Medical Society of the State of North Carolina. An.

Transactions of the Medical Society of the State of North Carolina [serial] (Volume 62 (1915)) online

. (page 44 of 58)
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cian will make out the certificate with tuberculosis as the cause of death,
and we have to return the certificate to get it corrected to show whether
the cause of death was tuberculosis of the lungs, the pleura, the peri-
toneum, or generalized tuberculosis, or some other form of tuberculosis ;
the physician will make out the certificate with cancer as the cause of
death, and we have to return it to find out whether the cause of death
was cancer of the skin, of the breast, of the stomach, of the uterus, or
of some other organ; a certificate will come in with the- cause of death
stated as violence, and we have to return the certificate to find out
whether the violence was accidental, homicidal, or suicidal. We are not
complaining, nor criticising the profession. These difficulties in statis-
tical practice are common to all States and can only be gotten rid of as
the profession becomes accustomed to standard statistical methods.
!N^evertheless, the doctors can save us money that may be used in other
public health work by referