis, but catch the dog and take himto your county health officer. Thehealth officer will observe the dog forfourteen days, and ifno symptoms ofrabies develop he is probably notmad, and there is no danger of rabiesinfection from the wound."If the dog is thought to be mad

16 The Health Bulletin August, 1930when it bites the person and if ithas been killed, cut the dog's headoff, pack it in ice, and send it immediatelyby express to the StateLaboratory of Hygiene, Raleigh, N. C."Ammonia water, and cloths wet incold water, are the methods of treatinginsect stings."Wash off the parts poisoned withpoison ivy with soap and water, andput on a dressing kept soaked in acold soda bicarbonate solution. Consultyour doctor."As a conclusion to my two talksto the Young Mothers Club of CraftonI want to again impress uponyou," Dr. Wright asserted, "the importanceof immediately getting intouch with a doctor, if this is at allpossible in cases of accidents. Thesetalks on first aid have not been madewith the idea of supplying you withinformation that may be used to savethe trouble of calling a doctor. Theinformation has been given you withthe hope that it will enable you toknow how to treat emergencies untilthe doctor comes, and to recognizesymptoms of the common diseases,and the nature of injuries to the body,the safe removal of foreign bodiesfrom the orifices of the body, thehandling and treatment of fire andburns, and the treatment of differentkinds of poisonnig."As she goes about her daily workin the home, the house-mother cando much toprevent accidents by takinga few precautions."These precautions I want to leavewith you as the conclusion to mytalks."First, rocking chairs and piecesof furniture that do not stand firmlyon the floor are not substitutes for afirm, strong ladder."Second, well lighted stairs, keptcleared of articles will save membersof the family from many accidents."Third, sand and ashes sprinkledon icy steps will do likevdse."Fourth, many a mother's heartwould be saved the anguish of seeingher little child suffering from thepain of scalding burns if kettles ofhot liquid are kept out of the reachof tiny hands and arms, and if childrenare never allowed to carry them."Fifth, a metal container formatches will save children from burns,and often the family from having tosuffer expensive fire losses."Sixth, naphtha and gasoline shouldnot be used in the house."Seventh, keep clothing away froma hot stove."Eighth, do not touch broken orsagging wires. It may be a live wire."Ninth, defective electric fixturesshould be left for the electrician tohandle."Tenth, gas burners turned low andleft burning all night may be thecause of another 'asphyxiated by gas'case."Eleventh, look well to the tubesof your gas stoves, and make surethat they do not leak, and that allfixtures and valves are tight."Twelfth, a gas heater that is notconnected with a flue should not beused in a closed room."TTiirteenth, label bottles containingpoisonous drugs, 'Poison,' andkeep them locked away. Read thelabel before taking the contents ofany bottle."Fourteenth, boards containingnails, tin cans, or any sharp-edgedobject should never be left lyingabout."And now members of the YoungMothers Club of Grafton, this concludesmy talks on first aid in thehome," Dr. Wright said as he gavethe last of the fourteen precautions."It has been a real pleasure to meetwith you, and to give the talks thatI have to the club. If at any time inthe future I can help the YoungMothers Club in any way, please donot hesite to call upon me."

Putli5\edbM Tn-^N^Ejna^^LmiK state. D^ARDs^AmLTnThi5 DuUelirxwillbe 5er\lfree to ars^ citizen of "the Stole upoi\ request. |Entered as second-class matter at postofflce at Raleigh, N. C, under Act of July 16,1894. Published monthly at the office of the Secretary of the Board, Raleigh, N. C.VOL. XLV. SEPTEMBER, 1930 NO. 9Preschool Clinic, Long School, Concord, N. C, May, 1930,Caharms County.

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTHA. J. CROWELL, M.D., President CharlotteCYRUS THOMPSON, M.D JacksonvilleTHOMAS E. ANDERSON, M.D StatesvilleE. J. TUCKER, D.D.S RoxboroD. A. STANTON, M.D High PointJAMES P. STOWB, Ph.G CharlotteJOHN B. WRIGHT, M.D RaleighL. E. McDANIBL, M.D JacksonCHARLES C. ORR. M.D AshevilleEXECUTIVE STAFFCHAS. O'H. LAUGHINGHOUSE, M.D., Secretary and State Health Officer.RONALD B. WILSON, Assistant to the Secretary.H. A. TAYLOR, M.D., Deputy State Health Officer.C. A. SHORE, M.D., Director State Laboratory of Hygiene.G. M. COOPER, M.D., Director Bureau of Health Education.H. E. MILLER, C.E., Chief of Bureau of Engineering and Inspection.ERNEST A. BRANCH, D.D.S., Director of Oral Hygiene.D. A. DEES, M.D., Field Assistant in County Health Work.FREE HEALTH LITERATUREThe State Board of Health publishes monthly The Health Bulletin,which will be sent free to any citizen requesting it. The Board also hasavailable for distribution without charge special literature on the followingsubjects. Ask for any in which you may be interested.Adenoids and TonsilsCancerConstipationColdsClean-up PlacardsChickenpoxDiphtheriaDon't Spit PlacardsEyesFliesFly PlacardsGerman MeaslesHookworm DiseaseInfantile ParalysisInfluenzaMalariaMeaslesPellagraPublic Health LawsPrenatal CareSanitary PriviesScarlet FeverSmallpoxTeethTuberculosisTuberculosis PlacardsTyphoid FeverTyphoid PlacardsVenereal Diseases"V\"ater SuppliesWhooping CoughSPECIAL LITERATURE ON MATERNITY AND INFANCYThe following special literature on the subjects listed below will besent free to any citizen of the State on request to the State Board ofHealth, Raleigh, N. C:Prenatal Care (by Mrs. Max West)"Our Babies"Prenatal Letters (series of ninemonthly letters)Minimum Standards of Prenatal CareWhat Builds Babies?Breast FeedingSunlight for BabiesHints to North Carolina Mothers WhoWant Better BabiesTable of Heights and WeightsThe Runabouts in the House of Health(pamphlet for children from 2 to 6years of age).Baby's dally Time Cards: Under 5months; 5 to 6 months; 7, S, and 9months; 10, 11, and 12 months; 1year to 19 months; 19 months to 2years.Diet Lists: 9 to 12 months; 12 to 15months; 15 to 24 months; 2 to 3years; 3 to 6 years.Laboratory Finds It Necessaryto Make a Small Charge forDiphtheria Toxin-Antitoxin..-. 3CONTENTSPAGEPAGESymposium on Child Health 3Everyday Practice Makes GoodHealth Habits for SchoolChildren 11

VOL. XLV SEPTEMBER, 1930 NO. 9LABORATORY FINDS IT NECESSARY TO MAKE A SMALLCHARGE FOR DIPHTHERIA TOXIN-ANTITOXINThe following letter, which Dr. C.A. Shore, director of the State Laboratoryof Hygiene, has recently issuedto the medical profession of NorthCarolina, will be of interest to mostof our readers of the Bulletin. Theletter is self-explanatory and needsno further comment from the editorof the Bulletin."To the Medical Profession of theState of"Dear Doctor:North Carolina."On account of the twenty per centcut in all appropriations for the year1930-1931, it has been found necessaryto discontinue the free distributionof diphtheria toxin-antitoxin."Beginning August 1, 1930, thisvaccine will be distributed only bysale—the 3cc \ials at twenty centseach and the lOcc vials at fifty centseach."We expect to be able to providethe toxin-antitoxin for all of the countycampaigns already arranged forwith the State Board of Health. Forlater campaigns it will be necessaryto buy the vaccine at the above price.In those counties where no funds areavailable it is hoped that they mayreimburse themselves by chargingtwenty cents to each person receivingthe vaccine."ITie laboratory regrets verj^ muchthis change in procedure as we believethat the State should encourageimmunization against diphtheria inevery possible way. The charge, however,is an absolute necessity and wehope, with this exception, to continuethe other services of the laboratory."Until August the first we will continueto distribute the vaccine withoutcharge, but the doctors are respectfullyrequested not to lay in asupply of free vaccine for vaccinationsto be started after that date.SYMPOSIUM ON CHILD HEALTHVery truly yours,C. A. SHORE."What Some Localities Are Doing For the Health of Their ChildrenBeginning on this page we are publishingsome very interesting reportsdescribing what some of the healthdepartments and schools have donefor the health of children during thepast year. It may not be quite so interestingto some people to talk aboutjobs that have been done as it wouldbe to enlarge on things in prospect. Infact, v.'e believe the average newspapereditor does not regard reports ofwork accomplished as even beingnews. What most of them want isspeculation on the future. We thereforetake pleasure in demonstratingagain that we are not much of aneditor by stubbornly insisting thatwe are not even interested in whatsomebody is "going to do." The reasonis because nine times out of ten it

The Health Bulletin September, 1930is never done. We are interested inand about the job that "has beendone." Do it and then talk about itis our platform. We ai-e publishingthese reports in our September issue,which is always our school number,because it will serve to sharply accentuatethe necessity for gettingschool children physically preparedfor school during the summer. It willalso stimulate other sections to makeplans right now for carrying out thesemeasures for young children earlynext spring.We are publishing these selecteditems from the sections mentioned becausethey sent their reports to theeditor of the Bulletin for his considerationat this time. Tliere are manyother counties and cities we feel surethat have carried out fine programsthis year but which have not been reportedto The Bulletin. To all suchwe cheerfully send our enthusiasticencouragement. We herewith presentsome of these reports in the order inwhich they came to us.Edgecombe Gets Operations DoneIn most of the counties of NorthCarolina the physicians cheerfully cooperatewith the health officer whenasked to do so. In counties Vvherethere are hospitals and operators ithas been easy for the health officerwho desired, to perfect arrangementsfor operations for school children andpre-school children, with such hospitalstaffs. While the physicians and hospitalsare willing to do all they canto help out, they cannot open theirdoors and offer their services at anyand all times and to any and everybody.It remains for the health officerto formulate the plans and to carryout the details of any arrangement ifit is to be successful. As an exampleof fine spirit and co-operation in thiskind of work the methods adopted byDr. R. E. Broadway, health officer ofEdgecombe, might well be emulated byother local health officers. Dr.Broadway first worked out his planand presented it at a meeting of theEdgecombe County Medical Societywith every member except one present.Dr. Broadway made it his businessto see the absent member andget his assent to what was done.Briefly described, the medical professionand the local hospitals atTarboro agreed to admit on two daysin each week to the hospital anychild expecting to enter school thefollowing fall, and any school childwho had not passed its 13th birthday,for tonsil operation. The fee to becharged was $15.00, which coveredmedical, surgical and hospital care.For any child financially unable topay anything a certificate from thecounty welfare officer was sufficientto secure free treatment. The periodwas limited to about two summermonths and specifically to school childrenand pre-school children, and, torepeat, to two days of each week.It is a practical, fair arrangementand one which assures an operationfor every child in the county needingit. It is hardly necessary to addthat an additional requirement wasthat the county health officer musthave previously examined the schoolchildren and the parents must havepromptly made application in writingfor the operation following Dr.Broadway's examination. It is a workingplan, as illustrated by a photographof one mother who had her sixchildren operated on under this arrangement.The work was successfullast year and the medical society approvedits continuance this year. Indescribing this enterprise it is apleasure to state that the Edgecombecounty health department has a sympatheticfriend and wise counselor inSuperintendent W. H. Pittman andthe county educational forces.Report of Cabarrus County Pre-School Clinics and Special HealthProject in One of the RuralSchools of That County.We know of no county in NorthCarolina that has been carrying onmore interesting developments of interestto health department workersduring the past year than Cabarrus.Dr. D. G. Caldwell, health officer ofthat county, was instrumental sometimeago in procuring subscriptionstotaling nine hundred dollars for athree months' extension of the StateBoard of Health dental clinics in thatcounty. The subscriptions were obtainedfrom a number of differentagencies in the county, and it wiUmean a great deal to the advancingcause of oral hygiene in that section.Dr. Caldwell has sent us a most interestingarticle describing a healthproject developed in one of the ruralconsolidated schools of CabarrusCounty this spring. The material wasprepared by Dr. Caldwell from the

Septe7nber, 1930The Health Bulletinteacher's written report of the project.It is so interesting that we herewithquote in full:"Through the awakened interest ofthe boys and girls, and under thefine guidance of the teacher, Mrs.W. L. Harris, an unusually completehealth project has been developed inthe Harfisburg School in CabarrusCounty this spring. The class whoseproject is described is a fourth gradein a rural consolidated school."Interest was aroused in the healthof the class and school bv reading'Boys and Girls of Wake-Up Town.'After this book was completed, severalothers were collected from varioussources, health pamphlets wereused, T'he Health Bulletin, and manyof the booklets from the State Boardof Health on the prevention and careof different diseases were read anddiscussed. The children were 'greatlyinterested in finding new material,and not only brought anything theycould find at home but borrowed fromfriends and neighbors whenever possible."Many other subjects were easilycorrelated with the health activity.Paragraph writing on such subjectsas 'The Cleanliness of Other Countries,''Good Health Habits,' etc.,readily found a place in the Englishlessons. The new vocabulary neededsent the children flocking to the dictionary,and many new words creptinto the spelling lessons."For about two weeks, the entirearithmetic period was devoted toproblems related to health."The drawing period was used inmaking health posters, and some verycreditable designs wei"e worked out."A study of the health and cleanlinessof vai'ious countries fitted intothe geography schedule, and Hollandand Japan served as shining examples.'"Civic pride was developed amongthe entire class. Bathing facilities inthe rural and city homes were studied,and a survey was made of the numberof homes having electric lightsand running water. The childrenlooked for and destroyed breedingplacesfor flies and mosquitoes.Homes and public buildings were observedto see which were cleanest. Aninterest was aroused in keeping theClean-up days were observed, and theclassroom and the school groundsclean and orderly. A student boardof health was organized, consistingof a doctor and a nurse who attendedto cuts or bruises received at school.walls, woodwork, blackboards andwindows were washed, the schoolgrounds were cleaned up, and flowerswere planted."The subject of play and exercisecalled for the arrangement of an idealplayground on the sand table. Smallmodels of see-saws, swings, slides,merry-go-rounds, etc., were made bythe children, and a small rock fishpool was constructed of putty andpebbles in an old pan. The interest inthis activity led to cleaning up asmall grove on the school groundsfor the playground for the elementarygrades. Here several bencheshave been built. The children themselveshave constructed a lily pooland have raised money and bought aslide. Other equipment will be addedas fast as possible."Another class activity was thewriting and presentation of a healthplay, 'A Sad Accident.'"But the outstanding classroom activityof the whole project was thehot lunch program, which has producedunusually gratifying results.The children were interested from thestart and their enthusiasm quickly enlistedthe cooperation of the parents.Many parents became as enthusiasticas the children when the merits of theplans were demonstrated."The equipment used was verysimple. The children brought cupsand spoons from home, and used anelectric hot plate for cooking. Alldishes and utensils were kept in acurtained cupboard and washed eachday before and after using. Hot cocomalt,vegetable soup, potato soup, potatoesand beans have been served.The children furnished practically allthe necessary ingredients for eachday's menu, rotating from time totime. After the program was oncewell started, the children were ableto make most of the plans, preparethe food and serve it. Duties of preparing,serving and cleaning wei'etaken by diff'erent children in turn."The benefits of this hot lunch program,have been two-fold. Every childin the class, with one exception, hasmade a substantial gain in weight. Aclassroom weight graph has demonstratedplainly the steady gain. Thegroup was weighed each month andinterest in the weighing has beenkeen."Also, this group has focussed theattention of the whole school on theadvantages of the hot lunch. A nurseexperienced in nutrition work wasasked to talk before the Harrisburg

The Health Bulletin September, 1930Community Club on the subject of thehot lunch. With the intei-est of theschool and community ai'oused, itseems probable that this little fourthgrade nutrition program may havebig results. Plans are being consideredfor serving the hot lunch throughthe whole school next year."Altogether, the results of thisproject have been all that could bedesired. It has proved to be a wellroundeddevelopment for the children.They know more about the laws ofhealth and their practical application:the members of the class have increasedin weight steadily; they havegained a knowledge of foods, theirpreparation and serving; their sociallife has shown great improvementthrough improvement of personal appearanceand eating habits; their civicknowledge and interest has beengreatly increased through study ofdesirable surroundings. The experiencegained in developing this projectshould be of much value to the childrenin the years to come."Cabarrus County conducted forseveral weeks last summer a preventoriumfor children who had reactedto the tuberculin test for tuberculosisand, upon examination, indicated thepresence of that disease. The workwas so successful that another similarperiod has been provided during thispresent summer. Dr. Caldwell alsosends us an interesting summai'y ofthe pre-school clinics held in CabarrusCounty this spring which we feel surewould be helpful and interesting toother sections of the State, and sowe close this summary with the excellentwork being done in CabarrusCounty by quoting from Dr. Caldwell'sreport:Report of Cabarrus County Pre-School Clinics"Pre-school clinics were held inthree schools in Concord, three schoolsin Kannapolis, and the six consolidatedschools in the county. The smallone-or-two-teacher schools were notreached. No colored schools were included.The total number of schoolsvisited was twelve, and the wholenumber of pre-school children examinedwas 390. These examinations weremade by the health officer, assistedby the county nurses and by MissEdna Oliver, from the Bureau of Maternityand Infancy. In all cases theParent-Teachers' Association was insympathy, and in some schools furnishedsplendid assistance. The schoolauthorities were very generous withtheir time and eff"ort."School officials estimate that inthose schools where the clinics wei-eheld about 1,390 beginners will enternext fall. That makes about 289c whocame for the check-up. In the entire29 white schools in the county, 1,990entrants are expected, and the numberof children examined representsabout 209'r, or one-fifth of this total.This does not seem a satisfactorypeix-entage, but it does show a considerablegain in interest and understandingof the value of the preliminaryexaminaiton when we considerthat last year only 184 children werebrought to the round-up, as against390 this year. TTiis is a good index tothe increasingly favorable reaction tocontinued health education in ourcounty."Two hundred and eighty-threechildren- were found to have physicaldefects. That makes nearly 73% needingcorrections of some sox't. An itemizedaccount of the defects found follows:Defective hearing 5Defective vision 25Diseased tonsils 174Defective teeth 148Heart defects 12Orthopedic defects 10Nutritional defects 94Other defects 8"In the six largest schools includedin the check-up, a majority of thechildren come from mill workers'homes. Unfavorable hygienic conditionsand a lack of understanding ofthe simplest rules of nutrition andhealth probably account for the largeproportion of defects, especially inteeth and nutrition."We have not yet been able tocheck up on corrections done. Thenurses are making follow-up visitsas fast as their other duties allow,and it is hoped that a call will bemade to each home where advice isneeded, during the month of June. Wealso hope to secure a tonsil clinic totake care of many of the poorercases."The clinics revealed a good manyinteresting cases. Probably the outstandingone is that of Paul, a boyeight years old, who had never attendedschool. He was eight poundsunderweight, had evidently had pellagrafor some time, and presented apitiful picture of poverty and neglect.His tonsils were not bad, but he hadthree defective teeth and was slightlycross-eyed. He was tuberculintested at once, and the reaction was

airSepte^nber, 1930The Health Bulletinnegative. He was suggested as a possiblecandidate for the summer Preventoriumput on by tlie local TuberculosisAssociation; so a chest x-raywasmade at the sanatorium as a matterof routine, but this was also negative.His teeth have been put in goodcondition by the State dentist."On June 3rd Paul was admittedto the Preventorium. Although hedoes not at present show symptomsof tuberculosis, his nutrition and generalcondition are so poor that it isfelt that building him up will be areal public health service, by wardingoff a potential case. Three monthsof good food and a sensible routine ofrest, cleanliness,. and sunshineought to give Paul an entirely newfoundation for health and happiness."Another child, in the group of defectivecases discovered, is alreadyunder treatment at the OrthopedicHospital at Gastonia for an uncorrectedfracture of the forearm."We feel that the educational sideof the clinics was decidedly worthwhile,as each child's condition wasdiscussed with the parent, if present.If no parent was in attendance, a noticewas sent home with the child asto how he compared with the norrnalchild at his chronological age. Quitea large amount of health literaturewent into the homes, also, as a byproductof the clinics."Inspiring Report From Winston-SalemIn no city of a hundred thousandpopulation or less in the country anywherewithin our knowledge is therea finer conception of health educationthan that held by the health officialsof Winston-Salem, North Carolina.The record of work which has beendone by both the city and countyhealth department in Winston-Salemand Forsyth County during the lastfew years has been a really inspiringpiece of work. Winston-Salem is fortunatein having two excellent newspapers,a morning and an eveningpaper, under the same editorial management.The editor, Mr. SantfordMartin, is intensely interested inpublic health work and probably devotesa greater proportion of his editorialand news space for advancingthe cause of public health than anyother large city daily in the Stateof North Carolina. Dr. R. L. Carlton,the city health officer of Winston-Salem, constantly presents to the citizensof that place some very attractiveliterature emphasizing the positivecharacter of public health work.We have just received a most interestingletter from Dr. Carlton describingbriefly the efforts of his departmentwith especial reference to thepre-school clinic work undertaken inthat city and county this year. Thedescription is so interesting, and theresults so gratifying, and the sampleof newspaper cooperation so very effective,that we feel sure Dr. Carltonwill not object to our reproducing apart of his letter here."We sent to the parents of childrenthought to have those who would enterschool for the first time this fallthe folder entitled 'Is Your YoungChild Ready for School.' This folderwas sent out by children of. theschools. Then later when we had alist of the parents who have childrenwho are to enter school this fall wemailed under first class postage thepamphlet which is really a letter entitled'The First Job—School. A Messageto Parents' and so on, askingthem to return to us a filled-in cardstating where they would take theirchild for examination and when. Theplan is working very well. We areexamining so far practically doublethe number of children we examinedlast year."Regarding the newspaper publicityconcerning this proposition, Iwould like to say that the countyhealth department conducted theirpre-school clinics before schools closedthis spring and carried an enormousamount of newspaper publicityregarding them. When our clinicscame on, after schools had closed, itwas the feeling in the office herethat the newspapers were tired ofthis material—that they had carriedpractically the same line of thoughtfor the county schools and we hesitatedto send our material to the papersfor publication. However, we did. Wesent them one article after another,we sent them the rehash of a radiotalk on this subject, and every articlewe sent was issued under good boldheadlines; and then a few days agoafter we thought the subject had beenexhausted the Sentinel had a leadingeditorial at the top of the colurnn concerningpre-school clinics. This editorialis clipped and sent to you foryour information. We are happy overthe cooperation our newspapers sowillingly and freely give us. We thinkour health program would not progresswith anything like the satisfactoryspeed it makes if it were not forthe help we get through these papers."

8 The Health Bulletin September, 1930The following is the Sentinel editorialon pi'e-school clinics mentionedin the foregoing letter by Dr. Carlton:"The City Health Department isconducting pre-school clinics for childrenwho are entering school thisfall, for the first time. These clinicsare being held in various schools, sothat they will be convenient to allparts of the city."Parents of children who are beginningtheir school careers are beingurged to bring the little folks tothe clinics. The children will be giventhorough physical examinations andif any defects are found, they will bereported to the parents. Remedial orpreventive steps will be suggested bythe physicians and parents will beadvised to have the necessary attentiongiven at once."If the children are treated duringthe summer, it is highly probablethat they will be in good physicalcondition by the time school opensand thus they will not be likely tolose time from the schoolroom. Theclinics were held last year for thefirst time and reports showed that agreat amount of pre-school work wasdone, with the result that many childrenwere able to put in full classroomtime, when othei'wise they probablywould have had to be absent, receivingthe necessary treatment."Parents whose children are justready to enter school would do wellto have the tots examined at theseclinics and then give them the requiredattention, as reported by thehealth officer."As a sample of an effective appealto parents of very young school childrenand prospective school children,we quote the following attractive letter,written by Dr. Carlton to theparents of his city having childrento be entered into school for the firsttime this year Dr. Carlton's letterfollows:"Dear Parent:"School is the child's first job—andit's a man's size job for the small boyor girl. New surroundings, new ideas,new companions, new responsibilities!They need to be fit for it."You'll take care of the new clothes,the books and all the rest. But whatabout the teeth? The adenoids? Theweight? The heart? The lungs? Areyou taking a chance on those?"In many cities, Parent-TeacherAssociations, Health Departments,Schools—are offering physical examinationsof children just before theyenter school. TTiis is so parents maybe informed of the state of health oftheir children—and may correct whateveris wrong, before the child tackleshis first job—getting an education."There are some things about thatchild of yours in which the Winston-Salem Health Department and youare interested. Because of this interest,arrangements have again beenmade to hold pre-school clinics byschool physicians and nurses at theseveral schools of the city in Juneand Julj''."You are urged to have a physicalexamination of your child who willenter school next fall. Take him toone of these clinics and talk overwith the doctor his physical condition.Your child will be weighed, measured,eyes and ears tested, lungs andheart examined, teeth carefully goneover and so on. A careful physical examinationwill be made and at theend, if nothing is found wrong—somuch the better. If there are defectsthey may be corrected before he|starts to school. 1"You will find on the last page ofthis folder a list of the schools wherethese clinics are to be held and when.Many parents took their children tothese clinics last summer. You areurged to bring your child on one ofthe days mentioned for the school heis to attend, to that school buildingand confer with the school doctor concerninghim."In order that we may know abouthow many children to expect at eachclinic will you please fill in and returnto the Health Department thecard enclosed with this folder? Youryoungsters, with all life ahead ofthem, deserve the best chances forhealth you can give them. We want tohelp you."In addition to the foregoing lettersent to parents, Dr. Carlton has sentout another most attractive folderwith beautiful illustrations, the closingparagraph of which is composedof three sentences urging parents tohave their children ready for schoolin September, 1930, by, first, medicalexamination and defects corrected;second, successfully vaccinated againstsmallpox; third, protected againstdiphtheria by toxin-antitoxin.Grade Teacher Puts on Novel Programin Nash CountyDoctor E. A. Branch, director of theBureau of Oral Hygiene of the StateBoard of Health, brings to the editorof the Health Bulletin the article

, time:September, 1930 The Health Bulletin 9published below, descriptive of afirst grade schoolroom project carriedout by a teacher in a Nash countyschool. Dr. Branch, in his workabout over the State, became interestedin this project and asked the teacherto write it up. It is almost toogood to be true. It illustrates perfectlywhat can be done in any sectionof the State where the teacher andthe right kind of people as patronsof a school come together in a determinedeffort to depart from ordinaryroutine in order to improve thehealth of the pupils. Following is theteacher's report exactly as she hassent it in. V/e hope every first gradeteacher in a rural school in NorthCarolina will read this story.How Our First Grade Cow Helped inTeaching HealthBy Mrs. C. Parker Poole,Teacher Benvenue School, NashCountyEvery first grade teacher may wellwish for a more nearly ideal worldthan the present, for not until thatwill all parents see that theirchildren have had a full measure ofhealth cai-e and personal understandingbefore they enter school. Untilthat time comes it is exceedingly nec-_ essary that the teacher realize thather job is most important, eventhought very difficult. At this pointin their lives, the children need helpnot only in forming good health habitsbut also in changing or breakingthe bad ones that are often of severalyears standing.On the first day of school, Septemberthe ninth, thirty-seven parentseither sent or brought their little sixyear olds to my room to enter schoolfor the first time. For many of thesenew clothes had been made, and theyhad been made to understand thatthey were to get along without homeand mother for the first time. Outof this number twenty were underweight—fromtwo to eleven pounds.This fact had not seemed to havemade so deep an impression on theparents as it did on me. Eleven hadfour plus tonsils; eight more hadthree plus; one could see from onlyone eye (a fact which the parents ofthe child had not discovered); oneboy who was starting in the firstgrade for the fourth time could notsee anything at all from any seat inIthe room, to even the closest boardi space, due to crossed eyes; nearlyf half of them needed dental treatment;and one little boy had two hcmorhageswithin the first month of school.These were some of the conditionswhich I found to be true from personalobservation and doctor's examination.But according to contract Iwas to teach those children to read,write, and learn to work independently.After nearly one month's work withthese little folk studying healthstories, writing health rhymes, andmaking health posters, we decided tocheck on our own health habits. Wedid this for several days and foundthat less than one-third of the childrenwere having milk, more thanhalf were drinking tea and coffee,only ten were getting the rightamount of sleep, and less than halfwere brushing teeth or even had toothbrushes. These facts started our campaign.The group decided on the tenhealth rules they felt were most important.Each child received a newchart each week, and a check wasmade at the close of each day. Therules as developed by the childrenwereSleep in open air eleven hours eachnight.Drink milk every day.Brush teeth every day.Eat vegetables and fruits everyday.Drink four glasses of water everyday.Warm bath on Wednesday and Saturday.Bowel movement every morning.Wash hands before every meal.Keep hands away from mouth.Play outdoors every day.These rules or standards were possiblynot ideal, but they v/ere the decisionof the children, after lots ofstudy and changing. They were along step forward for them.Many means were used to make itmore easy for them to be put intopractice. We sent numerous lettersto parents. Parent meetings were heldin the first grade room when themothers were asked to make talksalong this line. Of course the materialfor these discussions was madeavailable by the teacher. Parents wereasked to help the child check on Saturdayand Sunday, as the other checkingwas done at school. They werevisited, every one of them, and askedto help in many ways, especially inproviding tooth brushes and assistingwith baths. Each parent was asked tosend a small mayonnaise jar filledwith seme kind of vegetable, soup orcocoa, in the child's lunch.. I'his theydid very gladly as they found it to

—10 The Health Bulletin September, 1930he cheaper and easier than preparingseveral sandwiches. These vegetableswere placed in a large vessel with asmall amount of water, over a hotplate. At lunch time they were hot,thus providing children with a hotdish for lunch, and also making moresure that they were eating vegetables.We helped establish the habit ofhand washing before meals by doingit in our room every day before lunch.Our lavatory facilities were not atall adequate for the first graders, sowe purchased a large oil can to holdliquid soap, a gallon pot with funnelattached for the water, a ten quartbucket to catch the waste water. Thesoap and paper towels were furnishedby the school. With the help of threecaptains—one to squirt soap, one topour water, and one to hand papertowels—we soon learned to have thehandwashing for every one in theroom in four minutes. Of course thecaptains learned that they must haveeverything in readiness for us at theright time.The biggest problem was that ofdrinking milk. Was it right to scorethem down, when they could not getmilk ? We solved that problem by askingthe Parent-Teachers Associationto furnish half of the cost of a halfpint of milk each day for each child.We told them we would furnish theother half. I'his they gladly did. For afew months we bought the milk atgreatly reduced prices from one ofthe very best dairies. Even at reducedrates, the bills began to grow largerand larger both for the teacher andthe Parent-Teacher Association. Itwas then that the grade mother andthe teacher decided to rent a testedJersey cow. The teacher furnished therent and part of the feed, and thegrade mother and Parent-Teacher Associationfurnished the rest. Thegrade mother kept the cow and tendedto the milk. It was sent to schooleach morning on the school truck.One of the little boys took chargeof it. This method reduced the costfrom sixteen dollars per month toseven, as the grade mother got enoughmilk to pay her for the feed shefurnished.Each morning at ten o'clock, justafter our outdoor play period, thecaptain of each table acted as hostess,and served the milk. Other captainsas dishwashers—cleared the tables,and washed and scalded the cups,pitchers and bottles, and put themaway. Our first grade kitchen becamea very popular place, and affordedmany opportunities for teaching cleanlinessand sanitation.The results of such efforts are neverentirely visible. There were, however,many visible results from ouryear's work centering around improvement.By actual weighing andmeasuring at the last of school wefound that we had reduced the underweightsfrom twenty to two. Thosetwo gained three and four pounds respectively,but had started the yearnine and eleven pounds underweight.During the year we enrolled fortynine,seventeen of which were repeaters.At the close of school there wereonly six repeaters left for nextyear's first grade. Ninety-one percent of the average daily attendancev/as promoted, and eighty-four percent of the average monthly enrollment.During the year the class suffereda shift from one school to anotherof twenty-three. This made thepercentage of promotion even harderto attain.Now that the school is out, we arehaving a clinic, at which every underweightchild in the school will beexamined, and if the case warrants it,they are to be placed in a rest campfor the summer. We also have promisesthat these bad tonsils will be removedbefore another school year.Several charity cases are getting tonsilsremoved free of charge.The entire commencement programfor the elementary grades was ahealth pageant, worked out and presentedby the children and teachers,with all the children of the schooltaking part.Other visible results were in thevery appearance of the children, personalcare of their bodies. The ideaof heating vegetables and hand-washingin the room became very popular,and nearly every grade in our elementaryschool was given a hot plateby the grade mother. All the grades,even the high school grades, used themethod for handwashing.School became to those childrenmore nearly a "school home," wherewe tried to live health together, ratherthan just to teach and talk health.Having taught the fifth, sixth, andseventh grades in previous yearsmakes me realize that a child whohas needlessly fallen behind in theearly school years suffers from asense of failure fi'om which he willnot recover. It is, therefore, muchbetter to remove handicaps at the beginningof a race, than after it ispartly run.

September, 1930 The Health Bulletin 11EVERYDAY PRACTICE MAKES GOOD HEALTHHABITS FOR SCHOOL CHILDRENBy SUDIE E. PYATT"Bennie, didn't you brush your third grade at Mount Carmel schoolteeth this morning?" Daisy Miller, is going to brush his or her teethteacher of the third grade at Mount twice, every morning on rising, andCarmel Consolidated School, asked in every night before going to bed."a distressed voice of one of her little "My Papa thinks it is foolishnessboy pupils.to spend money on tooth brushes and"No'm," Bennie grinned cheerfully, tooth paste," a small sandy-hairedshowing a set of nine-year molars boy, with two teeth prominently missingfrom his front upper row, raisedthat were far from being what theteeth of a nine-year-old boy should his hand.be."Then I'll write your Papa a note,"Don't you ever brush your teeth?" the teacher said, not daring to allowThere was something of incredible the child to get away with this statement;too many others might makeamazement in the young, teacher'svoice this time.the same excuse."O, yes'm, sometimes I do, when I "All right, I'll tell him that if hedon't forget it, and Ma, or Gertie remindsme," answered the lad, his going to write him a note," the boydon't give me a quarter, the teacher'stones still cheerful, for not having said.been taught the necessity of the constantpractice of good health habits, ceptance of the talking point she hadDaisy smiled at the boy's quick ac-Bennie did not realize how his yellowedteeth, and bad smelling breath, on many of the other children's facesgiven him, and she saw by the lookswith the knowledge that he seldom that they, too, were preparing toever brushed his teeth, distressed his use the talking point.young teacher, v/hom he thought uncommonlypretty."that clean teeth mean good health,"Tell your parents," she instructed,If asked why he thought his teacher and help to save doctor's bills."pretty Bennie would have reddened The second day of school for theand stammered something that was third grade at Mount Carmel was over,and Daisy Miller, in her sturdynot very clear, but the night beforehe had told his mother that he liked little car was driving into the townthe new teacher, because she had such six miles away where her brother operateda drug store.a nice smile, with tv/o even rows ofwhite teeth, that were as clean and "Bill, I want thirty small size,bright as the white glazed plate he medium bristled tooth brushes, andwas eating his supper from.thirty small size tubes of tooth paste,Distressed by what she had just and you will have to take §7.50 forlearned about Bennie's teeth brushing the lot," Daisy announced, as shehabits, the young teacher decided to walked into her brother's store.make an investigation at once, to discoverhow many of her pupils regular-"Young lady, what have you done,ly brushed their teeth.Out of the roomful of thirty children,only five raised their hands,when she asked all who brushed theirteeth regularly twice each day toraise their hands. Fifteen other children,including Bennie, said theybrushed their teeth irregularly wheneverthey thought of it, and seldom ifever used a tooth brush."Children, when you go home tonightI want each of you to ask yourparents to give you twenty-five cents.With the money you are going to buya tooth brush and a tube of toothpaste, and we are going to take somelessons here in our school room onhow to brush our teeth, then we aregoing to take the tooth brush home,and every little boy and girl in theopened up an orphan asylum?" Billteased."Something like that," Daisy responded."I have thirty children mmy room at Mount Carmel school. Onlyfive of them brush their teeth regularly.I am going to give the five whodo use tooth brushes, a new one, andI am going to teach the other twentyfivechildren to know what a cleanmouth feels like.""Good for you, old girl!" Bill heartilyapproved. "If there were moreschool teachers like you, drug storesmight become rich sellmg toothbrushes and tooth paste, if all theteachers didn't hold the drugstores upon the price the way you have held meup." ,1 • JITie closing period for the thirdgrade at Mount Carmel school next

step12 The Health Bulletin September, 1930afternoon was devoted to a toothbrush drill.Thirty boys and girls recited asthey went through the motions ofbrushing their teeth with a toothbrush."Now, children, I am going to giveeach of you your tooth brush, andtube of tooth paste. You are to takethis home, and after supper tonight,before retiring, put some tcoth pasteon your tooth brush, and using aglass of water, brush your teethcarefully, just as you have learned inthe drill. In the morning I want everyone of you to report that youbrushed your teeth before retiringtonight, and in the morning beforeeating breakfast. Every day you willreport to me on whether or not youday be-brushed your teeth twice thefore, and at the end of the monthevery child who has not failed tobrush his teeth twice every day willreceive a reward."The children were delighted withthe idea of their new tooth brushes,the tubes of paste, and the announcementthat constant use of their newbrushes would bring a reward madethe thought of the constant use ofthe tooth brush more like play thanwork, or the acquiring of a desirablehealth habit that had been previouslyneglected.The weighing and measuring of allof her pupils when they began theregular use of their tooth brushes,and at stated intervals during theschool year after the regular use ofthe tooth brushes had been established,Daisy decided would be carryingthe health work a ' further, alsoopening the way to the discovery ofchildren who were underweight, andThe add-the correction of the defect.ing of v/eight for children who wereunderweight, the teacher, saw, too,would probably lead to the servingof milk lunches.The daily health inspection she hadalready inaugurated when she hadtold the children that their toothbrush activities would be checked onevery day. She would use the subjectmatter, arithmetic, spelling, English,reading and writing, together with thehome life, and general experience ofthe child to tie up with health activities,and most important the acquiringof good health habits.Finally a health examination forevei'y child in the room by a goodphysician, with the correction of anydefects he might find, would make acomplete school health program forthe year.No regular school health work wasdone at Mount Carmel school, butthis did not daunt Daisy. If duringthe eight month's school term shecould teach the thirty children in herroom the fundamental health habits,and instill into them the importanceof the habits, she felt that her workat the school would be worthwhile.The next morning every one of thethirty children in the room, reportedthey had brushed their teeth the nightbefore, and before coming to schoolthat morning.Bennie and Tom, the little boy whohad feared his father would not lethim have money to buy his toothbrush and tooth paste, reporting moreenthusiastically than any of the others.To make the report more impressive,Daisy inspected each littlemouth, as the oral report of the childwas given. In that way Daisy hopedto impress upon the children the importanceof both the twice daily toothbrushings, and the daily inspection, aswell as nipping in the bud any attemptsto falsehood in reporting theobservance of the twice daily habiton the part of the children.The announcement that the lastperiod of the day would be taken upwith a trip to Mrs. Green's store, nearthe school house for weighing, wasgreeted with delight by the children.Before leaving the school room,the name, address, and names of theparents of each child were recorded ona card, as v/as the heighth of thechild."Ha, Miss Miller, Tom's got a brickin his pocket," cried Bennie, who hadbeen given a place by the teacher tohelp her place the weights on thescales, as Tom stepped off the weighingplatform of the scales.Tom's sallow little face turned red,and he stammered a denial to Bonnie'sstatement, but under the calmeyes of his teacher, he produced thebrick, that weighed a couple ofpounds, and stepped back on thescales to be weighed.After that incident the childrenwere all careful that they carried nobricks in their pockets, for teacherhad told them that it was very importantthat she know their correctweight.I'en of her pupils Daisy found tobe underweight. Some of these childrenlacked only a few pounds of theirnormal weight for their age andheighth, while others were as muchas five to 10 per cent, or more underweight,which was serious for youngchildren.

Septemher, 1930 The Health Bulletin 13The underweight children, Daisydecidedmust have rnilk lunches everyday, and their parents must be informedof the failure of the childrento tip the scales at what they should.It would not hurt to give all of thechildren a milk lunch every day at themorning recess period, but where wasshe to secure the milk?The community in which the MountCarmel school was located was not byany mieans a community of wealthyfarmers, though there were severaldairy farmers, who lived near theschool, who apparently were successfulin the dairy business.The daughter of one of these dairymen,was in Daisy's room. This dairy-.man, Mr. Wood, was the man Daisyfirstmade her appeal to for milk forthe morning lunches for her schoolroom."No other teacher ever had suchfool notions as you've got about teachingchildren," Wood gruffly toldDaisy, when she went to him with herrequest for two gallons of wholesweet milk at a reduced price, everyschool day. "I ain't a wealthy man,my wife is sick now in a Tb sanatorium,and I'll tell you I'm not infavor of feeding children extra atschool. If they can't get enough toeatfeedatmyhome letgirl enough,them goandwithout.the othersIcan feed their own children.""But Louella," Daisy sweetly remarked,"is nine pounds underweight,Mr. Wood. For a nine-yearoldgirl, especially when she has amother who is in a Tb sanatorium,nine pounds underweight is a seriousmatter. A glass of fresh milk everymorning should help Louella put onweight considerably, if she observesother health habits.""Well, for my daughter, it is allright," Wood said. "I will see she getsplenty of milk, if you say she needs it,but I won't give a single glassful forany of the other children in this community,unless I'm paid the full marketprice for it. I look out for mychildren, the others can do the same."Disappointed, but not defeated,Daisy left Wood's farm for that of•boonhis contemporary, David Cooper, whoalso ran a dairy farm.Cooper had no children in theMount Carmel school, as his familyhad grown up, and passed the schoolage, but Daisy found him one of thosepublic spirited men that are always ato school teachers, and otherswho are seeking to do things a littledifferent, and really help people. Heagreed immediately to furnish hertwo gallons of milk five days a weekfor the children at the school, providingshe would have two of herlarger boys call for the can of milkevery morning. To this Daisy readilyagreed, and she went to bed happythat night. The milk lunches wouldbegin day after tomorrow, for shehad to acquaint the children with theproper use of the morning milklunches, and she had to have eachchild bring from its home a glass tobe used for drinking the milk."Now, children, remember thatyour name is on your own glass, onthe piece of adhesive tape," Daisy instructed,as the children sat in theirdesks, their glasses atop the deskwaiting for their first milk lunch.Using a pitcher to pour the milkDaisy visited each child, filling eachglass to the brim with the nourishingwhite fluid."Gee, Miss Miller, that was good!"Bennie heaved a man's sized sigh, ashe placed his empty glass on his desk."It sure was, teacher," Tom corroboratedBennie's statement, andall over the room children put downtheir glasses, while their faces showedsatisfaction.Several of the children showed adistaste for the milk, and Daisy devotedher time to persuading thesechildren to sip the glass of milk, forDaisy knew that if once she couldget the children to drink the milkthey would continue to do so, to belike their little friends if for noother reason.Little Louella Wood had broughther own milk in a bottle, for her father,the other dairyman of the community,had said that his daughtershould not drink any of David Cooper'scow's milk, after he himself hadrefused to furnish two gallons of milka day, at cost to provide the milklunches for the children of the thii-dgrade at Mount Carmel school.Their milk lunch completed, theboys and girls formed in orderly lineand moved to a pan of hot water,Daisy had placed on the stove early,and each child's glass was carefullywashed and scalded and returned tohis or her desk to wait for the nextmorning's milk drinking."I'll bet you don't have anji;hing inyour room like we have in ours," Bennieboasted to a little boy from thefourth grade room at Mount Carmelschool, and it was this little boy whotold his teacher that he, too, wouldlike to have a glass of milk to drink

14 The Health Bulletin September, 1930at recess every morning, and after allof the teachers at the school hadheld a joint meeting, regular milklunches were served every morningto all of the children at Mount Carmelschool.David Cooper furnished the milkat wholesale prices, for it was allright for the big-hearted dairymanto furnish the milk for one room ifhe wished, but not for all of the childrenin the large school.After milk lunches were inauguratedfor the entire school, all childrenwho were underweight were given themilk free, others paid two cents aday for their glass of milk.Children in all of the grades of theschool were weighed and measured, asthe pupils in the third grade hadbeen.At the principal's request the StateBoard of Health sent a dentist downto remedy defects found in the children'steeth. Escorting a group fromher own room to the dentist Daisywas surprised, and at first confused,when she discovered that the dentistwas George Mason, whom she hadmet on a summer vacation while hewas a dental student, and she at ateachers' college.Thrown together constantly throughthe glorious summer months at thefarm home where they spent theirvacation, the two had developed agenuine case of love before the seasonwas over.Back at their work for the wintera rift had occurred, which had endeda year before by Daisy breaking theirengagement. Where George had goneto practice his lorofession on graduationfrom the dental school Daisy hadnot known, until she saw him remedyingin a most businesslike and professionalway the defects in the teethof the pupils at Mount Carmel school."How do you do," Daisy greeted theyoung dentist crisply, and he disregardingDaisy's not too free greetinglaid down the drill he was using on athird grade youngster's tooth, andgrasped Daisy's warm soft hands inhis professional ones, only they werenotvery professional just then."Well, well, young lady! How luckyI am to find you here. I did not wantto come here when I was first toldthis was my next job, but how gladI am now that I came.""Doctor, don't you think you'd betterattend to business?" Daisy askedin her most teacherlike voice, as theyoungster the dentist had left in thechair seemed inclined to take lessonsin dentistry by investigating thedental tools spread out temptinglynear him."All right, young woman, businessis business," the doctor said, retrievinghis drill from the would-be dentist,"but when business is over Iwarn you. Miss Miller, business won'tbe business with us."Back in her schoolroom Daisy tookup her interrupted lesson in arithmetic,while her face burned, and herhands were hot. To think that Georgethought he could come back like thisafter a year of silence,, and win heragain as he had done that summertwo years ago, only to leave her ashe had done before. She would showhim, for at that moment Daisy didnot consider the fact that she had hadas large a part in the quan-el thathad caused their separation as theyoung doctor had taken.But her eager pupils were waitingfor their arithmetic class, which shewas tying up with their health lessonsin learning good health habits.She could not spend her time thinkingof the old love affair now."Tom, if you sleep nine hours everynight vnth your windows open, andplay outdoors one hour every day,how many hours do you have left outof the twenty-four?" Daisy asked.Tom's hand went up quick as aflash, "Fifteen, teacher!""No, he's wrong," Bennie's handwas up as quickly as Toms' had been,"It's fourteen hours, teacher.""Right, Bennie! And after we haveslept nine hours, and played outdoorsone hour we have fourteen hours leftin a day, now let's see hov/ we fillthat time up.""If we come to school at 9 o'clockin the morning and leave at 3 o'clockin the afternoon, how many hours dowe spend each day in school?""Six," it was Louella Woods, whoanswered this time."Fine, Louella," Daisy smiledbrightly at the little girl. Louella,rapidly gaining the extra weight sheneeded, was growing quicker in herstudies every day, as her body grewstronger, and her eyes brighter."We sleep nine hours, play out ofdoors one hour, and go to school sixhours, how many hours does that leaveus, Paul?" Daisy asked of a slender,dark lad, who also was gainingweight at a very satisfactory rate.Paul calculated rapidly, "Eight,teacher," he called while half a dozenhands were waving excitedly for thechance to give the answer.

IkThe Health Bulletin September, 1930 15"Very good, Paul," Daisy gave herapproval to the lad's answer."Now, children," she addressed theclass, "Paul says after we sleep ninehours, play out doors one hour and goto school six hours we have eighthours left. That is a lot of time. Letsfind out what we do with that time?From 6 to 8 o'clock in the morningwe help Mama and Papa about thehouse, dress, get breakfast and walkto school.""That is two hours," Lee Jones,raised his hand."Yes, Lee. From 3 to 4 o'clock weplay outdoors, and from 4 to 5 o'-clock we play, outdoors the last hour,too, if the weather is suitable.""Two more hours," several childrenraised their hands."Yes, and from 5 to 6 o'clock in theevening v\'e help Mama and Papaagain, and from 5 to 7 we eat, from7 to 8 play again, and from 8 to 9we read, at 9 we go to bed. Now, children,I want you to tell me how wospend our whole day."Bennie raised his hand, "Please.teacher, I can tell; nine hours sleep,three hours working, two hours eating,six hours in school, one hourplaying out of doors, two if the weather'snot bad, another hour playingafter eating at night, and one hourreading before we go to bed.""Very fine, Bennie! And now ourarithmetic lesson is over for thistime. Our English lesson is next. Todaywe are going to \vrite sentences.""What is a sentence, Mary?""A sentence is a complete thoughtthat tells what one is thinking about,"Mary answered."All right, Mary, give me a completesentence that will tell me whatyou are thinking about baths now.""To keep healthy litlte boys andgirls must take a full bath oftenerthan once a week.""Henry, I am sure you know asentence that tells about teeth.""I brush my teeth twice every day.""Good!""John, you want to use sleep in asentence.""Sleep nine hours every night withyour windows open," John immediatelyresponded."Louella, in a sentence about milk,what would you say?""Drink as much milk as you canevery day, at least three glasses, andnot tea or coffee," Louella's sentencecame quickly."Next I want a sentence about vegetablesand fruit," the teacher toldher eagerly waiting class.A dozen hands went up. "Eat somevegetables and fruit every day," achorus of voices called out, whenDaisy gave all of the children permissionto speak."Water is the next word I wantyou to use in a sentence," Daisy toldthe class."Drink four glasses of water everyday," Bennie, called out before anotherchild could beat him to thestatement."How '^0 we use play in a sentence,children?""Play part of every day out ofdoors," a timid little girl raised herhand and spoke before any of theother children had a chance to givethe sentence."Now, children, we have a difficultword to use in a sentence this time.It is bowel. How shall we use it?"Bennie, unabashed by the word,raised his hand, "I know. Miss Miller,Every child must have a bowel movementevery morning.""Very good, Bennie. This time Iwant you all to tell me what we callthese sentences we have been making,and how many of them there are."Tom's hand went up. "There areeight of them. Miss Miller, and theyai-e called the 'Rules of the Game.'They tell us about health habits thatare important for us to remember ifwe ai '^ going to stay well.""Ve^ fine, Tom! Can some otherlittle boy tell me what is most importantin health habits?"Every hand in the room went up."Every*^ day, and all of the time, donot forget your health habits.""That means, Bobby, that if youbrushed your teeth yesterday, you donot have to brush them today?" Daisyasked of a boy who was eagerly wavinghis hand.."No'm, it means that if you washedyour teeth yesterday you have got towash them again today, and tomorrow,and every day, for a habit is nota habit, unless it's something one doesevery day.". ."Yes, Bobby, that is true. "\Vhy is itso important for us to keep healthhabits?""Keeping health habits keeps uswell and happy, and saves money forour Papas and Mamas.""That is just what it does," Daisyagreed with her eager class. When weleave school this afternoon, we gohome and play outdoors for twohours, before helping Mama and

116 The Health Bulletin Sept^^er, 1930Papa, because this is a v/ai-ni, sunshinyday, and children can play outsidewithout danger of getting coldand wet.""Goodbye, Miss Miller," the lastchild called out happily as he passedout of the school room."Goodbye, Henry," Daisy answered,looking up for a moment from thehealth cards on her desk. They werethe same cards she had filled out lastfall for the thirty pupils of her room.There was now recorded on the cards,beside the age, weight an heighth-Iof each child when the card was firstmade, the records of weekly gains,weekly inspections, defects found, de-.->rfectscorrected, grades made by thepupils each month, and the prasenthealth status, and school standing ofthe child.The last records on Daisy's card?showed that sixty per cent of thechildren in her room had some c.ofect,teeth, tonsils, adenoids, nose,heart, lungs, underweight, bad posture,bad nerves, defective vision, orhearing. Of the number of child te.i.suffering from defects twenty-six percent had already had the defects remedied,and Daisy felt especially hopefulthat soon all of the childic' withphysical defects that couk'rected would have these df v o^rected.She was closing the desk file w^cush*» looked un to see George sihil' gat her in the doorway."The last youngster has receive'his last tooth filling today," tl a dentist announced, stating "v,",g ta^ iormon Daisy': desk without tne forma'ity of askmg permission.Daisy looked at the doctor in surprise."I did not invite you in here,"she said sharply."Sure, you did not invite me, andthat is just why I am here," Dr.George Mason lighted a cigar, andmade himself more comfortable inhis position on the desk."Constant practice makes anythingpossible; even the forgetting of heartache," he read from a framed and coloi'edmotto on Daisy's desk."Phew!" he ejaculated. "Is thatwhat you have been doing the pastyear, making a constant practice offorgetting me?" the doctor askedlooking steadily into Daisy's blueeyes."You flatter yourself, young man.The heartache that motto refers tohas nothing to do with you.""Hm-m!" The doctor lighted anothercigar. He didn't seem to be havingmuch success with the first one. "Iam disappointed. I was sure it didrefer to me. Now j'ou've shattered allof my beautiful dreams."Suddenly Dr. George Mason leanedforward until his strong, capablehands touched the slender shouldersof the blue-eyed school teacher,"Daisj'^, why be so cruel to me ? Iswear if I had known where you wereI wouldn't have been away from youfor a whole year.""I don't believe you," Daisy pushedthe hands from her shoulders."You have got to believe me," thedoctor was distressed. "When I lookedup and saw you in that room withthose youngsters this morning youlooked like the sunshine, and heaven,and everything beautiful and lovelyto me."Daisy was looking away past thedoctor, past the motto on her desk.Could she believe George, that hetared after all as she cared ?'lowly Daisy raised her face to the(I'.i tor's, and he read in those eyesih? message he was looking for. He.J opped quickly and quietly from the.'dask to the floor, where he took theslender form of the teacher of thethird grade at Mount Carmel schoolin his arms."Miss Daisy," it was Bonnie's voicecalling from the door, "may I comein? I forgot my lunch box, andMama doesn't have another one forme.""Yes, Bennie, come in," Daisycalled, slipping out of the young doctor'sarms.The lad went to his desk, securedthe lunch box, and started to leavethe room, then he looked inquiringlyat his teacher."Miss Daisy, you like Dr. Mason,don't you?"Daisy blushed, and the doctor lookedsmilingly down at the boy, a shinyquarter in his hand. "Sui-e, she does,Bennie. You take this quarter andrun along now, Miss Daisy wants totalk to me."Bennie pocketed the quarter, aftera grave, "Thank you," but he wasnot ready to go yet. "Miss Daisy, ifyou and Dr. George have any childrenare you going to teach them to brushtheir teeth twice every day, and allof the other health habits you havebeen teaching us?""Yes sir, Bennie, we certainly are!"Dr. George answered the boy's question,as he put him gently, but forcefullyoutside the class room, and closedthe door behind him.

utli5\ed b4 TAZ. 7^°Rm CARPLU^A 5TATL D'?ARD s^At^LTABulleliAwillbe 5er\l free to qa\3 citizen of Ihe Stole upoa request jEntered as second-class matter at postofttce at Raleigh, N. C, under Act of July 16,1S94. Published monthly at the office of the Secretary of the Board, Raleigh, N. C.VOL. XLV. OCTOBER, 1930 NO. 10CHARLES HAGAN LAUGHINGHOUSE, M. D.DIED AUUST 26, 1930

DirectorMEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTHA. J. CROWELL, M.D., President CharlotteCYRUS THOMPSON, M.D JacksonvilleTHOMAS B. ANDERSON, "M.D StatesvilleE. J. TUCKER, D.D.S RoxboroD. A. STANTON, M.D High PointJAMES P. STOWE, Ph.G CharlotteJOHN B. WRIGHT, M.D RaleighL. B. McDANIBL, M.D JacksonCHARLES C. ORR, M.D AshevllleEXECUTIVE STAFFH. A. TAYLOR, M.D., Acting Secretary and State Health OfficerRONALD B. WILSON, Assistant to the SecretaryC. A. SHORE, M.D., Director State Laboratory of HygieneG. M. COOPER, M.D., Director of Health Education and Vital StatisticsH. B. MILI>ER, C.E., Chief of Bureau of Sanitary Engineering andInspectionERNEST A. BRANCH, D.D.S. , of Oral HygieneD. A. DEBS, M.D., Field Assistant In County Health WorkFREE HEALTH LITERATUREThe State Board of Health publishes monthly The Health Bulletin,which will be sent free to any citizen requesting it. The Board also hasavailable for distribution without charge special literature on the followingsubjects. Ask for any in which you may be interested.Adenoids and TonsilsCancerConstipationColdsClean-up PlacardsChickenpoxDiphtheriaDon't Spit PlacardsEyesFliesFly PlacardsGerman MeaslesHookworm DiseaseInfantile ParalysisInfluenzaMalariaMeaslesPellagraPublic Health LawsPrenatal CareSanitary PriviesScarlet FeverSmallpoxTeethTuberculosisTuberculosis PlacardsTyphoid FeverTyphoid PlacardsVenereal DiseasesWater SuppliesWhooping CoughSPECIAL LITERATURE ON MATERNITY AND INFANCYThe following special literature on the subjects listed below will besent free to any citizen of the State on request to the State Board ofHealth, Raleigh, N. C:Prenatal Care (by Mrs. Max West)"Our Babies"Prenatal Letters (series of ninemonthly letters)Minimum Standards of Prenatal CareWhat Builds Babies?Breast FeedingSunlight for BabiesHints to North Carolina Mothers WhoWant Better BabiesTable of HeigOits and WeightsThe Runabouts in the House of Health(pamphlet for children from 2 to 6years of age).Baby's daily Time Cards: Under 5months; 5 to 6 months; 7, 8, and 9months; 10, 11, and 12 months; 1year to 19 months; 19 months to 2years.Diet Lists: 9 to 12 months; 12 to 15months; 15 to 24 months; 2 to 3years; 3 to 6 years.CONTENTSPAGEDr. Jacocks Succeeds Dr. Laughinghouse3Weight and Height as Related toMalnutritionLunchesas Related to School4Nutrition 6Then and Now 9PAGECourt Room Sanitation 9Our Children 10An Eye Trouble of Mid-Life andLater 11Growing Up to Thirty 12Water 16

VOL. XLV. OCTOBER, 1930 NO. 10DR. JACOCKS SUCCEEDS DR. LAUGHINGHOUSEThe State Board of Health in specialsession September 24 unanimouslyelectedDr. William Picard Jacocksto fill the unexpired term of Dr.Charles O'H. Laughing-house, as secretaryof the Board and State HealthOfficer.Dr. Jacocks was born December 9,1877, at Windsor, Bertie County. Hewas graduated with the degree of A.B. from the University of North Carolinain 1904 and received the degreeof M. A. in 1905. In 1911 he was graduatedin medicine from the Universityof Pennsylvania. He was licensed topractice in North Carolina the sameyear and joined the field forces of theState Board of Health in the statewidehookworm campaign. In 1914 hewas called to an executive position onthe staff as Director of Rural Sanitation.The following year he joined thestaff of the International HealthBoard, with which he has since servedwith the exception of duty as Captainin the Medical Corps of the UnitedStates Army during the World War.Following his discharge from theArmy he spent a year in the Schoolof Hygiene and Public Health ofJohns Hopkins University. For someyears he has been stationed in Ceylon.^The Board unanimously adopted thefollowing offered by the committeeconsisting of Drs. Thompson, Orr andCrowell:"TlieState Board of Health recordsin its minutes its profound sense ofpersonal sorrow and public loss atthe death of its late Secretarj^ Dr.Charles O'Hagan Laughinghouse, whoafter a brief acute illness, followingsevei-al weeks of declining health,died on the afternoon of August 26,1930.Dr. Laughinghouse stood easily inthe forefront of the profession ofmedicine and the excellence of men,and in the midst of remarkable publicservice he fell unexpectedly, a Princeand a great man.He was great in head; great inheart; great in integrity of character;great in industry, and in loyaltyto his friends and to the public.He knew medicine, but he knewmore than that: He knew men andbooks and the wisdom of the sages.He was a splendid example of thecultured medical man.He lived his life so serviceably, uprightlyand honorably, that whilehisgoing leaves a deep sense of loss, itgives no cause for tears or beating ofthe breast. He was all that NorthCarolina expects a citizen to be. Infull man-size, he was the Spirit ofNorth Carolina incarnate."

The Health Bulletin October, 1930MALNUTRITION AS RELATED TO SCHOOL LUNCHES

October, 1930The Health Bulletinthe school breakfast idea. In severalof the elementary schools in Cleveland,Ohio, this school breakfast programseems to be of very great importance.In practically every case thechild's breakfast seems to be inadequate.The coffee and cake breakfastwas found to be the most popular, althoughin some of the so-called betterhomes, breakfast consisted of a glassof milk. Investigators found that mostof these children retired at a latehour and got up late in the morning,thus having very little time to createan appetite and to eat a properbreakfast. Naturally the children hurriedoff to school in an unfit conditionto do their school work. In order tobetter these conditions the mid-morningmilk lunch became very popularin order to supplement the coffeecakebreakfast. Lessons were taught,breakfast menus were made, and considerableenthusiasm was arousedamong the children as to the properbreakfast diet. They were also invitedto eat breakfast at the school. Eachchild was asked to bring ten cents, asauce dish, a bowl and a spoon. Oatmealand prunes were cooked on theday before and reheated the followingmorning. For breakfast each child hadoatmeal, prunes, and sandwiches. Ofcourse the menus varied from time totime, but v/ith such an idea verymuch interest was aroused not onlyamong the school children but alsoamong the parents. The parentslearned how little a good breakfastcost and they begin to cooperate inhelping their children have a nourishingbreakfast. It was noted by theteacher in many instances that therewas an improvement in the children'smental and physical condition. Justfrom this type of experiment, perhapsthe time will come when every schoolwill have a lunch room. Indeed it isan enormous, but necessary problemwhich should be woi'ked out in orderto prevent malnutrition among schoolchildren.The food eaten by the child mustcontain the minerals necessary forbuilding and repairing all the differentparts of the body; it must containenergy oi' fuel for the work ofthe muscles; and it must serve to regulateall the chemical changes onwhich health and growi;h depend. Regularityof meals as well as quantityand quality are just as vital to thechild's health and well-being as theywere before he started to school.While the school lunch is no more importantthan any other meal, it ismore difficult to keep up the standardsof wholesomeness in it than inany of the others.A lunch room should be at leastself-sustaining during the school yearto justify its existence, unless somemeans of endowment is provided. Insome large cities the financial problemof the weak lunch room is takencare of by combining all the incomeof the lunch rooms in a common fundwith a central controlling office. Thisenables the strong lunch room to helpcarry the weak one along. The costof equipment for serving the foodshould come out of the regular schoolfunds and not from the pupil's pockets.If the school needs a new bookcabinet, laboratory table, or type-^vriter, the pupils are not asked tobuy it; the same is true for lunchroom equipment. Nevertheless, too oftenthe school board pays too littleattention to the lunch room; too oftenthe superintendent and school officialfail to tViink much of the problem ofthe lunch room save that it must bekept on a paying basis, be self-supporting—aplace where food is sold ata cost which allows a sufficient marginto permit the purchase of additionalequipment, dishes, etc., in factanything that is needed. Frequentlythe lunch room gets along as best itcan with the board refusing to buyany extra tables, etc., until the manager,becoming desperate decides thatthe only way to get the much neededequipment is to make a bigger profitby serving smaller portions, by

The Health Bulletin October, 1930using skimmed milk instead of wholemilk, by substituting inferior foodsfor the best; thus cheating the childrenout of their food values.The Parent-Teachers Associationshould be familiar with the work ofthe cafeteria, the preparation, etc. Itis the business of the mothers to observehow the lunch room is run, notin a critical way, but to just see howthe cafeteria is conducted. A differentpai-ent might eat at the lunchroom each day to observe the type oflunch, cost, 'etc. Undoubtedly manyof the lunch rooms would improve ifthis plan were worked out. Too manyof them serve the food on whichthere is most profit.Milk should always be served atcost and purchased from the cleanestand best diary. The noon meal shouldbe sufficient to suit or satisfy thechild's appetite and needs. For manyof our lunch rooms are run on theprofit basis. Does it pay to profit inthis case? In many school lunchrooms the children do not get fullvalue for their money. Half pints ofmilk sell for five cents instead of twoand one half cents that they cost. Yetwe cry constantly to the children todrink more milk.The question of economy seems uppermostin the minds of managers. Alack of food is preferable to a lackof funds. In many cases thesalary ofthe manager, the cost of equipment istaken out of the pockets of the schoolchildren, and especially out of thepockets of those who can least affordit.The time may come when ourschools will provide at cost an adequatelunch. Shall we let the factoriesand mills surpass our schools in providinga good meal at cost ? Manysuch firms serve food at a cost less,providing soup for thi-ee cents, rollsfor one cent each, etc. Our schoolchildren need this nourishment evenmore than the factroy workers, forthe latter are usually grown, whilethe girls and boys are at the periodwhen they need plenty of wholesomefood for body building. Serving aninadequate lunch encourages lunchingbetween meals. However, we shouldstress very emphatically that theschool lunch room has more importancein the school program than anyother department. Thus the schoollunch room should never be thoughtof as a place to make a big profit inmoney, but instead the profit shouldbe directed to the children who willobtain the necessary food values whichwill give them a healthy mind in ahealthy body.WEIGHT AND HEIGHT AS RELATED TO NUTRITIONByJULIA MORGANConservative estimates show thatat least one-third of the children inany ordinary American communityare undernourished. This condition isequally true in the preschool andschool periods, among both boys andgirls.We do many things badly in thiscountry, but nowhere have we shownless intelligence than in the care ofchildren from two years of age untilafter puberty. Malnutrition existsamong them to an almost incredibledegree. A recent survey in New Yorkshows that of the million children ofschool age in that city, approximatelyone hundred and fifty thousandare stunted in their growth, retardedone to three years both in heightand in weight.This condition is not confined to thepoor or to the children of parents in

October, 1930The Health Bulletinmoderate circumstances. A survey ofthe younger boys in two famous preparatoryschools noted for the wealthof their patrons has been made. Morethan thirty per cent of these boj'^sare ten per cent to twenty per centunderweight for their height.Why is such malnutrition allowedto exist? T'he reasons are various. Inthe first place, no effective steps havebeen taken either by the medical professionor in the schools to identifythis group. When children are examinedby the private physicians, iftheir various vital organs are normal,little attention is paid to theirstate of nutrition. If the child fallsbehind in his studies, pressure atschool is increased. If he fails he iscalled lazy. Later in life many ofthese children, unable to bear unusualstress, become physical and nervouswrecks.Study and treatment of these childrenin nutrition clinics show that inevery case causes for the malnutritioncan be found, and, when the causesare found and removed, the child, responsiveto a strong force in naturethat makes for recovery, will promptlyreturn to normal weight andheight.The first step necessary to treatthese children is to identify them.Scales, a tape measure and a tableaverage weights for height will enableany person to discover all butthe border line cases, because anychild who is habitually ten per cent ormore under average weight for hisheight is retarded at least a year inhis development. This simple procedureof weighing and measuring thechild is the first practical measurefor success in his treatment. If theparent, the teacher, the school, andthe nurse and the child himself understandhis condition, in most instances,steps will be taken for itscorrection.The child's whole life at home, atplay and at school, especially his habitsof sleep, study and exercise, shouldreceive attention as affecting his nutrition.Practical demonstration shouldbe made of the essentials of growthand health of the child to parents,teachers and all concerned in his care.Work in nutrition is partly medicalbut largely educational.As yet it is impossible to have inmost schools, a trained nutritionistand a child specialist; often neitherphysician nor nutritionist is available,and it is a rare school indeed that hasboth on its staff. It usually follows,therefore, that any nutrition workthat is done—the selection of childrenin need of nutritional care and theprovision of such care—must be donelargely by theteacher.In selecting children in need of nutritionalcare, the teacher has recourseto at least three methods, allof which should be used, but I willdiscuss only one. Determination ofweight and height is placed first notbecause it is the most important butbecause it is the simplest and can beaccomplished promptly at the outsetat one clear-cut, definite step in theright direction. Height and weightshould be determined for every childat the beginning of the school yearand weight at least every monththereafter. If the measurements areto be of any value, they must be takenaccurately at the same time ofday, with same amount of clothing,and with other conditions as nearlyuniform as possible.Weight alone is no longer regardedas adequate in judging nutrition.Nevertheless, weight is of decidedvalue in helping to determine nutrition,especially in selecting the markedlyundernourished group. Severalstudies have been made during thepast few years in which the resultsof weighing have been checked hymedical examinations. The generalconclusions from these studies is thatthe weight standard errs little in thechildren it selects as poorly nourished,but that it fails signally to selectall undernourished children. Many

8 The Health Bulletin October, 1930children who are less than ten percent underweight will be found on examinationto be poorly nourished, aswill also children of average weightor above. Such children may be ineven greater need of attention thansome of the underweight children becausethey are malnourished, whereasthose underweight may have dietsthat are qualitatively good but somewhatlow in amount.The teacher should be familiar withthe characteristics of a healthy, wellnourishedchild and should check eachchild against this standard. The chiefcharacteristics of nutrition whichthe teacher may observe are: thegeneral appearance of vitality andwell-being as reflected in the pupil'scai-riage, facial expression, and activity;his degree of thinness or fatness;the color of his skin and mucousmembranes; and the firmness orthe flabbiness of his flesh and muscles.Good nutrition requii'es a diet amplein amount and containing all theessentials for the growth and functioningof every part of the body.The teacher may get a fair idea of theadequacy of the pupil's diet by determininghis habits of eating and theextent to which essential foods enterinto his dietary. She needs to knowfor each child whether he eats breakfastand of what it consists of, whetherhe likes milk and how much hedrinks every day, whether he drinkstea or coffee and how much, whetherhe likes and eats vegetables, thenumber and the regularity of hismeals, and the amount of candy andother sweets he eats between meals.She should also know the usual hourof going to bed, the amount of sleep,the frequency of motion-pictureshows at night, the amount of homework he has to do, the number ofhours spent outdoors, and other importantfactors.The most accurate method of securingthis information is through privateinterviews. It is easy for theteacher, who is interested, to gain theconfidence of children or their parentsand to find out the exact facts.With this information before theteacher, she can plan her nutritionprogram to meet the needs of hergroup. She will know which food andhealth factors need to be most stressed;which children need to add extraweight; and what, in general, are theproblems on which she needs to work.She will be in a better position tojudge the nutrition of her group thanif she had trusted to weight alone,and she will have the data with whichto begin a sound piece of constructivework, her aim being not merely tobring a few underweight children upto average, but "to secure for everychild an adequate diet, a wholesomeprogram of living, and a state of optimumnutrition and good health."A study was made among 1773 childrenin the elementary schools ofMoberly, Missouri, including six publicschools, two parochial schools, andone negro school. This study was undertakenby the Nutrition Service ofthe Midwestern Branch of the AmericanNational Red Cress. The workwas under the direction of a trainednutritionist. The teachers made andrecorded all weighings of the children,exerting every effort to carry out theinstruction of the nutritionist. Thephysicians in the city assumed responsibilityfor the physical examinationof all children. Estimates of underweightwere based on the Baldwin-Wood table. Visits were paid to thehomes of the children and every effortmade to enlist the interest of themothers in correcting this conditionthrough the removal of physical defects,proper food selections, and theestablishing of good health habits.In addition to directing the study,the nutritionist spent a half-hour periodevery week in each room concerned,teaching the children nutritionand its relation to health.

October, 1930Effect of nutrition instruction onunderweight among the 1773 schoolchildren.The Health BulletinTHEN AND NOW

10 The Health Bulletin October, 1930OUR CHILDREN(Editorial by Miss Helen Dunlap in Edgecombe School News)The universal reason for the worldcontinuing to exist is children. Imaginethe chaos that would result ifsuddenly all children were taken fromthe world and the hope of any newchildren entirely killed.Overnight the fundamental urgethat keeps the world moving along ina well ordered manner would ceaseand take with it all the motives thatare building a civilized world. Barbarismwould succeed civilization,materialism would supplant idealism,selfishness take the place of unselfishness,and the present far-reachingachievements of mankind would crumbletodust.It is through our children that wemay continue to live; through themthe achievements of one generationare carried on to the next and thenext. Down through the pages of historychildren have been constantlymoving forward in the stage of life.Savage races had little regard forchild life, the higher the race is civilizedthe greater the emphasis isplaced upon childhood. And now in theeducational world the 20th century isbeing called "the century of the child."Of all nations, it is probably truethat America has the most idealisticattitude toward childhood. She is demonstratingthis in her nation-wideprogram of public education. The philosophyof present day educationalleaders is: That No Child Shall BeBarred From the Right of a GoodElementary and Secondary Education.Mothers and fathers, next Septemberyou are going to start your littleboy or girl upon a new adventure.They are going to leave the smallworld of the home and enter into anew and fascinating world. All of usknow that if we start the small onesout with strong and sturdy bodiesand good equipment that they will getmuch more out of their school life.We have six months in which toget them ready to start to school. Weare most anxious to have them cometo school in the best physical conditionso that they will be strongenough to do a good day's work everyday and stay in school every day. Wewould like to have every mother andfather in Edgecombe county take astheir goal the starting to school of a100 per cent healthy child next September.We, the schools, are very anxious tohelp your child develop good habitsthis first year. We want to have thekind of school in which he will findhappiness, success and stimulation togrow in a well rounded development.Won't you help us to make this yearthe best first grade year that we haveever known. If the doctor finds thatyour child has bad tonsils, or bad eyesor bad teeth won't you please havethese defects corrected this summerand send a strong healthy child toschool next fall?In addition to the importance ofhealth, may I not urge that you alsotry to keep your child in school everyday. We have so many first gradechildren that fail to finish first gradein one year merely because they missso many days. Won't you please keepyour child in school every day?TTie third important item that Iwish to call to your attention isschool materials. So many parentsseem to think a child can learn withoutschool material, or that all thatis necessary is a book. Outstandingeducators have found that little childrenin the first grade cannot learnand do not develop when they do nothave the needed materials. Won'tyou plan this summer to lay aside

October, 1930 The Health Bulletin 11enough money to buy the child'sschool materials on the first day ofschool next fall?Every year we haveseveral first grade children that cannotfinish first grade merely becausethey do not have their materials.i All parent-teacher associations areearnestly urged to make a united effortto help start the finest andhealthiest group of children next fallthat have ever been started in thehistory of Edgecombe County. Let'sremember that we cannot build an enduringprogressive state with weak,sickly, dull children for "the futurerace moves forward on the feet of littlechildi'en."AN EYE TROUBLE OF MID-LIFE AND LATERThe first serious change of visionto affect the man or woman approachingmiddle life is known as presbyopia.It is not a disease, but is anatural physiological process whichall human eyes and many animal eyesundergo at certain periods in life.Persons with beginning presbyopia,when reading, are often observed bytheir friends to hold a book or paperfarther away from the eyes than formerly.Why do they do this? The answeris simple if one appreciateswhat gives the human eye sharp nearvision.A few words of explanation.In every eye, the entering rays oflight coming from the near objectmust be brought to a focus in the centralback part of the eye on the retinain the region called the macula.The macula is the point of clearesti vision. This spot is not as large asthe end of a lead pencil. It is only inthis macular region that we get goodvision. If the focus is sharp, visionwill be clear. If the rays of light arenot brought to a sharp focus, then, aswith the microscope or opera glassnot sharply focused, we see indistinctly.In order that light may bebrought to a sharp focus on the sensitivespot of the retina, the crystallinelens, that firm, crystal-clear bodysuspended by nature just behind thepupil of the eye, changes its shape.Certain inside muscles pull or relaxto adjust the shape of the lens for thereading focus or for close work. Inyouth and early life, except with nearsightedpeople, as the muscles insidethe eye adjust their pulls for nearvisionthe lens bulges forward (bysome is even said to flow forward).This act sharpens the focus as needed.Nature, in making the lens, apparentlyhad some difficulty in providingnourishment for a long life, ashappens with other tissues of thebody, and, at the same time, keepingthe lens clear as glass. Blood vessels,if supplied to the lens as to otherparts of the eye, would shut out thelight,—the lens must be kept clear, Adifferent method had to be followed.In front of the lens is a clear wateryfluid resembling distilled water witha tiny bit of salt in it; back of thelens is a jelly-like substance (thevitreous), also clear and transparent,thus making nature's provision foreasy passage of rays of light. Fromthese transparent fluid substancessuitable nutritional elements mustpass through the covering capsule ofthe lens to nourish the tissues insideof it, in order to replace what wearsout from use and to keep the lens inhealth.At about the age of forty years,sometimes as late as fifty, changestake place in the lens and its capsuleand in the muscles which control thelens. These changes affect the easewith which the lens may be reshapedfor sharp vision. Its elasticity graduallybecomes affected. The insidemuscle pulls may, for a number ofyeai"s after this lens change begins,continue providing fairly sharp vision,but often these muscles show impatiencewith the added load of work, bysuch symptoms as headaches, sleepiness,inability to continue work for

12 The Health Bulletin October, 1930the visual length of time. The affectedindividual, unless he be near-sighted,relieves this strain by pushing readingmatter and exacting work fartheraway. Sooner or later, very commonlyin the middle of the forties, sometimesfive or ten years later, the individualnot previously wearing glasses, is requiredto wear glasses for near work.As a rule, in mid-life one sees at adistance of from arm's length up to along distance ahead just as accuratelyas in youth.With primitive people, as Indians,and those people who work in theopen, the elders may continue thehunt, or chase, or ordinary work withoutnoticeable inconvenience as longasthey are otherwise physically fit.Unless faults of vision were shownearlier, no glasses are needed for theelders of primitive people who loafabout the camp, tepee, or pueblo, norin times of idleness during old age,nor would glasses be required for ordinaryworkers at occupations beyondarm's length—plowing, chopping, digging,etc. Close vision is not requiredof these people for any extended periodof time.With the printing press and universaleducation, with the factory andindoor labor, with close use of theeyes during nearly all waking hours,came the demand for glasses. Afterthese physiological changes have occurredthe loss of elasticity needs tobe supplemented in most persons withappropriate glasses.No Hian or woman should worryabout this natural change requiringthe use of lenses for close work evenin early middle life. It comes to nearlyall some time between 40 and 55years of age, and until nature makesa better eye, or is able to supply nutritionto continue the elasticity of thelens as found in youth until old ageis reached, human beings will havetocooperate and wear properly fittedlenses for the time presbyopia developson throughout life, or adopt thealternative: cease close use of the eyes,which m.eans to cease reading andgive up close work.—National Societyfor the Prevention of Blindness.GROWING UP TO THIRTYBySUDIE E. PYATTThirty used to be an age at whichone had definitely left youth behind,and though not quite middle-aged, onewho had reached the age of thirty v/asrecognized as being a candidate in thenear future for the honors of themiddle-aged. A single woman at thirtywas a hopeless old maid, and amarried woman at that age had leftyouth forever behind her, while menwere going down the hill toward acomfortable middle-age.Todas'', at thirty men and womenare just getting ready to live. Singlewomen at thirty are far from beingold maids, or even bachelor girls.They are alert, wide-awake, youngwomen, looking as youthful as manyof them did ten, twelve, or even fourteenyears before.Married women atthirty are right in line with theirsingle sisters of that blessed age,and no one thinks of a man at thirtyas being eld, though he may alreadyhave accomplished more than hisfather or grandfather had at that age.This year I have an importantbirthday. I have grown up to thirty.I like being thirty. None of my othertwenty-nine ages have I liked quiteso well as I do this friendly thirty.Thirty, I decided was a convenientplace on the road of life at which tostop and take stock, to look back overthe years that were gone, and to lookforward to the years that were ahead.A philosophy of life, somethingto live by, makes life more comfort-

October, 1930 The Health Bulletin 13able and more satisfactory and happy.Thirty is a good place at which todefinitely formulate this philosophy,if it has not taken shape earlier, so Ibegan to put down in tangible sentencesand paragraphs my philosophyof life—this story!After formulating a philosophy oflife, which is another phrase formental health, thirty, I knew was, agood age at which to check up onphysical, as well as mental health,and to determine just how my bodystood, to my advantage, or disadvantage,and to plan to enhance theadvantages, and make the disadvantagesless of a drawback.At thirty, I realize, too, that I mustbegin to lay plans, so that when middle-agedand past that age, I mayenjoy some of the privileges thatcompensate for those ages.Ihave grown at thirty to:1. Know that good health, mentaland physical, is one of the most importantthings for any individual.2. Have a philosophical attitudetoward marriage.3. Be a square shooter in business,love and social relationships.4. Be a better friend, and to understandothers better.5. Know people like you just as wellif you are not a great success, providingyou have the other attributesof a good companion and friend.6. Stop expecting too much of myselfand others.7. Know that dreams if ever livedmust be lived in today.8. Know the beauty of passing happiness.9. Have a conception of a friendlyGod-Father.10. A happy view of death.11. A knowledge of the worth ofaccumulated months and years of experiencein one particular line ofwork.12. Appreciate the extra compensationsof work.13. Learn that somehow courage,hope, strength, do come to help onemeet storms of sorrow and disappointment.When I was a little girl I usedfrequently to hear my grandmother,a typical woman of the old southernschool, say, "Without health you cando nothing."It took a serious illness, and nearlytwo years and a half in a sanatoriumto teach me the value of health, andits relation to the success and happinessof the individual. For as mygrandmother said, neither success norhappiness is possible without, at least,a fair degree of good health.Learning the value of good health,and after many months finally acquiringa return to near normal health, Idiscovered that good health, bothmental and physical, was more a modeof living, and thinking, proper livingand thinking, than anything else. Tokeep my good health now I know thatI must live according to certain healthrules that with the aid of physicians Ihave formulated for myself. The lesscomplicated, and more natural theserules are, I find the better my healthis, providing I strictly observe thesefew simple rules.My rules, which are flexible, are:A tepid bath, ending with a coldshower each morning.Two glasses of water before breakfasteach morning, and six or moreglasses during the day.Teeth brushed twice each day, anda good mouth wash used once a day.Three good meals at regular hours,with milk, fresh fruits and vegetables,making up a part of my diet.Retire not later than 10 o'clock sixdays out of the week.One to two hours rest, minus myouter clothes in bed each afternoonwhen I return from woi'k before goingto my evening meal. (Formerly Irested two hours every afternoon, afterthe mid-day meal, but my workdoes not allow that now.)A checking up at the hands of aphysician, who is a specialist in the

14 The Health Bulletin October, 1930disease, which caused my serious illnessseven years ago. (This would notbe necessary for a person who hasalways enjoyed fairly good health,and has no fears of the possible returnto activity of some chronic condition.A checking up at the hands ofa physician once a year, is sufficientfor the average person.)Visit a dentist twice a year.Refuse to entertain regrets aboutthe past, or fears for the future.Expect happy, cheerful things.Meet everyone with a smile, nomatter how badly I dislike them. Itis marvelous how smiles clear awayclouds of dislike.Be as nice as possible withoutbecoming too intimate with everyone Icome in contact with in both my businessand social life.These aren't the best or the worstrules a man or woman might adopt tolive by, but in my case they fit, and Ihave found them workable.In love, in business, in social relationships,I have learned that if Ishoot square, and am honest with myselfand others the rest does not matter—somuch!I began to be a better friend somewhereback along the years I havetraveled to reach this pleasant thirtywhen I learned the advisability ofstudying people and discovering theirlikes and dislikes, and to respect theselikes and dislikes no matter how muchthey might be at variance with myown.Before I grew up to this friendlythirty I was too busy thinking of myown adjustment and maladjustment topeople and conditions to spend anytime trying to discover why peoplewere as they were, and why a certaincondition was as it was.A better understanding of the peoplein the world in which I live hasbeen one of thirty's gifts to me."I don't know what you have doneto yourself, but I like you much betternow than I used to, though I'vealways liked you." That's what afriend of mine, who has not seen mein ten years, said to me a few daysago, after our acquaintance had beenrenewed. The difference between whatthat friend used to think of me, andwhat she thinks of me today, I considerone of the greatest compensationsof having grown from twenty tothirty in the decade since she firstknew me.It isn't easy for me to tell just whymy friend likes me better now thanshe did ten years ago, but I think Iknow one of the reasons.I am more interested in her, and inother people than I was ten years ago.It was a great moment for me, inthese years as I have grown up tothirty, when I realized that peopleliked me just as well if I were nota great success, providing I had theother attributes of a good companionand friend. In my teens I was firmlyconvinced that people would not likeme unless I had rich parents, or Iwas very successful on my own account.My parents had never beenwealthy, and in order to have friendsI felt that I must first become a businesssuccess.I have discovered that people donot care a whoop whether I am a successor a failure as long as they likeme, indeed, they are more likely tolove me if they do not think I amsuch a howling success. A mediumamount of success, that is all right,but people do not want too much successof the people they associate within their everyday rounds. It makesthem feel less important themselves,and no on wishes to feel any less importantthan one has to.People are more interested in impressingme with their own importancethan they are in discoveringjust how important I may or may notbe. They had rather tell me of theirown successes—and operations—thanlisten to an account of the number ofstories and articles I have had published—ormy own tonsiloperations.

October, 1930 The Health Bulletin 15With the realization that I was underno obligation to be a great successin order to make friends a burdenrolled from my shoulders. The onlydifference was I had learned to be agood neighbor, which I had not beenbefore. I had taken time to discoverthat other people had ambitions, too,even if they frequently were not moreexciting than a deteilnination to bethe best little relator there was of along and uneventful life.I have stopped expecting too muchof myself, of others, of situations,of life. I have dreamed some wonderfuldreams, built some marveloushomes in the air that I have neverlived in, in growing up to thirty.I am glad I dreamed the dreamsand built the castles—and lived inthem for joyous moments of pureecstasy, but grown up to thirty Iam glad that I can find happiness,that the future looks inviting, andworthwhile without any dreams thatmight, but never do come true, or anycrystal, rainbow-hued castles in Spain,—I say Spain because that is the traditionalplace where castles thatmight be built by dreamers find themselvestowering among the rosyclouds of day and night dreams, morefrailthan soap bubbles.I am an incurable dreamer. I shallalways dream, but at thirty mydreams are much more possible of fulfillmentthan they were at sixteen.Growing up to thirty I was anxiousfor the days to pass, looking forwardalways to some marvelous day wheneverything would be perfect. No more.I have grown to know that dreams ifever lived must be lived in today. Inever know what my day is going tobring me. It may bring me only theprosaic commonplaces that everydaybrings. It may bring me many unexpectedthings, and in the unexpectedIfind some of my greatest joys.Happiness is a ray of sunshine betweentwo clouds, someone has said.The beauty of passing happiness ismine to enjoy at thirty. Younger, onewants the divine dance to last notall night, but forever, forgetting thatit takes many hours when there areno dances on the program to makepossible that one divine hour of dancing.God, and religion? At thirty Godis an informal father to me, to whomI can take the difficulties of my daysthat no one else could ever understand.God is very good to me, for alwayswhen I need aid, in those crisesthat will come to everyone, he hasnever failed me. When I need spiritualaid, moral strength and guidance, andask that friendly God of mine for itI always receive it.In my early twenties I was ill forlong weary months, an illness fromwhich I have not yet recovered, andfrom which doctors say I will neverentirely recover. The fear of deathwas very strong within me in thoseearly days of my illness. But throughmonths of calm thought while I layill I learned to think of death in whatI think is the right way—the naturalend of a period of growth here thatsomewhere, I know not where, will betaken up again.The thought of interment maddenedme in those days of critical illness.Gradually I learned to think of it assleeping quietly, held close in theearth mother's warm arms, whileabove me green grass and brightflowers would bloom, the birds wouldsing, and the sun would rise in theeast, journey through the sky and setin the west when the day was done,its bright rays that I had loved inlife, always shining there just aboveme.However wrong I may be thesethoughts bring me peace of mind. Iam glad that thirty has brought methis sun-warmed thought of death.Illness brought me—for no story ofmy growing up to thirty would becomplete without the story of thatillness of mine—a happy view of

—16 The Health Bulletin October, 1930death. It also taught me understandingand sympathy.I may find an old lady's account ofher illness boring—they usually arebut I listen now, because I know thatto her the trouble is very near andreal.Work that I have loved, becauseout of all the possible things I mighthave done I chose to learn to writeI do not say write, but learn to write—has kept my soul steady on its keelthrough moments when the storms onthe sea of my life threatened toswamp the craft. Through opposition,disappointment in both work and love,discouragement, illness, soul battles,and often ignorance and stupidity, Ihave gone steadily on toward my goal,working toward the thing I want mostof all—to be a real writer.I have grown enough in my workthat when I have to resort—as I occasionallyhave to— to advertisingin publishers' magazines, now I canadvertise: "Eight years experience,three successful years editing andmanaging small publication, featurearticle writer, general reporter."Not much, but that is anotherthing the years bring, the worth ofaccumulated months and years of experiencein one particular line ofwork.An appreciation of the extra compensationsof work, those pleasantlittle things that grow up out of businessrelations and connections, is oneof the things from which I derivemuch genuine satisfaction.Grown up to thirty I am lookingcalmly down the decade before me beforeI reach forty. I am not worryingabout forty. The forties will take careof themselves when they arrive. Youcan't plan your life and expect it towork out the way you plan it. You'vegot to mind your own business, andkeep plugging along, be it for thetime, or the years.It has taken me three decades ofgrowth to grow up to thirty. Tenmore years of growth of work, ofconstructive dreaming—for dreamingthat is not constructive is only apleasant pastime—and when I'vegrown up to forty perhaps I shall bethe real writer than I want to be atthii-ty, but am not. But always therewill be something else I want to do.I hope I die "with my boots on"notebook and pencil in hand, a typewriterhandy, working on that laststory that may or may not live forposterity.And out of it all, at thirty, it seemsto me that this is the only real thing:God sent to one, a storm, days ofsorrow, pain and disappointment.Ruthlessly he smashed cherishedplans and hopes. A body that had beentall and strong was laid low in illnessand pain, and there were long,weary, heart-breaking months ofwaiting.He gave courage, hope, strength tomeet the storm of sorrow and disappointment.He gave some friends, wholoved, who cheered, who understood.After weary months he brought an ill,pain ridden body back to health, andgave nev/ tasks—and God made asoul!WATEROf all curative agencies, water isthe most universal, the most versatile;in general, the most potent, atthe same time the most simple in itsmodes of application, and yet capableof the most highly specialized andtechnical adaptations.Said Claude Bernard, the greatFrench biologist, "All life is underwater." Underneath the skin, all thecells and tissues of the body are submergedin the blood and other liquids.We think under water. The heart,liver and muscles, the stomach—allour organs—do their work underwater. In fact, we "live and move andhave our being" under water."—GoodHealth.

Pu"bli5\edbij TnE./^°RmCARPLI/^A 5TATLE)9AR.D s^AmLTA1 Thi5 BuJklinw illbe ^ent free to arwj citizen of Ihe StaieupoAregugst jEntered as second-class matter at postoffice at Raleigh. N. C, under Act of July 16,1894. Published monthly at the office of the Secretary of the Board. Raleigh. N. C.VOL. XLV. NOVEMBER, 1930 NO. 11WHAT NORTH CAROLINA MAKESMAKES NORTH CAROLINAIn regard to this epigram of Governor Gardner, we would say that the mostimportant thing that North Carolina makes is its citizens, -present and future.Without them North Carolina would not make anything, nor be anything.NORTH CAROLINA MAKES CITIZENSCITIZENS MAKE NORTH CAROLINAt^WfW^^^^^

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTHA. J. CROWELL, M.D., President CharlotteCYRUS THOMPSON, M.D JacksonvilleTHOMAS E. ANDERSON, M.D StatesvllleE. J. TUCKER, D.D.S RoxboroD. A. STANTON, M.D High PointJAMES P. STOWrm, Ph.G CharlotteJOHN B. WRIGHT, M.D RaleighL. B. McDANIEL, M.D JacksonCHARLES C. ORR. M.D AshevllleEXECUTIVE STAFFH. A. TAYLOR, M.D., Acting Secretary and State Health OfficerRONALD B. WILSON, Assistant to the SecretaryC. A. SHORE, M.D., Director State Laboratory of HygieneG. M. COOPER, M.D., Director of Health Education and "Vital StatisticsH. E. MILLER, C.E., Chief of Bureau of Sanitary Engineering andInspectionERNEST A. BRANCH, D.D.S. , Director of Oral HygieneD. A. DEES, M.D., Field Assistant In County Health WorkFREE HEALT-H LITERATUREThe State Board of Health publishes monthly The Health Bulletin,which will be sent free to any citizen requesting it. The Board also hasavailable for distribution without charge special literature on the followingsubjects. Ask for any in which you may be interested.Adenoids and TonsilsCancerConstipationColdsClean-up PlacardsChickenpoxDiphtheriaDon't Spit PlacardsEyesFliesFly PlacardsGerman MeaslesHookworm DiseaseInfantile ParalysisInfluenzaMalariaMeaslesPellagraPublic Health LawsPrenatal CareSanitary PriviesScarlet FeverSmallpoxTeethTuberculosisTuberculosis PlacardsTyphoid FeverTyphoid PlacardsVenereal DiseasesWater SuppliesWhooping CoughSPECIAL LITERATURE ON MATERNITY AND INFANCYThe following special literature on the subjects listed below will besent free to any citizen of the State on request to the State Board ofHealth, Raleigh, N. C:Prenatal Care (by Mrs. Max West) The Runabouts in the House of Health"Our Babies"(pamphlet for children from 2 to 6Prenatal Letters (series of nine years of age).monthly letters)Minimum Standards of Prenatal CareWhat Builds Babies?Breast FeedingSunlight for BabiesHints to North Carolina Mothers WhoWant Better BabiesTable of HeigTits and WeightsPAGEThe Control of Tuberculosis by aCounty 3Resolutions Adopted by the StateConference on Tuberculosis 3Program for the Control of Tuberculosisin Forsyth County 7A Tuberculosis Program ShouldHead Up at the Tuberculosis Sanatoriumin Those Counties ThatHave a Sanatorium 10The Part Played by National, Stateand Local Tuberculosis AssociationsIn a Tuberculosis ControlProgram and the Relation of theSchool System to Such Program^ 14The Responsibility of the Physicianin the Program of TuberculosisControl 19CONTENTSBaby's daily Time Cards: Under Smonths; 5 to 6 months; 7, 8, and 9months; 10, 11, and 12 months; 1year to 19 months; 19 months to tyear's.Diet Lists: 9 to 12 months; 12 to 16months; 15 to 24 months; 2 to 3years; 3 to 6 years.PAGEWomen and Women's Organizationsin the Tuberculosis ControlProgram 23CharlotteCity-County TuberculosisClinic 24Mortality and Morbidity of Childrenof School Age 26Are We Educated? 27University of North Carolina OffersHome Study Courses 29Treat the Child, Not the Posture— 29Suicides 30Oral Hygiene 31"Heavy Trucks Prohibited" 31Important to Prevent TuberculosisNow 31Deaths from Pulmonary Tuberculosisby County and Race: 1929— 32

VOL. XLV. NOVEMBER, 1930 NO. 11THE CONTROL OF TUBERCULOSIS BY A COUNTYWe are glad to print in this issue,papers read before the Annual Conferenceon Tuberculosis held by theNorth Carolina Tuberculosis Associationat Salisbury, August 7th, 1930,which sets forth a county plan adoptedby Forsyth County for the controlof tuberculosis. The plan is good, andhas the approval of about every organizationthat one would think of asbeing interested.When an important piece of work,as this is, is attempted there are twoimportant things to do:1. Plan your work.2. Work your plan.In this instance the work is wellplanned, and every one in North Carolinaand elsewhere interested inhealth work and particularly in thecontrol of tuberculosis, will watchwith eager interest the working outof the plan.We are also using as the first articlein this Bulletin, resolutions passed,by the State Conference on Tuberculosisabove referred to. The NorthCarolina Tubei'culosis Association hasalways claimed, and rightly so, thatthe fight against tuberculosis is everybody'sfight.The North Carolina TuberculosisAssociation has rendered and continuesto render conspicuous serviceto the people of our state.G. M. COOPER, Editor.RESOLUTIONS ADOPTED BY THESTATE CONFERENCE ON TUBERCULOSISSALISBURY, AUGUST 7th, 19301. We congratulate the people ofour state, and express appreciation tothe National and State TuberculosisAssociations, State Sanatorium andState Board of Health, including localHealth Departments, over the constantlydecreasing number of deathsand number of cases of illness on accountof tuberculosis, over a goodlynumber of years. We also congratulatethe people of our state on theimmense economic saving incidentthereto.2. We desire to record our approvaland appreciation of the researchwork done in tuberculosis, initiatedand directed by the National TuberculosisAssociation and largely financedby the National Tuberculosis Associationfrom the sale of ChristmasSeals. It is stated on reliable authoritythat we now have sufficient knowledge,if it were made concrete amongall the people, to drive tuberculosisfrom our state and nation. It hasbeen truly said that tuberculosis is"everybody's fight," and we sincerelyrequest co-operation of every organization,every official, every man,woman and child in North Carolina infinishingthe fight against tuberculosisin our state.3. In times of stress, whether war,pestilence, famine, financial, unem-

ploment, or what not, the tendency isfor tuberculosis to show a marked increaseboth in number of cases andnumber of deaths. During the WorldWar some of the European nationsshowed more than 300% increase.It therefore behooves us and thepeople of the state to enter moreheartily, more enthusiastically, andmore efficiently into the fight againsttuberculosis than we have ever done,and our efforts should be directed towardthe prevention of infection andkeeping the bodies of our citizens,particularly our children, in at least anormal state of nutrition and we mustfind the cases and treat those in needof it.The Annual Seal Sale from Thanksgivingto Christmas is a splendid outletfor our energies, as its main objectis to carry on these very things.In this connection we desire to expressour regret that in the 20% cutin appropriations found necessary byour State Budget Commission, it hasbeen made to apply to the State Departmentof Health including CountyHealth Departments and tuberculosiswork. Appropriations for these thingsshould be increased rather than decreased,particularly in times of depression.The County Health Departmentsshould be enlarged and extendedrather than decreased and curtailed,and we express the hope that away will be found to do this. Whyshould we pay county and state taxesfor education and curtail the appropriationsto health and tuberculosiswork, thereby increasing the numberwho are unable to attend school andthe number who though able to attendschool are unable to pass theirgrades. We might ask which is themore important, the child or the educationwe try to give him?4. We approve wholeheartedly theplan of tuberculosis control with thecounty as the unit, as presented tothis Conference at the session thisafternoon and we express the hopethat every county Health DepartmentThe Health Bulletin November, 1930in this state adopt and put into effectthis program, and that all othercounties so unfortunate as not tohave the services of a health department,put into effect such parts ofthe program as may be possible. It isrecommended that all and every countyundertaking this completed programor any part of it, or any tuberculosisprogram, secure the adviceof experts and particularly the NorthCarolina Tuberculosis Association,and through it, the National TuberculosisAssociation and the NorthCarolina Sanatorium.5. We approve of the splendidwork of the North Carolina Sanatoriumincluding its extension department,which has been and is receivingnational and internatonal recognitionand approval. And we request the authoritiesto relieve the extension departmentof the 209c cut for thisyear and the general assembly to increasethis appropriation for the nextbiennium.6. Nutrition: Possibly we can affordto have our real estate sold byforeclosure, or for taxes, but we cannotafford to be sick nor can the stateafford to have its citizens sick, andleast of all can the state afford tohave its citizens ill with tuberculosis,and particularly is this true in timesof financal depression and unemployment,for the reason that tuberculosisis the most expensive disease thatany one can die from or get well of,in fact, tuberculosis costs the statemore than all other preventable diseasescombined.As the proper nutrition of the bodyenables it to resist casual infectionsfrom tuberculosis and all other diseases,and plays such an importantpart in the recovery of a person afterthe infection has become disease,we desire to express our appreciationof the teaching and practicaldemonstrations along this line by theHome Economics teachers and HomeDemonstration Agents, and to sayfurther that we need them more to-

November, 1930The Health Bulletinday and we need more of them todaythan any time in the life of any ofus now living. In this connection maywe give expression of our appreciationof the valuable aid in this mattergiven by the parent-teachers associations,the Departments of Educationas a whole, and many other organizedgroups in our state.While this Conference has no intentionof entering into a detailedscientific discussion of nutrition orthe subject of diet in connectiontherewith, we do feel that we shouldrefer to milk as the most importantsingle article of diet and recommendits use in every home.7. The Welfare Officer: This officernecessarily comes in close andfrequent contact with Tuberculosis,for this disease attacking the head ofa family destroys, both financiallyand physically. This contact bringsabout a deep and intelligent intereston the part of the Welfare Officer,and as naturally follows creates adesire for the prevention of the disease.It is not at all infrequent that theWelfare Officer, in the absence of aHealth Department, heads up andpromotes the tuberculosis clinics forboth children and adults and frequentlythe sale of Christmas seals.Their interest and activity are greatlyappreciated and commended.8. The Women's Clubs: We mustmake special reference to the cooperationof the Women's Clubs.Where there is no organized TuberculosisAssociation in a county, theWomen's Clubs through their HealthDepartments have organized and conductedthe Seal Sale and followedthrough in a wise expenditure of the75% left with them, and this is thecase in the majority of the counties.Examples of Accomplishments: Oneclub co-operated with the North CarolinaTuberculosis Association inbringing the first Public Healthnurse to North Carolina and fromthis a State Director of PublicHealth Nursing followed. Numerousothers have followed this lead andare now helping with public healthnursing in their local cities and countiesand in many instances havingbeen wholly responsible for establishingthis service, always using theSeal Sale funds for financing same.Another, through its President establisheda county-wide organizationwhich they named the County Healthand Welfare Association, and thisfine organization a little later establisheda good Health Department inthis county. Another has recentlybought a tract of land and erected aTuberculosis Camp with a capacityof thirty and is now planning todouble the capacity for next year.Every County Tuberculosis Associationand every Seal Sale organizationwhether or not it be the Women'sClubs have aided largely withnutrition and health habit formation,among the school children and manyhave financed the x-ray films usedin the children's clinics of the ExtensionDepartment of the NorthCarolina Sanatorium.9. Kiddy Kamp—Preventorium: Thefirst preventorium in North Carolinawas established by the Cumberland

The Health Bulletin November, 1930County Tuberculosis Association andit is nothing but justice to say thatMiss Lucia Freeman, Red Cross nurseat Fayetteville, was the mo^^ng spiritand largely responsible for the inceptionand success of the undertaking.This was conducted the year round,and that idea is something for us tothink about in connection with thiswork today. Salisbury and Row^anCounty three years ago began thesplendid work we have seen today.is impossible to compute the value ofthis initial work.It is a pleasure to invite your attentionto the fact that there are atthis moment five of these preventoriumsin operation in our state, Rowan,Cabarrus, Davidson, Durham andthe newest one Gaston, and there arein the neighborhood of 200 childrenbeing cared for in these five camps.There are also three children's divisionsof County Sanatoriums, Mecklenburg,Guilford, Forsyth and oneChildren's Sanatorium, Catawba,where about 160 children are beingcared for, and the children's divisionof our State Sanatorium, with a capacityof 70, making a grand total430 children that are being treatedat this time. The discharge and admissionsfrom State and County Sanatoriumswould make a total of 660 to700 children being treated annuallyin camps and sanatoriums. This iscoming a "far piece" in four years,but it is only an indication of whatwe ought to do and an earnest ofwhat we will do.10. Open Air Schools: While openair schools have been in more or lessgeneral use in the New EnglandStates, thanks to our State Departmentof Education and particularlyMr. Blair, who had immediate supervisionof the planning and architectureof our school buildings, we donot need open air schools, but we doneed to use the ventilation providedwhich in some instances we are informedand believe is not used,11. The 5% Must Be Cared For:ItofThe County Health Departments andschools with such help as they may beable to obtain must assume the responsibilityfor properly caring for2,500 children out of the 50,000 examinedby the Children's Clinics of theExtension Department of the StateSanatorium. There are about b% ofthe school children in the state, or atotal of 45,000 in round numbers,though only 2,500 have been found,that will come within this classification.These have been found infectedwith tuberculosis, but are not sufficientlyill to be in need of treatmentin a Sanatorium, but if not properlycared for will no doubt account forthe cases in the next few years, andparticularly the cases of adult tuberculosisfrom the teen age to twentyfiveyears. The proper way to carefor them is; (1) to find all defectsand have them remedied; (2) find alldiseases and have them cured; (3)stop whoever has been infecting themfrom doing so; (4) keep them in A-1physical condition by nutrition classesand health habit classes in theschools. It is apparent that each ofthese four measures will require theco-operation of a physician. The summercamp will be of great help also.12. Sanatorium Treatment: Oneand five-tenths per cent of the 65,000examined are in need of Sanatoriumtreatment, though if the camp wereconducted over a period of say tenmonths in the year, many of thesecould be treated there. That meansthat 900 out of the 65,000 examinedare in need of sanatorium treatmentand that 1.59c of 900,000 school childrenor 13,500 children in the stateare in need of Sanatorium treatmenttoday, while the state and county sanatoriumsincluding Catawba Countycan only treat about 500 to 700 childrenannually.13. The Pre-School Child: Thereis infection in the pre-school children,just how much we do not know, forstudies of this age group have notbeen made in our state. The Parent-

November, 1930The Health BulletinTeachers Association are interestedin this group, especially the five yearolds, and they with the Health Department,the Clinic physician andthe private physician should care forthem. When the plan of control outlinedand discussed this afternoon isput into effect this group will becared for. Many of these who nowdie can be saved.14. Name for Camp—Preventorium:Many different names are usedfor the summer camp or tuberculosiscamp even in these resolutions, butwe recommend that the official namebe Preventorium.PROGRAM FOR THE CONTROL OF TUBERCULOSISIN FORSYTH COUNTYByP. A. YODER, M. D.Superintendent Forsyth County Sanatorium(Editorial Note: Approved by State Sanatorium for the Treatment of Tuberculosis,P P McCain, M. D., Superintendent; most heartily approvedCarolinabv NorthTuberculosis Association. L. B. McBrayer, M. D., Manaeins Directorcordiallyapproved by National Tuberculosis Association, KendallM.Emerson'D., Managing Director; unanimously approved by Forsyth County MedicaiCooperation. There should be theclosest cooperation between the Sanatoriumand the Health Departments,the superintendents of schools, principalsand teachers, the social andwelfare agencies, the local tuberculosisassociation. The help of theState Sanatorium may be needed attimes and of course cooperation willbe forthcoming. Cooperation individuallyand collectively on the part ofall the physicians of Forsyth Countyis very vitally needed. In fact thereshould be cooperation of all the peopleof all ages if the tuberculosisprogram is to be a success—and bysuccess is meant the finding of allcases of tuberculosis within the bordersof the county, administeringthe treatment needed, putting into effectthe known methods of preventionand following them for a longperiod of years.Case Finding. The principal sourcesfor discovering the cases of tuberculosisare the practicing physicians,the health departments, the clinics,the field nurses, the various welfareagencies, etc.The general program for the tuberculosiscampaign should head up inthe sanatorium and the SanatoriumSuperintendent, the other agenciesconsulting him and working closelywith the institution.Reporting Cases of Tuberculosis.All cases of tuberculosis discoveredin the County are to be reported tothe County Health Officer and allcity cases be reported to the CityHealth Officer, they in turn will reportallcases once each month to theSanatorium.Examination of Contacts. All membersof the household in which a caseof tuberculosis is discovered, familyand employees, should be given thetuberculin test; all positive adult reactorsto be given a physical examinationand all positive children reactorsto be given physical and x-rayexaminations.When a case of tuberculosis isfound in an adult every member ofthe family should be examined inorder to ascertain and care for thosein the family who have been infectedby this adult, and the infecting adultshould be isolated from the family,preferably in the Sanatorium. When

8 The Health Bulletin November, 1930tuberculosis is found in a child everymember of the family should be examinedin order to ascertain and removeand treat the person responsiblefor the infection of the child and findand care for others in the family whomay also be infected.Clinics. The City Health Departmentclinic should be continued. Thesuperintendent of the Sanatoriumwill conduct a clinic at the Sanatoriumfor the county cases and forwhatever cases are referred to himby the physicians of the city andcounty.The Sanatorium will make x-raypictures of all cases who are foundat the clinics to need x-ray films andwho are not able to have picturesmade by private roentgenologists.Children's tuberculosis clinicsshould be conducted in the schools:—The Health Department, the Superintendentof Sanatorium, and, if possible,volunteers from the MedicalSociety, cooperating. TTie tuberculintest should be given and the physicalexamination of the positive reactorsmade by physicians of the Health Departmentsand the Medical Society,and the x-ray films, one posteroanteriorand one oblique, on each positivereactor, to be made by the Sanatoriumx-ray department and thex-ray films to be read and the correlationof all the findings to be madeby the Superintendent of the Sanatorium;the parents to be advised totake their children to their familyphysician for the correction of all defectsthat are found; those childrenclassified as positive tuberculosis andactive to be sent to the Sanatorium;those classified as positive but inactiveand also those classified as"suspicious" to be placed under thespecial supervision of school nursesand the teachers, and their familyphysician.Sanatorium. The Sanatorium shouldhave charge of the treatment of allcases of tuberculosis in the countyexcept those who are treated by privatephysicians, and every personwho has tuberculosis should remainunder the care of the sanatorium untilthe final termination of the case, withthe exceptions noted. Thorough recordsshould be kept and all the recordsin regard to every patient inthe County should be continuing andcontinuous for the period mentionedabove and in addition family recordsshould be kept where there is a caseof tuberculosis. From time to timethere will be much valuable information,which if properly correlated andinterpreted may add to the sum to-of the public knowledge in regardtalto the treatment and prevention oftuberculosis and such things shouldbe published for the benefit of tuberculosisworkers generally and thepeople particularly.The Sanatorium, with its capacityof 182 beds, should be adequate forall the needs of the county. All activecases who are unable to go toa private sanatorium should be sentto the County Sanatorium; all positivesputum cases should be receivedwhether active or not for a period ofat least two or three months, or longenough for them to be taught to practicethe necessary precautions for theprotection of others; cases that cannotbe benefited and who can be caredfor at home should be sent home,after learning to take the necessaryprecautions, such cases to be visitedperiodically by the Health Departmentnurses.Sanatorium Superintendent. TheSuperintendent of the Sanatoriumshould be ready at all times to offerhis services as consultant to everyphysician in the County and shouldmake it possible for the physiciansto come to the Sanatorium to observemethods used and to study clinicalmaterial available.He should from time to time presentpapers on various phases of tuberculosisbefore the County MedicalSociety.The Health Department. In a gen-

—November, 1930The Health Bulletineral way the City and County HealthDepartments should have charge ofthe Health Education program as itrelates to tuberculosis, the nursingprogram, the nutrition and healthhabit formation program and thecomplete physical examination of thechild other than for tuberculosis. Physicaldefects and diseased conditions,other than tuberculosis should bediscovered and corrected and in thisthere is needed the closest cooperationof sanatorium. Health Departmentsand private physicians.The nutrition and health habit formationprogram should be carried onwith every child, whether it is infectedwith tuberculosis or not.Newspapers and Civic Clubs. Acounty-wide campaign to interest andinform the public should be carriedon and the cooperation of the newspapersand the civic clubs, such asthe Parent-Teacher Associations, theKiwanis, Rotary,Women's Clubs, theCivitan, Lions, etc., be enlisted. Inthis campaign the prevention andearly discovery of tuberculosis shouldbe especially stressed, and that allwho have suspicious symptoms shouldbe urged to report to their privatephysicians for examination and thatthe private physician be requested torefer any questionable case to theHealth Department or Sanatoriumclinic.The State Sanatorium. The ExtensionDepartment of the State Sanatoriumoffers its support in everyway possible to the furtherance ofthe Forsyth County Tuberculosis program.It will assist to the extent ofits ability with both adult and children'sschool clinics. It will furnishmuch of the literature. In the eventmore active cases of tuberculosisshould be discovered than can be caredfor in the local sanatorium, theState Sanatorium will take the overflowfor treatment, under the sameconditions as patients from othercounties.Tuberculosis Association. Local,State and National T'uberculosis Associationsapprove such a programfor the control of tuberculosis inForsyth County and will assist in everyway possible with such program.COMMENTThe County Sanatorium has a veryimportant role to play if this planis to work out successfully. Being theheadquarters for all the elements ofthe County Antituberculosis Unit, itis evident that nothing less than amodern well equipped and first classinstitution in every respect must bemaintained. It must have beds enoughto take care of the cases needinghospitalization; it must have serviceablex-ray equipment; it must havean operating room with apparatus foremploying the different forms ofcompression therapy; it must have anefficient clinical laboratory—in shortit must be able to give to the man inbed the benefits accruing from allscientific research, the blood-sweatingthought, the diligent labor—thathave piled up the mass of presentday knowledge of tuberculosis.An out patient department is necessary—wherean accurate decisioncan be made regarding suspectedcases as well as contacts of knowncases. And where follow up work withdischarged patients can be done. ThisThe Sanatorium should be theservice should be made available topatients through their family physiciansor the public health organizations.centerfor the dissemination of tuberculosisinformation for its districtworking through the health departments,its personnel should make everyeffort to aid in educating the citizenry—especiallyin methods of preventionand early detection. It shouldalso stimulate the interest of thepractitioners in watching for earlycases in their practices—and in doingsomething about it when a caseis found or suspected.Another important function is the

—10 The Health Bulletin November, 1930maintainance of contact betweenthe elements of the county unit andthe higher organizations of our antituberculosisarmy. The National Association,the State Association, andthe State Sanatorium must have agenciesconnecting them with the individualworkers—and it is up to theCounty Sanatoria and TuberculosisAssociations to serve as non-commissionedofficers (so to speak) if weare to have an efficient and well disciplinedarmy instead of an unorganizedmob.Along with all these shoulds thereis also at least one very importantshould not. While we are of coursefirst and chiefly concerned with thetuberculosis fight—still, we should notforget that we are one division of theforces striving for the betterment ofall health conditions. And the countyTuberculosis institution should be soconducted as to fit its activities inwith the general health programlending a hand whenever possible inall phases of all the health work undertakenin its county.A Tuberculosis Program Should Head Up At TheTuberculosis Sanatorium In Those CountiesThat Have A SanatoriumByJ. ROY HEGE, M. D.Health Officer Forsyth CountyA few years ago, we of the ForsythCounty Health Department prepareda recommended program of futureHealth work for the Women's Club,which was compiled and printed inpamphlet form by the MetropolitanLife Insurance Company for the GeneralFederation of Women's Clubs. Inthis recommended program we statedas follows: With the completion ofthe New Tuberculosis Hospital a wellorganized tuberculosis program forthe entire County including the Cityof Winston-Salem is needed—the directorof this hospital should be thedirector of this program and shouldfeel the entire responsibility of everycase of tuberculosis in the County.The City and County Health Departmentsand all outside official and unofficialagencies should cooperate withthe medical director of the hospitalin promoting this program. To derivethe most benefit from the hospital,the medical director should feelthe responsibility of the fieldwork aswell as the care and treatment of thepatients at the institution. Some suchprogram has been worked out and hasthe approval of the National TuberculosisAssociation and the State TuberculosisAssociation. The CountyMedical Society adopted it. I thinkall the necessary ground work hasbeen laid for a splendid piece ofwork in Forsyth County. Such a programhas unlimited possibilities towardthe complete eradication of tuberculosisin our county and withsuch a goal in mind, if we will directour combined activities to remove everyobstacle that presents itself, weshall in the course of a few years seethe results of our efforts.Let us consider in some detail theactivities of the Health Departmentsin such a coordinated programagainst tuberculosis. First, let mesay that we are not inaugurating thisdrive with any intensive mushroomenthusiasm. We are laying out a programwith deliberation and determinationto win the fight. We are diggingin. We want trenches on the

—November, 1930 The Health Bulletin 11front lines well fortified and protectedagainst any onslaught or even insurrection.We want a well laid fieldinfantry. We want some hand to handactivities. We will have a plenty ofbig guns in the rear ranks—somebig Bertha's. We have several ofthem here today. They are very necessaryin this war. It isn't the damagethat these boys do to Tuberculosisthat counts—its the influence theyhave on the morale of the field workersand their long range that reallycounts. You take today, these bigguns will be heard in Manteo andMurphy. The field workers in whichwe refer are the Public HealthNurses, the Associated Charity'sNurses and workers, the MetropolitanNurses, the Junior League field workers,the Civic Club interests, the generalpractioners and the private dutynurses—Women's Clubs and manyothers too numerous to mention. Theyare the only ones that can and willwin this battle. With this in mind, wepropose in Forsyth County to all putourselves at the order or commandof our Hospital Director rather thanto each and every agency attemptto direct his own activities. We feelthat he is just as capable to directa field program as he is an institution.We will go even farther thanthat, we don't believe that a publicowned and operated Tuberculosis Hospitalcan serve the best interests ofeach and every citizen in the County,without the Medical Director havinga full knowledge and authority toadvise and direct the field cases.When he has a vacant bed in his hospital,he should have before him suchinformation that would enable him tofill that vacant bed with the case thatbest adapts itself to general interestsof the program. Gentlemen: I saythis realizing that I'm opening theway for some interesting and worthwhile discussion, but any amount ofdiscussion will not change the factthat the worst enemy that Tuberculosishas in North Carolina today isthe waiting list at the State Sanatoriumand the County Sanatoria. Thesolution to this is a target for theBig Bertha's to focus their attentionSpeaking as one of the field workers—But in terms of a Big Bertha, Iwould say more hospital beds, is thesolution—But whose judgment wouldlead him to say so at this time ofcutting and slashing of budgets andall kinds of curtailment, regardlessof needs and demands. Speaking interms of a field worker, I would suggestthat the degree of advancementof the case should determine thestatus for admission and that that bedrawn as close to incipient casesonly, as the number of hospital bedsdemanded. I wish to apologize formaking this suggestion to Sanatoriasuperintendents. I make it because ofmy sincere regret and sympathy forearly cases that progress to advancedinvolvement, while waiting to getinto the Sanatoria. Tlie field workersdo all that can be done to protect thecase from advancing, but as youknow that is hard enough in the institutionmuch less in the home of thecase, where there is a thousand andone interests and demands to preventthe case from resting, relaxing andimproving. Forsyth County TuberculosisHospital was planned with malitionand intent to prevent an advancedcase ever blocking the entrance ofan incipient one. I would like to seeevery case admitted and remain longenough to be schooled in methods ofsanitation, personal hygiene and theproper care of himself so that hewould take care of himself and protectthose that he comes in contactwith. Other than the waiting list, Iknow of nothing worse than making aCounty Home for Tuberculosis cases,out of a County Tuberculosis Sanatorium.It is about as unreasonable as itwould be to hospitalize permanentlyall disabled veneral disease cases ina general hospital.The field workers in the Health Departmentsare pleased to have the di-

12 The Health Bulletin November, 1930rector of the hospital assist them withhis suggestions and advice. Any informationrelative to a tuberculosiscase that he desires, is gotten withpleasure. Any policies or plans thathe and his board may adopt are lookedupon with favor. The hospitalboard has on it both the city andcounty health officers. The city has aspecial Tuberculosis Nurse that handlesthe tuberculosis problems in thecity. The County has district nurses,eight in number, who do generalizedpublic health duty and in their regularline of duty they handle the tuberculosisproblems of the county. Werecognize in the field two types ofTuberculosis, the childhood or Juveniletype and the Pulmonary type. Inthe homes of tuberculosis parents orrelatives, where there are children wemost usually find the Juvenile reactor.The Public Health worker findsthat where school children react tothe tuberculin test that the parentsor a relative of the child has or hashad active pulmonary tuberculosis.These two types usually exist in thesame home where there are childrenand susceptible adults. Where thereare a sufficient number of field workers,all case contacts can be studiedand worked out for the Hospital Director,also all school children can beexamined and the tuberculin test reactorsstudied, which usually resultsin the finding of the donor of theinfection.In this age of enlightenment workingwith people with average intelligenceone would naturally assumethat when one infoi-ms an individualthat he has tuberculosis, that theworkers duties would end and the individualwould take such steps aswould be to his best interests as wellas the best interests of his contacts,which are most often other membersof his family. But there is most oftena lot of work yet to be done beforethe individual will move along certainpredetermined lines laid down by theTuberculosis directors and workers.Our program of controlling Tuberculosisin Forsyth County has splendidendorsement, but the individual withtuberculosis doesn't give anything excepta cuss about that. TTie individualisn't concerned at all about your program,he is concerned only about himself,his family and his relatives. Sothe problem that confronts the workeris to appease an individual andhis interests. This takes persistentwork, forethought and tact on thepart of the worker. Sometimes thesepositive cases resort to a re-examinationof their case by a less expertmember of the medical profession.This sometimes puts the worker in anembarrassing position. About the onlyconsolation the worker has in sucha muddle is to remember that he wholaughs last has adenoids.The control of Tuberculosis in aCHRISTMASwith its joy and good will—whynot extend its spirit over thewhole year? The fund from thesale of Christmas seals inDecember will carry help andeducation against tuberculosisthroughout all 1931.The National, State & Local TuberculosisAssociations of the United StatesBuy Cluristnias SealsFi^t T«i1>erciilosis

November, 1930 The Health Bulletin 13community resolves itself into abouttwo major factors. First, finding thecases and second supervising themthereafter, both at home and in theSanatorium. If these two factors arecarried on in an efficient manner, thetuberculosis problem will be controlled.If they are partially carried onthe tuberculosis problem will be partiallycontrolled. How are we going tofind the new cases of tuberculosis?The physicians will report some, theneighbors will report some far advancedcases, the nurses will findsome in making her home visits ofone kind and another. We will findsome through the routine examinationof school children, Tuberculintest and subsequent investigation inthe home of the positive reactors.Some will be found in making the ex-Sanatorium case follow up visits.There are no doubt other ways thatsome will be found. In all these variousways of finding cases, we are cooperatingone with another in controllingTuberculosis and so far aswe are inefficient or dilatory in carryingout our obligations, so far weare falling short of controlling Tuberculosis.The second factor deals with supervisingor treating the case once wehave found it. The burden of this activityrests upon the family physicianand the hospital director. The workerhere occupies the position of assistantto the physician. The degree of efficiencyof the control measures dependsupon the family physician'sability, skill and integrity. The trainedworker will go the limit, which thephysician allows. Some physicians desirea physical examination by thehospital director, x-ray examinations,etc., while others desire that no outsideassistance be had and so "moteit be." Our field workers will eventransport the cases or suspiciouscases to the Sanatorium Clinic, whichis held two mornings each week.We need in Forsyth County tofurther our Tuberculosis controlmeasures: First, the colored divisionof our hospital, which is at presentthe old Tuberculosis hospital, movedto the site of the new hospital. Itcan be operated more economicallyand much more efficiently. Second,Dr. Yoder needs an assistant. Heshould have more time to devote toClinics and the study of the field activities.There are over a thousandcases of Tuberculosis outside thehospital that needs supervision andprophylaxis. His entire time could bewell spent in the administration ofthe hospital and the supervision ofclinics and field activities.We need a colored worker to dospecial Tuberculosis work among thecolored people, including the coloredphysicians. We are not getting thesame type of case into the colored divisionof our hospital as we are inthe white. Dr. Carlton and I had plannedto put on a worker of this kindthis year, but since our budgets forthis year have shrunk to the tune ofa prune, we will have to abandonany such plan or even hope. We hadin mind that such a worker workingout from the colored hospital amongthe colored population and physiciansthat such contacts could be madewhich would give the hospital a lessadvanced colored case or even incipientcolored cases. Some such planmight aid much in the control measuresamong the colored population,which is as you know most urgentlyin need of control. Without the aidof this colored worker, we will continueto do our best to get bettercases into the colored division. Thecolored people are hard to get in duringthe incipient stage due to an impressionthat they have, that all casesgoing there for treatment die, and thesad part of it, it is true, for only thefar advanced cases go and certainlythe most of them die there.Our tuberculosis control programwill cost Forsyth County $109,908.51or .94% cents per capita for the fiscalyear 1930-31. $101,408.51 or .87%

14 The Health Bulletin November, 1930cents per capita will be expended inthe hospitalization of the tuberculous.88,500.00 or .Qiy^ cents will be spentin carrying on the field activities.This does not include the activitiesof the physicians, the voluntaryworker, county physician and healthofficer, nor does the .94% cents includethe expense of testing thedairy herds for Bovine Tuberculosisor the loss of the Bovine reactors ofthe herds, nor does it include the lossof earning power of the patient andhis nurse or caretaker. The .87 ^/^cents expended in hospital care of thetuberculous applies to those casesonly that are hospitalized, which inForsyth County is about 135 out of apossible 1200 cases. Thus you see wehave no idea of what Tuberculosisactually costs us. We only know approximatelywhat we are spending tocontrolit.SUMMARYWe think that our hospital directorwith his broad experience in hospitaltreatment and clinical observationsover the entire state has qualifiedhimself to direct this program of preventionand treatment. We think heis just as interested in the preventionof new cases as he is the treatmentof existing cases. We wish toaid him in combating all present fociof infection and prevent the occurrenceof future ones and when allis said and done, that is controllingTuberculosis.We realize as does our hospital directorthat in order to fight Tuberculosis,we must find the cases. Theearlier the better. It is here that wefield workers render our most valuableassistance. We desire to visitevery case that is reported—studyand ren-the new case and classify itder all assistance we can in teachingpersonal hygiene and prophylaxis. Wetry to assist in making social andeconomical appraisals and adjustments•There is a qualification that afield worker should have aside fromhis scientific training, which cannotbe measured by charts or statistics.We may call it the emotional quality.God forbid that we in our enthusiasticefforts to put across a drive or aprogram should allow success and efficiencyto stand out so in our mindsthat we might become indifferent towardour patients and forget that acase is a human being or that a houseis a home and the hope of the communitylies in healthy happy families.The Part Played By National, State and Local TuberculosisAssociations In A Tuberculosis Control Program andThe Relation of the School System to Such ProgramByR. L. CARLTON, M. D.City Health Officer, Winston- SalemThe fact that the National TuberculosisAssociation, organized in 1904when there were less than a dozentuberculosis organizations, all told, inthe entire United States, has sostimulated thought and activity inthis line of work that there are nowmore than 1400 state and local tuberculosisorganizations affiliated withthe National and the additional factthat in these 26 years the tuberculosisdeath rate of this country has beenmore than cut in half, are sufficientevidence to convince the most skepticalthat a tuberculosis program and

November, 1930 The Health Bulletin 15organizations to carry it on have beenvastly worth while.National, State and local tuberculosisassociations are engaged in thesame thing—to attempt a descriptionof the aims and activities of each ofthese would be to describe many,many things about three times. Thisdoes not mean duplication of efforthowever—but simply that one, theparent, directing, guiding organizationis a little farther away from thefiring line than are the others—thatthe State organization is the homebase of supplies, advice and guidanceand that the local is in direct everyday, personal contact with tuberculosisand all its devious problems, ison the firing line of battle, if youwill, and is dependent upon State andNational for much ammunition, advice,encouragement, instruction.Therefore what I have to say willof necessity be very general concerningwhat the organizations designatedas National, State or Local have todo with a Tuberculosis Control program.The program, already discussed,covers, in brief, treatment of the sick,detection of cases, prevention of diseaseby promoting positive healthconditions, prevention of infection bydiscovering sources and breaking contacts,making economic adjustmentsfor patient and dependents, etc. Youare all familiar with these the fundamentalactivities of the program. TheNational Tuberculosis Association andevery one of its affiliated organizationsare constantly at work on everyone of them.All these fundamentals "seem simpleenough and their recital rolls offthe tongue glibly," said Dr. Allen K.Krause a few years ago at a conferencein Pennsylvania. "But," Dr.Krause said, "think of what effortthey involve: the construction andequipment of hundreds, perhaps thousandsof places for the afflicted; themaking over of countless homes forthe same purpose; the special educationand training of thousands of physiciansand nurses to attend these unfortunates;the continued instructionof the entire practicing medical professionin the detection of early tuberculosisand the proper appraisalof active tuberculosis; the arousingof every man and woman to the realcondition of affairs; the enormouslydifficult—and often discouraging taskof breaking through their prejudicesand having them put aside age-longhabits and customs; the introductionof the masses to new standards ofliving—and what is just as important—the adaptation of these to economicand social conditions; the establishmentof sympathetic relations—thoseof minister to body, soul and perhapspurse in hovel, cottage and mansion;the devoted study and investigationof tuberculosis in the even quiet ofthe laboratory, the grim reality ofthe bedside and the hurly-burly ofthe affarirs of man; sanatoria, preventoria,dispensaries, clinics, schools,physicians, nurses, fieldworkers, students,laboratories, streets clean,homes spacious and light, milk withoutseeds of disease, cattle healthy, aninformed and reformed public intelligenceand conscience: all these arebut a few of the countless details thatenter into the elements of a successfultuberculosis program: all andmany more must be devised and triedand applied and fitted each in itsproper place."All of these items are just as importantand just as appropriate inthe program as they were a few yearsago when enumerated by Dr. Kr.ause.

——16 The Health Bulletin November, 1930Boiled down—the thing that Is takingthe grip out of tuberculosis, thatis literally "knocking the spots outof it"—now and always is educationknowledge.The managing director of the NationalTuberculosis Association saidat the annual meeting in Memphis inMaj'- that the work of that organizationmay be classified under threeheadings:1. Acquisition of knowledge abouttuberculosis.2. Dissemination and application ofsuch knowledge.3. Fund raising to achieve thesetwo ends.Th.\s acquiring of knowledge abouttuberculosis implies, as I have alreadyquoted Dr. Krause as saying,the education of doctors, nurses,teachers and every health workerhaving anything to do with that disease.In this field there has been no moreimportant nor far-reaching activitythan the work of the Medical ResearchCommittee which the Nationalorganization established seven yearsago. This committee under the leadershipof Dr. William Charles Whiteand other eminent scientists havemade very important findings whichwill assist doctors in the early andmore accurate diagnosis of tuberculosis.They are devoting their livestrying to find out the still unknownfundamental problems of this disease.Why is the tubercle bacillus harmlessin one individual or one family? Whyare some people chronic invalids whoapparently have had no more tuberclebacilli introduced into their bodiesthan others who remain well? Whydoes one individual recover rapidlyand remain well? Why does anotherin apparently good health becomerapidly ill and the illness becomemore grave resulting in chronic tuberculosis,with ultimate death ? Cansome serum or vaccine be found whichwill prevent tuberculosis? At leasttwenty-one scientific bodies, includingthe U. S. P. H. Service, National ResearchCouncil, Henry Phipps Institute,the Rockefeller Institute, severaluniversities and biologic laboratoriesare working with this researchcommittee on just such questions.Grants of money from the NationalTuberculosis Association make possiblemuch of this work. Such an activitywould obviously be an impossibilityfor State or local organizations—butthese immediately derivebenefit from the results of the workof the scientists on the National Organization'scommittee.Other efforts of the parent organizationare devoted tosocial research.Why has not the tuberculosis deathrate for men in industry declined asrapidly as for other groups? WTiy doyoung women between the ages of 15and 25 have a higher tuberculosisdeath rate than other age groups ?Why does the negro death rate fromthis disease not come down as it hasfor the white race? These and otherquestions are being intensively andminutely studied from a good manyangles and just as rapidly as informationof value is gleaned from surveysand studies it is passed on tothe affiliated associations for practicalapplication.Demonstrations at various placeshave been participated in by the NationalAssociation. That one at Framingham,Massachusetts, some yearsago has served as a measuring stickfor the intelligent guidance of manyprograms in many sections of thecountry. There is a demonstrationunder way at this time in the schoolsof Lynn, Mass. It is expected to continuefor three years, at the end ofwhich time there may be availablefactsand comparisons of value to allof us.One of the means of interpretingto tuberculosis workers the facts developedby these demonsti'ations andstudies is by various publicationsfor example, the booklet "ChildhoodType of Tuberculosis" issued recently

November, 1930 The Health Bulletin 17by the National organization is oneof the most instructive and interestingpieces of information available;Tuberculosis Abstracts, a leaflet publishedmonthly for physicians is ofvalue; The American Review of Tuberculosis,a technical journal forspecialists, is very helpful.Another thing of great value tothe tuberculosis campaign is thetraining of tuberculosis workers byan expert of the National Associationwho holds institutes at various pointsin the country. Many hundreds ofsecretaries, staff members, boardmembers, social workers, healthworkers, and nurses have benefittedgreatly and been made more efficientfor their work by these institutes. Anotherthing the National does is totake junior staff members into theirorganization, train them thoroughlyand then let them go into the fieldas secretaries or directors of localcampaigns. Such activities are peculiarlythose of the National TuberculosisAssociation—State and Localorganizations not being in positionto attempt such things as the publicationof scientific journals for the assistanceof workers nor for the trainingof workers themselves.The practical every-day applicationof the knowledge we have regardingtuberculosis must depend onState and local associations. ITieNational organization renders availablecommon materials for education,lays plans, conducts demonstrations,etc., but the local organization mustpersuade the man in the street.The Early Diagnosis Campaignswhich have been conducted for thelast three years are splendid examplesof the cooperative efforts ofthese various associations. The 1928slogan— "You may have tuberculosis—let your doctor decide"—followedby 1929 which emphasized— "EarlyDiscovery—Early Recovery"—and theslogan of this ear— "Protect the Childrenfrom Tuberculosis" have ledmany thousands of persons to seekan examination and medical advice.Cases of tuberculosis have been discoveredand put on the proper pathsto recovery. Children have been savedfrom the disease. Results have beenachieved because the National TuberculosisAssociation popularized themovement by producing and distributingmillions of leaflets, pamphletsand posters; by newspaper and magazineadvertisements; by newspaperpublicity; by securing the cooperationof companies which do much advertising—oneinsurance companyalone causing to be carried full pageadvertising in magazines reaching21,000,000; the backs of millions ofletters carried a sticker on which waspictured the tousled head of a babyasking to be "protected;" bill boardson every hill and in every glade mentionedit. In short there was no excusefor any one to be ignorant ofthe fact that tuberculosis exists andthat something ought to be doneabout it—and that's where State andlocal organizations got in their work.It was their duty to inform directlythe complaining man as to where hemight go for an examination andwhat to do if trouble were found. Itwas their function to find the contactsand direct them to their physicianor a clinic. Already in manyplaces there had been provided largelybecause of first hand informationdelivered by the local and State associations,clinics, nurses, social workers,doctors really and truly interestedin tuberculosis, sanatoria, preventoria,camps. So, the National Associationstimulates a general interestby nation-wide publicity concerningtuberculosis, its early diagnosis, etc.,and the state and local organizationsactually seek out those persons whohave the disease and tell them howthey may be cured and how othersmay be protected from it—and whilethey are doing this they do not neglectother features of the health program,but they teach children goodhealth habits; they instruct about the

18 The Health Bulletin November, 1930importance of heart defects, of diseasedtonsils, of underweight and thecorrection of such conditions; theyhave to do with housing and workingconditions, with the economic affairsof the family-—in fact a tuberculosisprogram is not a complete programif it leaves out any part of a generalworth-while public health program.Ifa sanatorium, a preventorium ora children's camp is needed for thecommunity it is not the National Associationnor the official health agencyas a rule which first stirs publicsentiment to the point of makingsuch provision—but generally it isthe local tuberculosis organizationwhich takes the lead and, as Dr. LinslyWilliams said, "pesters" a groupof leading citizens until something isdone. If a clinic or a public healthnurse or special nutrition worker inthe schools is the need frequently itis the logical organization to makepossible such activity as a demonstrationand carry it along for a time untilit can be taken over by the gov.ernmental health agency. Such thingshave been done over and over againin many parts of this country.Now, to finance these matters offinding out about tuberculosis and ofhow to practically apply that knowledge,all these organizations areagain found working closely together.National, State and local depend verylargely upon the receipts derivedfrom the sale of Christmas seals tokeep their work going. Here, as inother lines, the National acts as aclearing house and source of supplyfor the various things needed in theseal sale campaign. The National Organizationfurnishes the seals, muchof the publicity material, news artricles,stories, stunts, advertising inthousands of periodicals, and succeedsin attracting nation-wide attention tothe fact that Christmas seals must bebought if certain much needed thingsare to be done—and then all that isleft for State and local organizationsto do is merely to deliver the sealsand collect for them.A seal sale that has grown fromthree thousand dollars to more thanfive million in not many years musthave some merit and must have backof it some hard-headed business planningand study as well.Let me lay aside generalities nowfor a moment to mention the NorthCarolina Tuberculosis Associationspecifically. It has had something todo with most of the worthwhile healthactivities of our State. Time will notpermit detailed comment but NorthCarolina folks should not forget thepioneer work done by our Associationin public health nursing in this State;nor should they overlook the childhealth education work so well carriedon; nor should they fail to recognizethe splendid work carried on with thenegroes of North Carolina. Our Associationdid pioneer work in providingextension service for the Bureauof Tuberculosis of the State—demonstratingin no uncertain terms thevalue of this activity which was finallytaken over by the Bureau. EveryNorth Carolinian should be proud ofthe record this extension service underthe direction of Dr. McCain ismaking. To have finished examinationsof more than 50,000 children andhave the findings of 40,000 of themclassified and intelligently recorded isa piece of work of decided value. TheNorth Carolina Tuberculosis Associationis proud to have had a part inthe beginning of this admirable pieceof work. Our association has had aninfluence in various pieces of legislationfor the benefit of the tuberculousand has had a hand in helping mouldfavorable public opinion in more thanone county in this state leading to theprovision of hospitals and sanatoria.It has had much to do with the establishmentof intelligent nutrition andother health teaching in our schools.And this brings me to a considerationof the last part of my subject:the relation of the school system to

November, 1930 The Health Bulletin 19the tuberculosis program, which partwill have to await a future paper.Let me in conclusion say with myfriend and co-worker Dr. David Lymanof Connecticut, that, "we havegreat need to take counsel together,to pool our resources to see whichgroup can best take charge of a givenproblem and how all the rest of uscan best help, to lose sight of wherethe credit goes, and to work togetherfor the greatest public benefit withthe least duplication of effort and theleast waste of resources.We have found that the intrenchmentsof our enemy are so widespreadwe must ally ourselves with all otherforces working for public health andwelfare in its broadest sense. All theefforts of our National Association,with its great affiliated state associations,are being directed toward thisgoal and we are confident that in thenext decade,If we can dream and not make dreamsour master,If we can think and not makethoughts our aim.If we can meet with triumph or disasterAnd treat those two imposters justthe same,the victory will be ours together."The Responsibility Of The Physician In The ProgramOf Tuberculosis ControlByS. D. CRAIG, M. D., F. A. C. P.Winston-SalemThe early diagnosis of pulmonarytuberculosis is a responsibility thatthe physician should take most seriously.We are confronted with thefact that tuberculosis claims thelives of more than seventy-five thousandcitizens of our country yearly.We have with us something like twomillion cases, and a large percentageof these cases can, by early diagnosis,be arrested to the point that they cancarry on their usual occupations. Economically,think of the loss, for themajority of these cases die at theage when their production should beat its highest level.The diagnosis of early tuberculosisis not easy, especially what we termincipient tuberculosis, but by painstakingsecuring of history and mostcareful physical examination we willallow a very small percentage ofcases to escape detection.The general practitioner is a gooddiagnostician, and it is frequently dueto his being in a hurry from overwork or from being so exhausted thathe allows cases to slip by without detecting.As it does require most acuteattention and the best that is in usto decide about some of these cases,it is wise to have a patient returnwhen we can give more time or whenour senses are more acute after rest.In fact it is frequently necessary tohave them to come back severaltimes, if you haven't all the necessaryequipment, x-ray, etc., at your disposal.It is the duty of every general practitionerto refer his doubtful cases toone who has had special training indiseases of chest, and equipped tomake laboratory and x-ray studiesthat the busy general practitioner,even if trained would not have thetime to devote to an exhaustive studyof these doubtful cases. It so happensin a great many counties in our statethat we are fortunate enough to have

20 The Health Bulletin November, 1930County Sanatoriums well equippedwith personnel, laboratory and x-rayto decide about these border cases.These County Sanatoriums have beenof great service in relieving the StateSanatorium staff, who have been andstill are overworked. I would like tospeak at this point of the wonderfulassistance the Forsyth County TuberculosisSanatorium has been to thoseof us living in Forsyth County. Infact, I now wonder how we have evergotten along without it. For a practitionerto refer his cases for diagnosisto a Sanatorium, or State healthclinic it is necessary that these institutionsbe in charge of doctors whopositively know their work, and commandthe confidence of the generalpractitioner. So far as I have beenable to observe and know, we haveall that could be desired in the personnelof our State and County Sanatoriums.The family physician's duty doesnot end with his diagnosis of tuberculosis;it is his duty to recommendthat every member of a family, orany others who have been living inclose contact with the case that hediagnoses should have an examinationto be sure that they are not alsoharboring the tubercule bacilli. Sinceprivate physicians cannot ethicallysolicit patronage, if his suggestionsare not carried out, it is his duty,(as we are living in an age of preventivemedicine) to get in touch withhis city or county health departmentand get their assistance in a diplomaticway in having them to go toindividual may think, totheir family physician for such examination.This is not done, as somegive the doctorwork, or put money in his pocket,but from a humanitarian standpoint.The greatest and most certain stepin the eradication oftuberculosis hasbeen started in the last five years,and that is the diagnosis and treatmentof childhood type of tuberculosis.Our State should be proud ofthe fact that Dr. P. P. McCain, is oneof the pioneers in this work, and hasdone a great deal to advance ourknowledge in the diagnosis and treatmentof same.As this is such an important andvital field, if we hope to ever wipetuberculosis out of the land, the physicianshould acquaint himself withthe latest in the diagnosis and treatmentof the childhood type of tuberculosis.The diagnosis depends upon theconsideration of the following factors.History, Symptoms, Physicalsigns. Tuberculin test, and x-raystudy.A careful history in diagnosis ofall diseases is important, but this isespecially true in childhood tuberculosis.Statistics show that the proportionof cases found in children thatgive a definite history of close contactin comparison to those that havenot been closely exposed is 8 to 1.Regarding symptoms in children,probably the most outstanding one isthat they tire easily. They may, ormay not be underweight, if they onlyhave a tracheobronchial gland involvementthey may not cough at all.Fever in children is a very uncertainsymptom I believe the records of theclinic of Winston-Salem health departmentwill show that practicallyevery child under ten years of agewill have a temperature of severalof a degree when presented forfifthsexamination.Personally, I must admit that Ihave not the confidence in my physicalfindings in examination of childrenthat I should have. Of course ifthere is an infiltration or consolidationof lung tissue, or a pleurisy with,or without effusion this is not so difficult,but so far as making a diagnosiswhen you only have atracheobronchialgland involvement, I perferthe diagnosis being made fromx-ray study.Regarding the tuberculin test Ithink the men who are doing workin tuberculosis probably have more

November, 1930 The Health Bulletin 21faith in the tuberculin test then theyhad some years ago. The intracutaneous(Hantou test) tuberculin test isnow being used in preference to theVon Pirquet test; first because it ismore accurate and can be given fasterby those who are conducting clinics.A positive reaction to tuberculin testalways means infection with tuberclebacilli, but does not necessary indicatedisease. It will, of course, not tell youeither whether it is latent or active.Every case that gives a positivetuberculin reaction should be x-rayed.The private physician can make thephysical examination, the laboratory,tuberculin and other tests, but unlesshe has had years of training inx-ray work he cannot make a diagnosisfrom x-ray standpoint. Any personwith an x-ray can make a picture,though the technique of making thex-ray of the chest is very important,but it takes a lot of training and experienceto interpret what the plateshows and if the public could be educatedto this fact they would be morethan careful who does their x-raywork. I think a diagnosis from x-raystudy that is not made by trainedeyes is very harmful and very misleading.The diseases that stimulate childhoodtype of tuberculosis and frequentlyrequire a differential diagnosisare: Hodgkins disease, bronchopneumonia,pulmonary abscess, bronchiectasis,mediastinal abscess, enlargedthymus, and neoplasms. I thinkabscess following tonsillectomy morefrequent than we recognize.While I am on the subject of childhoodtype tuberculosis I am going tospeak briefly of the treatment. Tliisdoes not differ from that of theadult; rest, fresh air, good food andsunlight. This treatment may betaken at home but I think the trainingat an institution is of great value.Those that have no open lesion neednot be excluded from school.Children, or so far as that is concernedadults, with a latent diffusetuberculous pulmonary infiltrationshould not be given cold vaccines,typhoid, or other vaccines withoutcareful consideration of each individualcase by the physician. I am surewhen I was in the army and we usedvaccines of all kinds rather freely wefrequently caused activity in cases ofquiescent tuberculosis. Another pointworth mentioning is the necessity ofcareful examining chest of patientbefore a tonsillectomy, especially incases that come to the doctor complainingof becoming fatigued easily,some loss of weight, running a littlefever, no appetite and may or maynot cough. I believe I see on the averageseveral cases a month, that havegiven a history of this kind and weretold to have tonsils out. A month orso after their operation they will noticethey are still no better and probablythe other has caused chest conditionto become more aggravated,so they seek further cause for theirnot feeling so well. By this time thediagnosis is easily made, but it wouldhave been so much better if conditionhad been found before operation, soif tonsils really needed removal itcould have been done under localanaesthesia.The physician in private workshould, as a rule, devote more time tothe examination of his patients. Todevote more time will be more satisfactoryto both physician and patient,even if patient is charged a largerfee.A record should be kept of allcases, this especially true of chestexaminations. On the history and examinationsheet have a diagram ofthe chest upon which to note findings.The signs for recording physical findingsare very much the same in allchest clinics. The State Sanatorium,I am sure, will gladly send you acopy of the form they use, which isvery satisfactory.Before proceeding with the physicalexamination of patient get a verycareful history of case, question pa-

\22 The Health Bulletin November, 1930tient carefully regarding family history,his past history, his exposure totuberculosis, and his present illness.In questioning him regarding hispresent illness go into detail regardingloss of weight, fever, cough, expectoration,pleurisy, pneumonia,hemoptysis, night sweats, dyspnoea,loss of appetite, digestion, diarrhea,chills,etc.In beginning the physical examinationthe patient should be stripped tothe waist line. He can either be seatedor stand for examination as the examinerprefers. When examiningfront of chest, patients arms shouldhang loosly by his side. When examiningback have him to lean forwardwith shoulders drooping. The axillacan best be examined with hands uponthe head.The successful practice of the artof physical diagnosis is dependent toa large extent on very careful inspection.This is best done with patientsitting or standing in a good light.Note whether pupils equal or faceflushed. A dilated pupil or flushedcheek are commonly associated withtuberculosis of the lungs; occurringon the affected side. The thyroidgland should be examined for it issometime necessary to have a metabolismtest to help clear up differentialdiagnosis between a hyperthyroidcondition and an incipientpulmonary tuberculosis.The following points should be notedin the chest inspection: (1) Whetherthere is any drooping of eithershoulder. (2) Whether one claviclemore prominent than the other andwhether some flattening beneath theclavicle. (3) Whether there is on inspectionany lagging beneath the clavicle.(4) Posteriorly the angles ofthe scapula should be watched to seeif one moves outward less than theother.When the diminution of expansionis very slight one may not be quitesure from inspection as to whetherthe two apices expand equally or not.Palpation is a more delicate methodand usually helps us to decide positively.The method most commonlyused in palpation is to sit in frontof the patient with the hands placedbeneath the clavicles. In this waymovement of hands can be watched orby closing the eyes the degree ofmovement felt. If there is an infiltrationof one of the apices this side willexpand less freely. Increase in tactilefremitus is due to infiltration so asan aid to early diagnosis is of littleimpoi'tance. However, even in veryslight trouble the muscles over affectedarea are found to be morerigid, and this can be elicited by lightpalpation.Percussion is of more value to somethan others. Those who have a musicalear and are able to interpret thefiner shades of pitch and quality getmost out of percussion. The soundselicited from percussion of the samepatient, by several physicians willcause more difference of opinion thaneither inspection, palpation, or auscultation.It is well to remember thatnormally the right apex note isslightly higher in pitch than on theleft. T'he note over the apices is lessintense than over the bases, for thisreason, it is better in percussing tobegin over the bases and percuss upward.Percussion is important in examiningchildren for it is the mostimportant physical sign found in paravertabralor parasternal tuberculosis.We all rely more on auscultationthan any other procedure in physicalexamination. It is essential to keepin mind the normal variations whichexist between the two apices. Expirationat right apex is frequently prolongedand tubular in quality. Normallyvocal resonance is also exaggeratedover right apex. Differentmethods are used to bring out rales;some are heard on ordinary inspiration,some on deep breathing, othersonly after forced expiration is followedby cough and deep inspiration.

—November, 1930 The Health Bulletin 23In early tuberculosis rales are rarelyheard with ordinary or even deepbreathing, but after cough and deepinspiration rales may be elicited.Coarse rales that are heard with ordinaryquiet breathing are usually indicativeof rather extensive infiltration.Persistant rales in upper portionsof lungs if not due to bronchitis orinfluenza are usually always evidenceof active pulmonary tuberculosis. Incases where rales are only in base oflungs we are not justified in makinga diagnosis of tuberculosis, withoutother evidence. Rales in base may bedue to chronic bronchial pneumonia,pleurisy, or non-specific spirochaeteinfection.The most important single thing inthe fight against tuberculosis isfindingthe cases, all the cases, for thiswe rely wholly on the physician.The next most important thing isgiving those found to have tuberculosisproper treatment and again werely on the physician, and third preventthe patient who has tuberculosisfrom infecting others and here againthe physician plays a very importantpart.WOMEN AND WOMEN'S ORGANIZATIONS IN THETUBERCULOSIS CONTROL PROGRAMByMRS. CHAS. R. WHITAKERChairman Health, N. C. Federation of Women's Clubs and Vice-PresidentN. C. Tuberculosis Association, Southern Pines, N. C.There is in every true woman'sheart a spark of heavenly fire. Godplaced it there, and ordained that sheshould be the helpmate of man,through all the changing vicissitudesof life. We believe for the most part,woman has lived up to this biblical injunction.We can assure every one presentthat the women of North Carolina inevery county, city, hamlet and community,are willing to be helpmates tomen, doctors, health officers, nurses,the official and non-official agenciesin the great fight against Tuberculosisand for health in North Carolinaand the United States.It is truly amazing the manner inwhich an army of women in NorthCarolina seemingly arises over nightevery year to enlist in the waragainst Tuberculosis as representedin the Christmas Seal Sale.Practicallyall these women are volunteers,each soon learns her place, and pennyby penny and dime by dime the moneyrequired for the fight against thegreat white plague is raised. Not onlyare we ready now, but. many of ushave been acting as pioneer womenhave stood behind the workers andloaded their guns—for quite manyyears.The Women's Clubs have givenwillingly of their time and means inaiding in our Seal Sales and havebeen very successful. In some placesas a County Tuberculosis Association—sometimes as direct representativesof the North Carolina TuberculosisAssociation.Usually this work is done throughthe health department of the club,and when the latter is the case, theclubs have followed through andshowed a very wise expenditure ofthe 75% of the Seal Sale money leftin their hands. One club by co-operatingwith the North Carolina TuberculosisAssociation established publichealth nursing in North Carolina. Anotherestablished and maintained a

24 The Health Bulletin November, 1930littlesantatorium which grew, flourishedand bloomed into the first realCounty Sanatorium in our state. Otherclubs used their percent in demonstratingthe value of health education;many others have used their moneyfor children's tuberculosis clinics intheir schools. Others have furnishedmilk and hot lunches for the infectedand undernourished children, whileothers have provided Sanatoriumtreatment. One has established aChildren's Camp.A president of a club being sincerelyinterested in the TuberculosisAssociation work, organized a countyhealth association, which has functionedfor seven years and been instrumentalin building up a finehealth unit consisting of a wholetime county health officer, clerk, sanitaryinspector, nurses, etc., with subunitsof women in every communityin the county who look after theircommunity's welfare, sell TuberculosisChristmas Seals to raise their portionof the money to aid in providingmilk and nourishing food forthe tuberculous patients and hotlunches and -milk for the undernourishedschool children.The Parent Teachers Association isa well organized group, accomplishingmagnificent work in the schoolsin furnishing hot lunches and milk;and through the wise advice and guidanceof the North Carolina TuberculosisAssociation, many, in fact nearlyall, have abandoned the sale ofcandy, coca cola, etc., and confinedtheir offerings for sale to milk andwholesome nourishing food for thegrowing child, and in nearly everyschool the lunch room furnishes milkand other food, without charge, tochildren who are unable to pay. ToHome Economic Teacher and thetheHome Demonstration Agent we offerour sincere appreciation for makingthe latter possible in many places.We note most interesting healthprograms are being evolved by theAuxiliaries of the County and StateMedical Societies and the Auxiliariesto the American Legion, which showthe wide range of health work doneby the women of North Carolina inthe many organizations with whichthey are connected.These are only a few examples ofwhat has been accomplished by theNorth Carolina Tuberculosis Associationthrough the women of the state,and an earnest of what the women inevery community and county in NorthCarolina stand ready to do if you willonly lead the way, and you can counton them 100% in the County TuberculosisControl program being discussedin the symposium at this time.CHARLOTTE CITY-COUNTY TUBERCULOSIS CLINICByJOHN DONNELLY, M. D.Superintendent Mecklenburg County SanatoriumThis Clinic is one of the oldest, ifnot the oldest Tuberculosis Clinic inthe state. It was first organized inconnection with the North CarolinaMedical College Dispensary in theearly fall of 1911 by Dr. W. R. Engel,who died in 1912, and myself. It wasconducted in connection with the college,until about the middle of theyear 1916, when the college was discontinued.In a very short time after its opening,the volume of work in this clinicdemonstrated the necessity for a Sanatoriumfor the care and treatmentof tubercular cases. There, with theassistance of a few always loyalworkers outside the college (one of

—November, 1930 The Health Bulletin 25whom w&s Mrs. Finger, the presidentof this organization) originated theidea for the erection of such an institutionas we now have in the MecklenburgSanatorium. However, thisresult was achieved only after aboutfifteen years work.As I have said, the clinic was discontinuedfor a time after the closingof the North Carolina Medical College,but it was renewed in connectionwith the Charlotte Health Departmentin 1919 under the regimeof Dr. C. C. Hudson, Health Officer.The Clinic has been in continuous operationsince that date, over tenyears. For practically this whole period,it has been conducted during twoafternoons of each week.The following figures will illustratethe amount of work that has beendone. These figures cover the somethingover ten-year period from theyear 1919 to date:Examinations of new patientsfor suspected tuberculosis 4,645Lowest No. was in 1920 208Highest No. was in 1927 615Total visits (old and new patientscombined) 10,230Lowest number of visits wasin 1924 538Highest number of visits wasin 1921 1,228and in 1929 1,210Nurses' visits to the homes ofclinic cases during the period 34,542(an average of 3,454 per year)

26 The Health Bulletin November, 1930Since the opening of the MecklenburySanatorium the T*uberculosisClinic has been conducted, actually,as an out-patient department of theSanatorium. Patients seeking admissionto the institution are examinedthere, and the follow-up of dischargedpatients is conducted through theclinic. These patients, on discharge,are requested to report once eachmonth, if possible, to the clinic forobservation. In addition to this thenurses make visits to the homes whennecessary.The Sanatorium was opened for theadmission of patients on September7, 1926. Since that time to date, wehave treated in the institution 680cases, divided as follows: ,White 400Colored 295Children 75680Of this number there were admittedthrough the Tuberculosis Clinic:White 211Colored 120Children 71402In addition to this number, I havereceived in this clinic 158 applicationsfor admission from prospective patientswho either died before they couldbe admitted, decided to go to otherSanatoria, for various reasons decidednot to enter the Sanatorium at all,or could not be located after filingtheapplication.MORTALITY AND MORBIDITY OF CHILDRENOF SCHOOL AGEThe number of deaths of childrenof school age would be "shocking" ifwe were not so accustomed to theirdaily and hourly occurrence. There issuch a death every 10 minutes.The latest statistics are those for1925. These are for the "registrationarea" which at that time had an estimatedpopulation of 103,109,000 personsof all ages (about 90 per cent ofthe total population) of whom 9,057,-000 (or about 9 per cent) were colored.Statistics by groups are givenfor children 5 to 9 years and 10 to 14which represent fairly well the agesof the school population. While comparativelyfew children are in schoolduring their fifth year and the deathrate is a trifle higher than for thosewho have reached six years the figurescan be considered approximatelythose for children 6 to 15 years ofage. In the 5 to 9 years group therewere about 11,027,664 children andin the 10 to 14 group 10,222,908. Thedeaths in the former group in 1925were 22,513 (white, 19,488; colored,3,025) and in the latter 18,448 (white,15,218; colored, 3,230). The totaldeaths from 5 to 14 years of agewas 40,961. Roughly one in every 500children at these ages died in an averagerecent year in the registrationarea. As the registration area representedabout 90 per cent of the totalpopulation the estimated deaths at 5to14 years of age for the country atlarge would therefore be about 45,000.Many children attend school aftertheir fifteenth year and the total enrollmentfor this year at school agesas determined by the Bureau of Educationwas 24,650,292 so that the totalnumber of deaths in children of schoolage was probably around 50,000 orabout 135 for each day of the year.The deaths among colored childrenwere relatively much higher thanthose for white children, being approximately3 per 1,000; thus loweringthe rate for white children toabout 1.95 per 1,000 at ages 5 to 9and to about 1.65 per 1,000 at ages10 to 14. (There are proportionatelyfewer colored children at the latterages.)Dublin and Lotka, in 1927, estimated(on the basis of attaining an earningcapacity of about $2,500 per year)the money value of a human life at

November, 1930 The Health Bulletin 275 years as $14,156 and at 15 years$25,341. Taking a general averagevaluation of each child of school ageat$20,000, we have (for those who desireto consider human life in dollarsand cents) an annual monetaryloss from deaths at school age ofabout $1,000,000,000. The loss in expensefor schooling at $100 a year, ifIn its issue of October 6, 1928 theChristian Herald published an articleunder the above title by Dr. HermanHarrell Home, a professor in NewYork University. This article is amost comprehensive discussion of theall who died had been in school fiveyears, would be, in addition, $22,500,-000 or at any rate sufficient to removethe "about" from the billion dollarestimate. One-tenth of this sumwould suffice to furnish one physicianat $4,000 and one nurse at $2,000 forevery 1,500 children enrolled in ourschools.ARE WE EDUCATED?subject of education. Of especial interestto our North Carolina readersis the fact that Dr. Home is a nativeof North Carolina, and is a man whohas made a distinguished record as aprofessor in the School of Educationof New York University.It would be well worth while forany of our readers to procure a fullcopy of Dr. Home's paper. He statesin his article that "education is adjustment."He says further that "theideally educated person, who, ofcourse, does not exist, has, we think,the following characteristics." ThenDr. Home proceeds to enumerate on apercentage basis thirty-three especialcharacteristics which an ideallyeducated person would be foundpossessing. He rates each point ata fraction of over 3, making a totalof 100 points, if it were possible toreach, for the fully educated person.We quote here, as especially fitting,the first four items, which heenumerates, exactly as he has writtenthem down in his article. It is morethan significant that the very firstitem begins with the physical fitnessof the individual. We have not thespace to publish the article in full,but as these first four items shouldbe of especial interest to all our readerswe herewith set them forth:"1. He is physically fit. He is notusually below par. He pays thenecesary price for physical fitness inregularity of habits, no health-destroyinghabits, proper diet, outdoorexercise, adequate sleep, enoughwork, but not too much, and theabsence of worry. I do not say,'Never overwork,' but this; 'If youdo overwork, make the period sl;ort,and allow time to recuperate.' Whilethe nervous system is young and growing,better omit the cigarette. ReadElbert Hubbard on 'The Cigarettist,'a valuable brochure more pertinent byhalf to the American scene now thanwhen written years ago. The memoryof Roosevelt is an inspiration forall the weak who would be strong.Physical fitness is itself a form of adjustmentand is a condition of efficiencyin the other adjustments tocome."2. He lives near the maxium ofhis efficiency..—His physical fitnessallows him to do so. He is not doingjust enougli to get along in the world.He is doing, without strain, all he cando. Most of us do not utilize morethan half the energies we have available.Nor do we expend that half togreatest advantage. Efficiency is afraction whose numerator is productionand whose denominator is expenditure.You become more efficientby either increasing productionor diminishing expenditure or both.That human machine is most efficientwhich accomplishes most withleast damage to itself."3. He has a body which is theThis meansready servant of his will.

28 The Health Bulletin November, 1930mind and body are adjusted. Thephrase is Huxley's We must masterour bodies or they will master us.The weakest body is the greatesttyrant. The head of man is carriedby the body, but should be able tocommand whither. The body wasmade to serve, and it will serve well,if well served. Every man shouldknow his own machine, respect itslimitations, and utilize its power."4. He is capable of earning aTUBERCULOSIS -ALL FORMSProspective deathrates, /9j29 to 1957Ori^naiDEATH RATEPER 100,000Rc^strotion Stote5 and District of Columbia

November, 1930 The Health Bulletin 29living for himself. This is economicadjustment. He is not dependentupon the earnings of another. Thisrefers, of course, to adults, not to thesick or children in school. This iseconomic independence, equally desirablefor women and men. The marriedwoman who is making a home ismore than supporting herself, she isactually increasing the family incomeby her service. Be able to earn yourown living, and do so for self-respect,even if above financial worries."UNIVERSITY OF NORTH CAROLINA OFFERSHOME STUDY COURSESWe take pleasure incalling the attentionof our readers to the excellentcorrespondence courses now offered bythe University of North Carolina. Itis now possible to study any of onehundred and fifty different Universitycourses by correspondence. Practicallyall of these courses lead to adegree or to the advancement ofteacher certification credit.Correspondence instruction is nolonger an experiment. Numbers ofindividuals have been benefited in thepast by utilizing these courses offeredby the University. A statement issuedfrom the University recently explainsthat there were sixteen hundrenand ninety-five individual registeredfor university correspondencework last year. Some of these peopleregistered for more than one course.The enrollment last year showed anincrease over that of previous years.It is a matter of satisfaction to recordthat there was a high percentage ofcompletion of all the courses afterthey were begun.A distinct advantage of correspondenceinstruction is that it is especiallyadaptable to adult education. TheExtension Division makes satisfactoryarrangements to meet the requirementsof adult students who forvarious reasons, desire to continuestudy after securing academic or professionalcredit.Correspondence instruction offersmany unusual advantages, especiallyto students who are engaged in fulltime positions, or teachers who wishadditional professional training.It isprobable that many of the readers ofthe Bulletin would find one or moreof these courses helpful, as the feesare low enough to be within reach ofalmost any individual. It might offerhelpful recreation and diversion tosuch people as desire it. A letteraddressed to Dr. R. M. Grumman ofthe University Extension Division,Chapel Hill, North Carolina, wouldbring full instructions about thecourses offered to anyone desiring it.TREAT THE CHILD, NOTTHE POSTURE"Treat the child, not the posture,in cases of 'poor posture,' whichshould be regarded as a sign thatthe child needs a careful and completemedical examination. Find thecause of the grotesque attitudes, whichmust have good reasons. When a childis 'nervous,' examine the parentsfirst, for very often the child's healthand behavior are referable to themrather than to itself. When a child'won't eat for a meal or two,' let himalone and don't force him to eat betweenmeals. Water is sufficient. Givehim an opportunity to eat at eachregular meal and give him only avery small amount of food at a time.When he begins to eat and wantsmore food, give it to him, but putonly a little bit on his plate at atime, until his appetite is fully recovered.This will cure many of the casesof 'lost appetite' seen." Thus saithDr. Wilkes, Director of the Divisionof Medical Service, American ChildHealth Association.

30 The Health Bulletin November, 1930SUICIDESFor the last two or three monthsmore cases of suicide have been reportedto the State Board of Healthfor each month than were reportedduring any whole year's period as recentas fifteen years ago.Every individual who is concernedabout the health and well being ofour people cannot but fail to experiencean uneasy feeling on account ofthe menacing increase of suicide reportedall about. In many foreigncountries, especially European countries,and among many tribes of savagesthe suicide rate has always beenhigh, but in free, liberty-loving Americathis is a new and painful experience.In the more highly civilizedEuropean countries the practice hasbeen common among such classes ofthe population as army officers, politicians,and the professions generally.In North Carolina the increase in suchtragedies is a matter which calls forfaithful consideration. We all knowthat the pressure of making a livingtoday and keeping the pace set byour neighbors is more tense than everbefore. Even the distressing periodof the War between the States, followedby theterrible years of reconstruction,was not accompanied by so manytragedies as we have experienced duringthe past few years.The opinion of one student is aboutas good as another as to why this increasein suicides prevails to such agreat extent at present. It may bethat the increasingly high standardsof the schools, the lengthening of theterm, the long school hours, are layingthe ground work for nervoustroubles later on. Depression in business,the loss of jobs, low prices forproduce, may play a part. The freedomand ease of transportation, theincreasing amount of money necessaryto keep up the standards wehave laid down as desirable for ourpeople, may be one cause. It can hardlybe pleaded, as was once the case,that the monotony of life has muchto do with it, although undoubtedlysuicides among women who have largefamilies of children, as in the past,include a large number of these suicides.No one knows the terribledrudgery day in and day out that isnecessary for a woman to go throughwith in rearing a family of children,especially if she is the wife of afarmer or a day laborer. The hardshipand monotony of such a life canonly be appreciated by those whohave experienced it.There can be no doubt that manycases of suicide occur because of thelack of grit and stamina to face adversitiesin fortune, and to workgradually out by a slow and painfulprocess of industry and stick-to-itiveness,when surrounded and almostoverwhelmed by business or domesticentanglements. There are also a largenumber of suicides, probably the largestof any single class, on accountof mental derangement. This isoftenincident to ill health and many othercauses. The strain and stress of thetimes in which we are living tend, ofcourse, to increase the number of suchcasualties, we might call them.If there is any one thing that peopleneed above anything at thistime,it is an effort to more correctlyevaluate the real things of life whichH^>Beautiful Catherine Lake in Onslow.

November, 1930 The Health Bulletin 31are of enduring worth, and toreturnto a more quiet and philosophicalmanner of living. The philsophy ofthis writer has always been similarto that attributed to Owen D. Youngsometime ago, and that is to expectbut little from life and to be contentwhen only a little is forthcoming.Disappointment can never follow suchaphilosophy.ORAL HYGIENEEvery parent in Tarboro and thistownship should have heard the ableand educational address last nighT;by Dr. Branch of the State Departmentof Health at the Monday eveningsession of the Parent-TeachersAssociation. Dr. Branch is a dentistand he knows whereof he speaks. Inhis talk he stressed the great importanceof the care of the teeth ofchildren in our public schools. Notonly did he tell of the many childrenwho were suffering from the effectsof bad teeth and diseased gums, buthe told how these troubles could beremedied and after all his remedy wasa most simple one that could be takenadvantage of by all parents with asmall cost.One thing that struck us was thatin many cases the child was sick andno one seemed to know the reason. Hespoke of one child, a girl, who hadbeen in the first grade for four years,at a great cost to the taxpayers ofthe county where she lived. An examinationof the teeth and mouth disclosedthat she had been intoxicatedby pus flowing from her gums intoher stomach, causing a sluggishnessin mind and body. But he did notstop her, for, said he, after this girlhad received treatment she wentahead with her studies and wasthereafter one of the brightest pupilsinher class.Dr. Branch did not deal as much intheory as he did in actual facts andfigures and this he did with slides,showing the actual conditions foundin many cases. He called upon peopleof the county to continue thesedental clinics from year to year,stating that if the county peoplewould raise the sum of $900 the statewould furnish each year a term ofanother four weeks fi-ee of charge tothe taxpayers.—Tarboro Southerner."HEAVY TRUCKSPROHIBITED"If they would only reduce the strainto something below the ability tobear, they could continue to livehappy and serviceable lives. But ifthey won't, they don't, and that's theend of them. And one more figure isadded to the columns of preventabledeaths from heart disease, tuberculosisand many other diseases.IMPORTANT TO PREVENTTUBERCULOSIS NOWEconomic conditions generallyspeaking are fair barometers of tuberculosis.Just after the World Warended, the mortality from tuberculosisin the war impoverished nations ofEurope was much higher. At the sametime in the United States the mortalitycontinued to decline. Unfavorablehealth conditions manifested inan increase in such diseases as tuberculosisnearly always follow "panics"and "depressions" in the businessworld. Insufficient food, irregular livinghabits, unemployment, and worryall tend to favorable conditions forthe contraction of tuberculosis. Thesoundest investment people can makein "hard times" is in efforts to preventthe spread of disease.

32 The Health Bulletin November, 1930DEATHS FROM PULMONARY TUBERCULOSISBY COUNTY AND RACE: 1929TOTAL DEATHS (Tuberculosis all forms) 2,553County

,^^PxM^d h^ TAE. N°^H\ CAR9LI/m STATE. RPARD y"AmonThi5 Bulklirwvillbe aent free -to arwj citizen of Ihe 51:crteupor\requgst. |Entered as second-class matter at postofflce at RaleiKh, N. C. under Act of July 16.1894. Published monthly at the office of the Secretary of the Board, Raleigh, N. C.VOL. XLV. DECEMBER, 1930 NO. 12HELPING THE UNDERNOURISHEDOur front cover this month is siippUed by the Durham Health Department.The picture represents one of the children tvho ivere so greatly benefitted bya six weeks sojourn last summer in a camp on Eno river for Durham countyschool children physically below normal. .This year instead of wasting money on the usual Christmas trifles it wouiabe fine if real service could be planned for those icho cannot help themselves.Hotv about a Spi-ing camp for pellagra sufferers in every county needingit, to be folloxved by a Summer program for the children?Plans should be made now.

MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTHA. J. CROWELL, M.D.. President CharlotteTHOMAS E. ANDERSON, M.D StatesvllleE. J. TUCKER, D.D.S RoxboroD. A. STANTON, M.D High PointJAMES P. STOWE, Ph.G CharlotteJOHN B. WRIGHT, M.D RaleighL. E. McDANIEL, M.D JacksonCHARLES C. ORR. M.D AshevllleEXECUTIVE STAFFH. A. TAYLOR, M.D., Acting Secretary and State Health OfficerRONALD B. WILSON, Assistant to the SecretarvC. A. SHORE, M.D., Director State Laboratory of HvgieneG. M. COOPER, M.D., Director of Health Education and Vital StatisticsH. E. MILLER, C.E., Chief of Bureau of Sanitary Engineering andInspectionERNEST A. BRANCH, D.D.S., Director of Oral HvgieneD. A. DEES, M.D., Field Assistant In County Health WorkFREE HEALTH LITERATUREThe State Board of Health publishes monthly The Health Bulletin,which will be sent free to any citizen requesting it. The Board also hasavailable for distribution without charge special literature on the followingsubjects. Ask for any in which you may be interested.German MeaslesAdenoids and TonsilsCancerConstipationColdsClean-up PlacardsChickenpoxDiphtheriaDon't Spit PlacardsEyesFliesFly PlacardsHookworm DiseaseInfantile ParalysisInfluenzaMalariaMeaslesPellagraPublic Health LawsPrenatal CareSanitary PriviesScarlet FeverSmallpoxTeethTuberculosisTuberculosis PlacardsTyphoid FeverTyphoid PlacardsVenereal DiseasesWater SuppliesWhooping CoughSPECIAL LITERATURE ON MATERNITY AND INFANCYThe following special literature on the subjects listed below will besent free to any citizen of the State on request to the State Board ofHealth, Raleigh, N. C:Prenatal Care (by Mrs. Max West) The Runabouts in the flouse of Health"Our Babies"Prenatal Letters (series of ninemonthly letters)Minimum Standards of Prenatal Care"What Builds Babies?Breast FeedingSunlight for BabiesHints to North Carolina Mothers WhoWant Better BabiesTable of HeigTits and Weights(patTTphlet for children from 2 to 6years of age).Baby's daily Time Cards: Under 5months; 5 to 6 months; 7, 8, and 9months; 10, 11, and 12 months; 1year to 19 months; 19 months to 2years.Diet Lists: 9 to 12 months; 12 to 15months; 15 to 24 months; 2 to 3years; 3 to 6 years.CONTENTSPAGEPAGEChristmas Gifts for Betty 3 Some Classic Allusions to Milk _ 13"Vitamins May Be VibrationsHard Years for Old People^_..... 7m the Ether" 16Food and Diet in Relation to Recommends Group HearingHealth 9 Apparatus 16

VOL. XLV. DECEMBER, 1930 NO. 12CHRISTMAS GIFTS FOR BETTYBySUDIE E. PYATTBetty's feet were sore, her backached, and her temper was short duringthe closing hours of the heavyChristmas Eve sales at Dunningham'sDepartment store. If the slender highheeled,narrow-toed brown suedepumps, size four, did not look so prettyon her feet, she would discard themand wear a pair of low-heeled, flattoedoxfords, the sort that stout, plainMary Lou, of the hosiery wore, butthe brown suede pumps did look sopretty and fashionable on her feet, evenaristocratic, Betty told herself, asshe regarded her aching feet encasedin the narrow-toed, high-heeledpumps.How a girl's feet looked v/ere important,especially when one had asweetheart like young Dr. Rhodes Mc-Lean, and a girl's feet did not havethe nifty, stylish appearance, in flat,square toed shoes, that they had inslender high-heeled pumps, at leastBetty did not think so, and in thinkingthis Betty was like ninety out ofevery one hundred women, young,middle-aged, and even old."What's the price of those boxedgloves?" a customer asked, interruptingBetty's mental soliloquy on feetand shoes.With an eye to the clock, Dunningham'sclosed at seven o'clock, for itwas no cheap department store thatremained open until nine or ten o'-clock, even on Christmas Eve, withher sore feet and her aching back,Betty forgot her long months of carefultraining in salesmanship, and answereda customer sharply. "Don'tyou see the price is plainly markedon the box, $2.98?"The customer looked at Betty witha malignant eye, and without sayinga word, elbowed her way through thecrowd in front of the counter to afloorwalker.Betty watched the woman fearfully,two years at Dunningham's for her,and never before had a customermade a complaint against her.For the next person who came tothe glove counter Betty made herselfforget her feet, and her back and controlher short temper, and gave herthe best of service. It was only herlong record for courtesy, and hertreatment of the next customer, whichthe floorwalker watched, that savedBetty's job at Dunningham's thatChristmas Eve.Betty wanted to run through theside entrance the employees used tomeet her sweetheart, when the bigstore had finally closed for the holidays,promptly at 7 o'clock, but herfeet hurt too badly to do that, but shedid manage to walk a bit faster, consolingherself that the view the youngdoctor would receive of his sweetheart'sfeet and ankles through thelower portion of the glass door at theside entrance, would be one of the most

The Health Bulletin December, 1930lovely views of feet and ankles thatpassed through the door."O, Rhodes, I am so tired!" wasBetty's greeting to her waiting sweetheart."Sorry, girlie, I knew this would bea hard day for you, Christmas Eve,and those slippers you have on madematters worse. Betty, darling, far beit from me to dictate what you shalland shall not wear, but I do wantyou to wear sensible shoes to workin, if you can not wear them for dressand social occasions."Betty looked at the doctor, a teartrembling suspiciously in her softbrown eyes. She had been consolingherself that her feet would look prettyfor her sweetheart in the brownpumps, and here he was actuallyscolding her on Christmas Eve, forwearing them."It's not my shoes, it's the hardday's work that makes me tired," Bettysaid crossly, "and if you are goingto lecture me on the wearing of shoeson Christmas Eve, I am going toleave you and go home to bed.""All right, young woman, that isexactly what you need, but first we'regoing to stop at a shop along thestreet here, and I'm going to buy youa Christmas gift."There was surprise in the look thatBetty gave the young doctor. Ofcourse, she had known he was goingto give her a Christmas present, butshe had been expecting somethingvery different from what one couldselect in a few minutes in the casualway, he was going to make the purchase."Do you know, Betty that there aretwenty-six bones in each of your feet,connected with four times that manyligaments, and I can not tell you howmany muscles and nerves?" the doctorqueried his sweetheart on herknowledge of anatomy, and went on,not waiting for her to answer. "Thereare four arches in the feet bound togetherwith their ligaments, musclesand nerves, all made especially tosupport the body, and at the sametime to act as an engine of motivationfor it. You say it is your hardday's work that is causing you tofeel so badly now. I grant that is oneof the reasons, but the chief reason isthat you started the day wrong byputting your feet into those highheeled,tight slippers, not giving yourfeet a fair chance to help you carrythe strain and worry of the day, ratheryou did everything you could tomake it difficult for your feet.""Rhodes McLean, if you do not stoplecturing me on feet on ChristmasEve, I am going to leave you even ifyou are going to buy me a Christmasgift!"Betty cried."The wearing of badly designedand ill fitting shoes, is the cause ofnearly all foot troubles, including thatmost common of all foot ailments,fallen arches, flatfoot or weakfoot,as some people call it," Dr. McLeancontinued, ignoring his sweetheart's athreat. "Flatfoot is caused by theflattening of the long arch, which extendsfrom the heel to the great toe.In flatfooted persons the impressionof the foot is practically the samefrom the heel to the toes. This is nottrue in a normal foot. The impressionof the normal foot will be narrowerin the center than at the heel andtoe.the"Lots of women have trouble witharch that extends across the ballof the foot from the little toe to theopposite side. This difficulty is usuallycaused by wearing the kind ofshoes you have on this moment."Betty's lips trembled with somethingthat was like a badly twistedsmile of scorn, "You have told meenough times tonight, that you do notlike my shoes, thank you.""No, I do not, Betty," frankly confessedthe doctor. "The proper way tocarry the weight of the body on thefeet is in a straight line through thecenter of the feet, with all five toespointed straight ahead to give afinal forward push at every step. The

December, 1930The Health Bulletinshoes you are wearing, throw yourentire weight onto the balls of yourfeet, and your toes. Improper use ofthe feet in walking and standingcauses most foot troubles. If you aregoing to wear shoes that you can notpossibly stand and walk correctly in,hew do you expect to have healthy,comfortable feet?"The heels of Betty's brown suedepumps pounded indignantly on thesidewalk paving, jarring every organin her slender body. She was gettingmore cross with the doctor every moment.He would not listen to whatshe said, perhaps he would heed theangry pounding of her heels. He did,but not in the way Betty expectedhim to."No, no, Betty, do not walk thatway. One should never jar the body inwalking, or pound the heels. You are'toeing out,' too, and that is not theproper way to walk. Point your feetstraight to the front, four or fiveinches apart, the weight of your bodysupported on the outside of your feet.In sitting, still point the feet to thefront.""If you keep on walking as youare," the doctor suggested mildly asBetty continued to pound the sidewalkwith her high suede covered heels,"you will wear those pretty, little,slim heels out on the sides in such away they will never look well again,and the inner side of the sole willwear, so you will have to buy a newpair the first thing you know. That iswhat happens to shoes when the personwearing them 'toes out,' or isflatfcoted.""O, so I have flat feet, and I 'toeout' when I walk. Too bad you didn'tdiscover all of these defects before."Betty was getting more angry everymoment."Not yet, Betty, but you may haveif you persist in wearing the wrongkind of shoes. Here's a little shopwhere I know they keep good sensibleshoes for women, and the owner hasmade a special study of foot troubles,and the proper way to correct them. Ibuy all of my shoes here. I want youto come in and have a pair of comfortableshoes fitted for your Christmaspresent from me.""Shoes for my Christmas present?"Betty gasped. "I am not a pauperquite yet, Dr. McLean, thank you. Ifshoes are all you can give me forChristmas, I'll be going on. I am verywell pleased with my brown suedepumps. Dick Pelton likes them if youdo not. He told me so today."Dr. McLean's eyes were puzzled ashe looked at this cross Betty. "Darling,I am not making any reflectionson your financial standing. In buyingyou another pair of shoes I merelywant you to have your pretty, littlefeet properly fitted for one time, soyou can see how differently your feetwill feel shod in a pair of the rightkind of shoes."Betty walked past the doctor intothe shoe shop. "If you insist," shesaid, with the air of a movie queen.The brown suede slippers removedfrom Betty's tired feet by the shoeshop manager, who came forward togreet Dr. McLean as an old friend,the shoe shop manager told Betty tostand with her heels together, andbring her great toes together. WonderinglyBetty complied."See, as I thought, Simpkins," thedoctor said to the shoe shop manager,"can not do that simple, little stunt.Shows her shoes have not been whatthey should be. If one wears the propershoes all of the time it is easy tobring the feet together along theirentire length, from the heels to thegreat toes."Simpkins fitted Betty's feet with apair of low-heeled, broad-toed, brownalligator leather oxfords, while Dr.McLean approved both the style andthe fit. ''See," he said, stooping tofeel Betty's foot in the oxford, "it islong enough, wide enough across thetoes, and fits snugly around the heeland over the instep. These are all importantin buying shoes."

The Health Bulletin December, 1930The shoe shop manager had fittedboth of the brown alligator leather oxfordsto Betty's feet. She wonderedwhy, for she never tried on but one ofa pair of new shoes she intended tobuy."Stand up, Miss Reed, and throwyour full weight on one foot at thetime," the shoe shop manager said,and Betty still wondering, did as shewas told. She had never tried this,either in buying shoes."You see," Simpkins explained hisreasons for the tests, "It is alwayswisest to try on both shoes of a pairwhen you go to buy a new pair ofshoes, and always try that little stuntof standing with the full weight ofthe body on each separate shoe. Theshoe may feel all right with yourweight distributed evenly on bothshoes, but put it all on one, and thefeeling may be very different. It isjust as bad to have a shoe too big asit is to have one too small, and alsoimportant to see that your stockingsas well as your shoes are of the propersize.""Do those feel comfortable in everyway, Betty?" the doctor asked."They certainly do," Betty replied,for a moment forgetting that she wascross, very cross at Dr. McLean forgiving her shoes on Christmas Eveinstead of the diamond engagementring she had felt for months that hewould present her with at Christmastime."Wrap these,Simpkins," the doctorsaid, handing Betty's brown suedepumps to the shoe shop manager, justas a woman with two children cameinto the shoe shop. The woman wantedto buy shoes for the children forChristmas."Babies' feet are nearly alwaysperfect," Dr. McLean observed to theshoe shop manager."Yes, and they stay perfect untiltheir parents spoil them by buyingthe wrong kind of shoes for them,"Simpkins replied. "I wish every motherand father would teach theirchildrento walk softly, let them walkstreet curbs, follow a narrow boardon the floor, or do anything that willteach children to walk lightly withtheir feet straight ahead, the bodyproperly balanced on the feet.""Yes, and be sure you sell thoseyoungsters who have just come inbroad toed, flexible shoes, and telltheir mother to see that their stockingsare not too large, but largeenough," the doctor cautioned theshoe shop manager, as he placed hishand on Betty's arm, and they leftthe store.On the way to Betty's home neitherBetty nor the doctor said very much.Already Betty felt much better, thesore feet, aching back, and the shorttemper that had all been hers only ashort time before were rapidly improving.Looking at the doctor walkingearnestly along, close beside her,holding her arm tightly against hisbody, Betty felt almost, but not quiteas if she could forgive him for notgiving her the ring.Wait until she got him into thewarm, bright living room at her mother'shome, and she would tell him thiswould be their last Christmas, andthat she did not care to go throughlifewith a man who put such prosaicthings as low-heeled, broad-toed shoesagainst the romantic flitter and beautyof white gold, chased, diamond setengagement rings.The warmth of the little livingroom, after the crisp cold of the street,greeted them both pleasantly as theycame in. Somewhere in the rear Betty'smother was doing Christmascooking, and the delicious smell of thecooking food, the holiday greens, decorations,and the brightly burningwood fire in the living room wrappedBetty and the doctor about with a delightfulChristmaslike atmosphere.Betty slipped off her coat, and putdown the bundles she carried in herarms, while the doctor divested himselfof his overcoat and scarf.They stood before the fire, holding

December, 1930The Health Bulletinout their hands, chilled from the airof the street, gratefully to the blaze.Then quite simply Dr. McLean took asmall, a very small package,, fromhis pocket, and Betty cried, "O youdarling!" while Dr. Rhodes McLeanfitted just the kind of ring Betty hadmade up her mind months ago that hewas going to give her for Christmas,on the fourth finger of her left hand,Betty's second gift that ChristmasEve."Now, little girl, do I get a kiss,and am I forgiven for buying theshoes?""You certainly will," Betty laughedhappily as she kissed the doctornot once but many times, as he heldher close in his'arms."But, Rhodes," Betty suddenly drewback in the doctor's arms, "how canyou, a doctor, marry a girl who isthreatened with flat feet, as you saidI was tonight?""Honey, I would marry you if youwere flat footed, pigeon toed, knockkneed and bow legged," the doctor answeredBetty's query earnestly," andthen I would have you fitted with theproper shoes to correct the defects asnearly as possible.""Can't I ever wear a pair of highheeledshoes again?""Possibly for dress occasions, ifyou make sure the heels are not toohigh, and they are not too short andnarrow," the doctor answered easily."You dear," Betty gave the doctoranother kiss, but whether it was forChristmas, his gifts to her, or hispromise, Betty did not know, butlooking at her neatly shod feet in thealligator brown leather oxfords shesaid, "I am not going to mind notwearing high-heeled shoes. I had noidea what stunning looking shoes onecould find without high heels, if onereally looked for them."HARD YEARS FOR OLD PEOPLEByNELLE SWARTZMember, New York State Industrial BoardDo you know that two out of everyfive persons reaching the age of sixtyfivein this country find themselvesdependent? Do you know that thereare today almost two million old folksin the United States who have nomeans of their own and must dependupon others for their support? Canyou think of anything more pitiful ortragic than old age when it is surroundedby poverty, indifference andloneliness?The population of our poorhouses ison the increase; the last pauper censusshows an increase for men andwomen over sixty-five years of age of10 per cent over the preceding census,and there can be no doubt butthat the next few years will show agreater increase. This will be due tothe fact that not only has the span oflife of man been lengthened becauseof much better health conditions, butthe working years, the productiveyears, the income-producing yearshave been shortened. In other words,the span between the stoppage ofwork and death increases every year.Industry is developing in this countryin such a way that it is being donein an increasing measure by theyounger group. Machines are replacingmen; the process that once requiredthe skill of trained and seasonedworkers can now be done by a sixteenyear-oldgirl pushing the button of amachine. A clothing factory illustrateshis point, whex-e three hundredexpert cutters had been employed atthe cutting of men's clothing. A ma-

8 The Health Bulletin December, 1930chine was invented and built whichcould cut more clothing in a given periodand do away with the services ofthe three hundred cutters. What happensto them ? Men skilled at one trademen grown old in their craft? It ismore difficult than ever, now, forthem to take up something new, becauseonly young men are being engaged.This story can be duplicatedhundreds of times. Behind each storythere is the repeated tale of an honestand industrious life. They try forjobs as watchmen, elevator men, janitors,peddlers. All overcrowded jobs,all at the lowest rung of the wageladder. They slip and fight again toretain their independence.Fewer workers are needed sincemachine power can produce in muchlarger quantities than man power.This point can be illustrated by oneinstance after another. The paperboxindustry, for example, that industrywhich provides boxes for ourshoes, our hats, our candy, and themanifold things which come neatlypacked in a paper box. The increasein the value of its product over a tenyearperiod was 51 per cent, while thenumber of wage earners in this sameperiod decreased 32 per cent.A textile mill which produced 137,-000 yards of cloth with a pay-roll of5,100 workers, introduced modernmachinery and produced the sameyardage with 2,000 fewer men.Thousands of musicians are beingdisplaced as a result of the introductionof the "Talkie."Instances could be multiplied. Someof these workers, of course, are beingabsorbed by other industries inwhich employment has grown at arapid rate. If this had not been true,this country would be in the midst ofcritical and continuous unemployment.Tlie extensive sales and use ofautomobiles has given employment tothousands of salesmen and garageemployees. New hotels have addedthousands to their staff, beauty parlorshave absorbed another largegroup; the wider use of the telephonehas meant an increase in thenumber on the pay-rolls of telephonecompanies. Until ten years ago, industrialexpansion seemed to takecare of these men replaced by machines;but during the last few yearsthe supply of new jobs has not keptpace with the workers displaced, plusthe young workers coming on eachyear, and so somewhere a line has tobe drawn—some group has to be permanentlylaid aside and industry hasbegun to establish an age line. Withsome industries, compulsory retirementis fixed at sixty years, some atfifty, and the dead line at forty is beingdiscussed. Many leaders in industryhave devised pension plans bywhich, at a certain age, the worker isretired on a pension proportionate tohis earnings. Others continue to carryold and disabled employees on theirpay-rolls. However, only the mostsuccessful industries are financiallyable to carry the burden of extensiveinsurance or pension systems. Thelast Census of Manufacturers showsthat there are 290,105 establishmentsin this country, of which 261,263 employless than fifty persons, or 90 percent of the total number. Obviouslythe vast number of industrial plantsare small, and in them pension systemsare often impracticable.The shortening of the work life ofour industrial workers means that incomesstop at an earlier age; it meansthe prospect of saving for old age becomesless and less, for there are feweryears in which to save. Assumingthat the father of a family works regularly,which is most unlikely, fromeighteen to sixty years of age, a periodof forty-two years; assume thathis yearly income over that period$1,500, which is high, and further assumethat he is married and has threechildren, and that there are no doctors'bills or emergencies, what can he saveto carry himself and wife after hisproductive years are over?This is answered by a study of theis

—December, 1930The Health Bulletincost of living in the United States,where families with a yearly incomeof $1200 and under $1500, had, afterthe bare necessities of life had beenprocured, a yearly surplus averaging$48 per family. If this entire amounthad been saved for old age, it wouldamount to only $2,016.It is often argued that the childrenshould assume the financial burden oftheir dependent parents. Thousandsdo, of course, but there is an old andtrue adage which says: "It is mucheasier for a mother to care for sixchildren than for six children to carefor a mother." Furthermore, manywho are compelled to live in the householdof one of their children find itboth humiliating and unpleasant,especially when their children's childrenare needing shoes, when for everyfive cents which the parent mightwant he must needs ask for it.Just a pittance of one's own, forone placed in such a position, addstremendously to one's self-respect;just enough to be free to give a bitof chocolate here, ten cents to church,to buy an evening paper, or to take abus ride.Everything attacks the old peopleat once; low pay, irregularity andunemployment, illness. Whatever savingsthere were are soon eaten up.And so, on goes the story as largerand larger the numbers grow. Destituteold men who for all the years oftheir productive life have contributedto the economic life of the country,heroic old women well past theirthree-score and ten, going out to doan occasional day's work—on goes thetale of years of hard work and ofsaving, coupled with illness and unemployment,which turns these peoplefrom self-respecting, thrifty citizensinto a class not only financially dependentbut hopeless and forlorn atan age when they are least able tobear it; at a time when their livesshould be crowned with peace and satisfaction.Economically this country has developedrapidly; mechanical invention'has taken rapid strides ; mighty machinesare taking the place of humaneyes, ears and hands. It would not bepossible to return to the old days ofhand labor with its resultant decreasedproduction. Socially, has it keptpace? It was only after millions ofchildren had been exploited in factoriesthat the first child-labor lawswere passed; it was only after peoplewere allowed to live in crowded, unsanitary,ill-ventilated tenements thatfresh air had to be rediscovered, andnow when it has been known foryears that machines were rapidly replacingmen, that the dead line foremployment each year is fixed at ayounger age, we find ourselves withthe problem of adequately planningfor the care of those who are too oldto be of use in our modern industrialcivilization, and who through no faultof their own have been unable to save.It is a challenge to the richest andmost prosperous country in the world—a challenge to our intelligence andour love of mankind. Christian Herald.FOOD AND DIET IN RELATION TO HEALTHByTHOMAS A. MANN, M. D.(Radio Talk)Food and diet play a more importantpart in their influence on goodhealth and long living than any otherfactor of our environment. A goodcomparison can be made between theautomobile and the human machine.

:—10 The Health Bulletin December, 1930If we run an automobile without theproper lubricants, it quickly beginsto wear. If we continue to run itwithout them, it soon wears beyondrepair. If we try to run it withoutcylinder oil, a bearing goes out inshort order; and without gas, itceases to move. With the human machinefood has the same relationshipas gasoline, cylinder oil, and otherlubricants have to the automobile.There are certain elements that mustbe supplied for the human machineevery minute, oxygen for example;others every day, and others less often;but nevertheless they are necessary.If we do not get every foodessential, we may go for a time, perhaps,without knowing that somethingis wrong; but if we fail to putin the proper mixture, a break inthe human organism is inevitable. Ifwe continue long enough with an inadequateand unbalanced diet, thebreak becomes irreparable.The functions of food are1. To supply waste and build newtissue.2. To furnish heat and energy.3. To promote growth and repairof tissue.Three different types of food supplythe building material, the heat,and the energy. These are proteids,fats, and carbohydrates and areknown as organic foods. Besides thesewe must have inorganic salts, such ascalcium, iron, phosphorus, iodine,etc. We also must have vitamins.These are very important, as will beshown later. A lack of them is responsiblefor many of the deficiency diseases.A balanced diet is one that containsthe above constituents in theproper proportions. The amount offood needed daily depends, of course,upon the work done. The footballplayers of the country will consumemany calories tonight after theirstrenuous game.The standard by which we measurethe energy value of food is the caloryor heat unit. It is not necessaryto understand all about calories inorder to select a diet with the propercaloric value. Physiologists havefound the daily caloric needs for thehuman system. Chemists have foundthe caloric value of different foods.Tables showing the proteid, fat, andcarbohydrate value in calories of portionsof food as ordinarily eaten areavailable. The daily caloric requirementin proteids, fats, and carbohydratesper pound of body weight isalso known. With this information athand, a little arithmetic will enableus to solve the problem of the amountof food needed daily to supply thesedemands. We have not time to givedetails in this talk.The inorganic salts, such as calcium,iron, and phosphorus, are foundboth in animal and vegetable foods.Tables showing the caloric value offoods and foods containing variousmineral salts will be supplied by theState Board of Health upon request.We have time now to mention onlya few foods containing these minerals.Calcium—Milk is our most importantcalcium food. One glass containsa third of our daily requirements.Cheese, beans, oranges, figs, fish, andeggs also supply calcium.Phosphorus — Fish, beef, beans,milk, peanuts, and eggs are goodphosphorus foods.Iron—Beef, spinach, beans, whitepotatoes, and fish are good sources foriron.While calcium, iron, and phosphorusare the only mineral salts mentioned,other mineral requirements aresupplied in a balanced diet containingthese three. One mineral elementiodine—is found in sea foods. Peoplewho live in goiter districts should eatan abundance of sea foods, since simplegoiter is due to a deficiency of thissalt.The VitaminsVitamins are accessory food substanceswhich are necessary for normalnutrition in both lower animals

December, 1930 The Health Bulletin 11and men. TTiey do not furnish energy,but supply certain substances that arenecessary for tissue growth. Verylittle is yet known of their chemicalnature. Much of what is known ofthem has been elicited through theobservations on animals that havebeen deprived of the special factorstudied. At the present time six vitaminshave been classified; namely, A,B, C, D, E, and G. The particular diseasedue to a deficient supply or lackof each vitamin is known.Vitamin A is called the opthalmicvitamin, because, when deficient orlacking, an eye disease known as xeropthalmiadevelops. Vitamin A alsopromotes growth and brings about aresistance to infection. Vitamin A isfound in butter, egg yolk, cod liver oil,and the fats of liver and kidney.Vitamin D is found associatedlargely with vitamin A. Vitamin D influencesthe formation of bone by itsaction on calcium and phosphorus.Formerly we thought rickets wascaused by lack of vitamin A. We nowknow that vitamin D is the controllingfactor in this disease. Vitamin Dis found in butter, cod liver oil, andmost green vegetables. Cod liver oilis the best natural source, but it canbe produced in pure form by irradiatingergosterol. Most cod liver oilnow has vitamin D added, whichmakes it a more valuable product.Vitamin D in viosterol is sometimescalled bottled sunshine, since sunshineon the body has the same effect asvitamin D when given artificially. Thecustom of exposing the body to thesun is a good one.Vitamin B is water soluble and isnot associated with fats and oils. Itis distributed in natural foods and isabundant in yeast, eggs, most meats,and especially the glandular organslike liver and kidney. It is found invegetables, as potatoes, spinach, carrots,and turnips, and in grains. VitaminB is removed from grain in themilling; hence the disease known asberi-beri, which in Asia was found tobe due to a diet of polii^hed rice. Yeastis rich in vitamin B.Vitamin C is the antiscorbutic vitamin.It prevents scurvy. Oranges,lemons, tomatoes, lettuce, and rawcabbage are excellent sources of thisvitamin. Heat, especially in the presenceof oxygen, destroys it; hence thewise custom of giving infants orangejuice or tomato juice to insure anadequate supply of vitamin C.Vitam.in E is the reproductive factor.Feeding experiments on small animalsshow that when this factor istaken from them they cease to propagate.Vitamin E, however, is presentm most foods. Lettuce and wheatgerms are especially rich in it. Thereis no shortage of vitamin E in anordinary mixed dietcontaining vegetables.Vitamin G. Vitamin G is the antipellagrafactor. It is present in mostfoods that contain vitamin B. Wholewheat, however, which has B, has almostno G. Fresh milk, fresh meat,and fresh vegetables have more Gthan B. Yeast has both B and G. Toprevent pellagra, it takes a generoussupply of meat, milk, eggs, and freshvegetables. A balanced diet of energyfood so selected as to supply abundantvitamins is very important for the expectantmother. It will assure goodteeth for her offspring and preventdecay in her own teeth.We have spoken so far of the compositionof foods. A brief discussionof their preparation is now in order.We cook foods to render them moredigestible, and to protect them fromdisease transmission. It is not alwayspossible to tell by the eye when afood is safe or is contaminated. Milk,which is one of our most valuablefoods from a nutritional standpoint,may be sweet, and apparently of thehighest quality, but at the same timeit may be contaminated by diseaseproducing bacteria. For this reasonstudents of preventive medicine andpublic health officials are almost

12 The Health Bulletin December, 1930unanimous in their advocacy of pasteurizedmilk supplies.The claim that heating the milkchanges the vitamin value does notoutweigh the safety factor broughtabout by proper pasteurization. Wemust look to other sources for vitaminsthat are destroyed by the heatingof the milk. Animal foods should becooked. Meats should be cooked notonly to render them more digestible,but to render them safe. Cysticercus,the larva of the tape worm, is foundin beef and pork. Unless cooked, thereis danger of transmitting the cystto man. In cooking vegetables, careshould be taken to save the m.ineralsalts. The new plan of waterless cookingis a good one. Any water extractleft after cooking vegetables shouldbe consumed. In other words, weshould drink the pot liquor.Many vegetables can be eaten raw,but we must be sure that they areclean and safe. Raw cabbage, carrots,turnips, and sweet potatoes can safelybe eaten raw. If raw turnips andraw sweet potatoes were as dangerousas some would lead us to believe,many a country boy and girl wouldbe in danger. Grated sweet potatoesand grated carrots, finely choppedcabbage, and lettuce flavored withpineapple or other fruit make an excellentsalad, and furnish an abundantsupply of vitamins.After food has been properly preparedfor the table, it should then beproperly prepared for digestion byslow, thorough chewing and mixingwith the secretions of the mouth. Donot wash unchewed food down withwater. A reasonable amount of fluidwith the meals is all right, but itshould be used properly.This reminds me to speak of thewater supply. Be sure that it is safeand unpolluted. Our bodies are verylargely composed of water, about 60per cent of our body weight. Theaverage adult needs from three to fivepints daily. There is not much dangerof drinking too much water, providedone does not try to drink it all atmealtim.e. If your water is from oneof the city supplies in North Carolina,you are fortunate, for this Statehas very fine water supplies. If yoursupply is from a well, be sure thatthe well is sealed at the top, and thatthe water is drawn through a pump.Every open bucket well is a potentialdanger, it matters not how fine thewater may be chemically.The object of this talk has not beento give in detail instructions in selectingan individual meal, but to arouseinterest in the subject of selecting andpreparing a balanced dietary.The climatic conditions in NorthCarolina are such that any one v/hohas space for planting can have a finegarden. If the people of the Statewould raise more vegetables, morechickens, eggs and fruits, more milkfor home consumption, it would notbe many years before pellagra and allother deficiency diseases would be athing of the past.DO NOT FORGET THAT TOXIN-ANTITOXIN WILL PROTECTCHILDREN FROM DIPHTHERIA

—December, 1930 The Health Bulletin 13SOME CLASSIC ALLUSIONS TO MILKByJAMES A. TOBEY, Dr. P. H.New York City, New York"Honey and milk are under thy tongue,"sang the son of David somethree thousand years ago. This referencein the Song of Solomon (4:11)is but one of about fifty such lyricalallusions in the Bible to the foodwhich is the most valuable of themany possessed by man. Mention ofmilk occurs often in ancient literature,with much that is interestingand inspiring to those persons of thepresent who seek to foster a greaterpublic appreciation of this importantfood. When the people "is hungry andweary and thirsty in the wilderness,"they shall have for sustenance "honey,and butter, and sheep and cheese ofkine," says the Book of Books (2 Samuel17:29).Whenever the ancient Hebrewswished to extol the virtues of a particularlocality, they characterized itas "a land which floweth with milkand honey." There are a score of suchreferences in the Bible, contributed bymanj' different writers. One enthusiastof the period promised that "thehills shall flow with milk (Joel 3:18),while another threatened, "I will deliverthee to the men of the eastthey shall eat thy fruit and they shalldrink thy milk (Ezekiel 25:4). Shakespearealso couples milk with its nectareouscompanion when he pleads inhis Love's Labour Lost (v. 2-231) for,"one sweet word with thee, honey,and milk, and sugar." Another bard,Coleridge, tells us in his Kubla Khanthat "he on honey dew hath fed, anddrunk the milk of Paradise."This Kubla, or Kublai, Khan was indeedone who imbibed frequently ofmilk, for Marco Polo, most celebratedof world travelers, who sojourned atthe khan's court, has related that thispotentate maintained large herds ofwhite mares for the sole purpose ofsuppljdng milk to assuage his augustappetite and to provide for hisfamily. No doubt this sustenance aidedthe great Mongol ruler in his conquestof China in the thirteenth century.The Chinese have never had theadvantage of many dairy productsand, besides, the Mongols were accustomedto sprinkle the native souredmilk, Koumiss, on their battle flagsbefore engaging in combat. This libationto the Mongolian Mars musthave been of a propitious nature.Old Marco Millions, who had a keeneye for novelties, brought back fromthe East a description of a dried milkmade by his Mongolian friends, thefirst product of this nature on record,and he also sampled the intoxicatingsoured milk of the Tartars. Once ayear the Mongols held a ceremony inwhich the milk of a white mare wasscattered upon the ground and to thewinds, so that the Earth and Air andthe False Gods should each have theirportion of the most valuable offeringof man to his gods.The propitiation of pagan deities*"Dr. Tobey is co-author with Dr. Samuel J. Crumbine of a new book on milk entitled"The Most Nearly Perfect Food,'' published by the Williams & Wilkins Companyof Baltimore, Maryland. This article was prepared to furnish interesting historicalmaterial to nurses addressing children or mothers on food topics."This article was first published in the Trained Nurse and Hospital Review, a NewYork magazine for nurses, and is republished in the Health Bulletin by special permissionof that magazine.

14 The Health Bulletin December, 1930with milk was also a Roman custom,for the East and the West were onewhen it came to an appreciation ofmilk. Romulus, foster-child of theshe-wolf, and founder of Rome, poureda libation of white milk to Jupiter,who could appreciate the gift, for hehad been suckled by the she-goat onhis island refuge where the Sea Kingsof Crete reared the stately palace ofBroad Knossos. In this palace of twothousand years before Christ, vasesdecorated with cows have been uncovered.The ceremonies in honor ofJupiter, with their libations of milk,were continued for eight centuriesafter the founding of Rome, accordingto Pliny the Elder, noted naturalistof the first century. Pliny was an advocateof milk himself and wrote oneor two treatises on the subject."One uses milk," says ProfessorPliny, who though not exactly a physician,never hesitated to write onmedical topics, "as a beverage in allinternal ulcerations, especially thoseof the kidneys, of the blood vessels, ofthe intestines, of the throat and ofthe lungs; and externally for itchinessof the skin, for fever blisters afterhaving been put on a regime for ashort while." Speaking of the externaluse of milk, the Empress Poppaea,wife of Domitius Nero, had 500 assesto supply her with milk for a dailybath of cosmetic quality.'Milk was also advocated by all theancient healers for the treatment andcure of consumption, the diseasecalled phthisis by the Greeks, Hippocrates,the father of medicine, advisedmilk for all light fevers, but for someeccentric reason he did not particularlyfavor it for persons "that arethirsty." These ancients were not alwaysso archaic in their ideas, formilk is, of course, one of the modernmainstays in the treatment of tuberculosisand many other maladies.The great Greek doctor, Aretacus,was even more enthusiastic in hispraise of milk. "To take milk," hesaid, "'is pleasant; to drink it is easy;it contains solid nutrition and it is ofall foods the one with which one ismost familiar from childhood; it iseven most pleasant to the sight on accountof its whiteness." He then goeson to describe its medicinal value andconcludes, "If a person drinks muchof this he needs no other nutriment;and it is indeed well that milk is bothfood and medicine in ill health; as amatter of fact, there are nations wholive on milk and who are called 'Galactophagi'and who never eat anygrain whatsoever."Other famous writers of old havementioned these milk-drinking peoples.Strabo, a Greek explorer andgeographer, stated that milk was theprincipal subsistence of the Ethiopiansand the Lusitanians, while Homercalled a Scythian tribe "maremilkers" and also related that neithermilk nor cheese was lacking in Libyathroughout the year. In the Iliad,Homer tells us that the Achaeans resembledthe swarms of flies aboutmilk vessels in the springtime. Nodoubt the eminent minstrel sought tosmite those flies as he smote his inestimablelyre, for sanitation in thedays of the siege of Troy apparentlyleft something to be desired. It mayhave been better in Shakespeare'stime for in Two Gentlemen of Verona(VII, 1-277), the immortal poetsays, "She can milk; look you, a sweetvirtue in a maid with clean hands."authors whose names areClassicalfamiliar today many centuriesafterthe lit-they lived have contributed toerature on milk. Herodotus wroteabout it, and so did Plutarch, who alsopraised cheese. Virgil and Caesareach told about dairying, and Josephus,the contemporary of Christ, revealedin one of his historical booksthat "Abel brought milk and the firstfruits of his flock as offerings." Galen,one of the most notable figures inmedical history, was a staunch believerin milk, which, he averred, "repeatedlyhas been set down by all physiciansas of the best nutritive value."

December, 1930 The Health Bulletin 15In one of his books Galen described aman who lived to be more than onehundred years old on a milk diet.Long since Galen's era, longevity hasfrequently been attributed to milkdiets. The late Professor Eli Metchnikoffcited the cases of Marie Priou,who died in 1838 at the reputed ageof 158 after living most of her lifeon cheese and goat's milk, and ofNicole Marco, who survived to themature age of 110 on a diet of breadand cheese. That there may be somethingscientific in such phenomonahas been indicated recently by the investigationsof Professor Henry C.Sherman at Columbia University inNew York, who has demonstrated byexperiments on more than 21 generationsof white rats, including some400 of these supple rodents, that anincrease in the proportion of milk inan already adequate diet results in aten per cent increment in the span oflife. The chance of error in his studieshave been computed to be only one inten thousand and his work presentsremarkable evidence of the possibleinfluence of diet on longevity, withpure milk playing a leading role.The ancients appreciated the significanceof milk in human affairs, forpractically all peoples of the earlycivilizations worshipped the cow as agoddess. To the Babylonians she wasthe mother of the Moon, while inEgypt she was the deity called Hathor,who produced the fertility of theland and caused the Nile to overflowat regular intervals. In the Vedicsongs of India, as venerable as theOld Testament, the cow was declaredto be man's chief benefactor. Theseancient hymns declare that milk anddairy products are the most valuableof all offerings to the gods.The oldest of all references to milkwas discovered in Mesopotamia a fewyears ago by members of the joint expeditionof the University of Pennsylvaniaand the British Museum,working under the direction of Mr. C.Leonard Wooley. At Ur in the Chaldeesthese archeologists uncovered amilk scene which is at least five thousandyears old. It was constructed bya king of the first dynasty with thealliterative cognomen, A-an-ni-pad-da,who used the scene to decorate a templeon a mound at Tel Al Ubiad, fourmiles from his capital at Ur.On the facade of this shrine theking placed a continuous frieze cut inlimestone, which depicted an interestingview of pastoral life as it existedamong the ancient Sumerians. In thecenter was a byre, or cow-stable, madeof reeds bound with rope, with thedoor-way flanked by spears and surmountedby a crescent. Two heifersare emerging from this doorway, andtwo cows, each accompanied by acalf, are already outside. The cowsare being milked by men seated directlybeneath their tails, and thecalves are muzzled so that they cannotinterfere with this lacteal production.The other side of the doorway isoccupied by four dairymen. One hashis hand in a large jar, the next ispouring milk from a small jug into astrainer held by his colleague, whilethe fourth straddles another largecontainer. The whole operation obviouslydepicts an interesting dairyprocess, such as the making of butter,or the collection and storing of milk.The nearest approach to it from thestandpoint of antiquity are the bonesof cattle and goats, and the remainsof dairy implements found at the siteof the homes of the lake dwellers ofSwitzerland, who resided there from4,000 to 2,000 years before Christ.Modern appreciation of milk i"' asgreat as that of the ancients. Thepeoples of the past had experience togive them cause for their admirati'mof milk, but we have e.xperience plusscientificresearch, which has producedfor us logical and incontrovertiblereasons why milk is the most valuableof all human foods, the one article ofthe diet for which there is no single

——16 The Health Bulletin December, 1930substitute. And so we can sing withPindar, poet laureate of the goldenage of Greece:"Rejoice, my friend! Lo, I send you,though at late hour, this honey mixedwith white milk, fringed with thefroth of blending, a draught of songconveyed in the breathings of Aeolianflutes." The Trained Nurse andHospital Review."VITAMINS MAY BE VIBRATIONS IN THE ETHER"A few months ago Sir James Barrs,an English physician, made an interestingspeech at a British medical societymeeting. We quote two paragraphs:First. "I am more concerned withthe preservation and efficiency ofhealth than the mere prolongation oflife; a sound mind in a sound body,the former can scarcely exist withoutthe latter. When I travel outsidethe beaten paths of traditional medicineI do not wish you to accept anythingwhich I may say until you haveproved it for yourselves. The onlyknowledge worth a tinker's imprecationis that which you acquire foryourselves and make your own. Proveall things, hold fast to that which isgood. Accept facts and not mere opinions,no matter by whom uttered.Second. It is easy to know all thatis known about vitamins, and if youacknowledge not to know your patientsmay think you very ignorant,and much behind the times. You canbuy vitamins by the ton at a verysubstantial price, yet no chemist, noreven a bio-chemist, has been able todiscover their chemical composition;the nearest approach is that whensome of the sterol compounds such asergosterol are exposed to the mercuryvapor lamp they become charged withvitamin D and you must be carefulnot to overcharge lest the stuff becomepoisonous. It may thus turn outthat vitamins are vibrations in theether of definite wave lengths, and abio-physicist may eventually be ableto measure the wave length and determinethe dosage."In the meantime good advice toBulletin readers (and that is not opinioneither) is to continue to raise yourown vitamins and fats, proteins, carbohydrates,sugars, calcium, etc.)wherever possible and where you can'traise them yourselves, your grocer,dairyman, and produce dealer hasthem. Fruit, vegetables, cereals, freshmeats and milk, butter and eggs. Youcan thus extend a welcome to the vitaminsand say goodbye to pellagraand pessimism.RECOMMEND GROUP HEARINGAPPARATUSPersons with seriously impairedhearing should employ a hearing aid.Dr. Wendell C. Phillips advises in anarticle in Hygeia for December. Itmust always be understood, however,that even the best hearing devices aresimply aids to hearing and do not improvethe actual hearing function.Deafened persons are especiallywarned not to be misled by any formof newspaper or magazine advertisingsetting forth claims to curedeafness. For ages hard of hearingpersons have been exploited by fakers.In recent times electrical engineershave developed not only individualhearing devices, but of late the grouphearing aid has come into existence,whereby it is possible for largegroups of the hard of hearing to receivethe benefits enjoyed by hearingpersons. The group hearing aid ishere to stay. Dr. Phillips points out,and hard of hearing persons in everycommunity should demand thatchurch authorities, managers of theatersand concert halls should installthis hearing apparatus which scientistshave selected and developed.Hygeia.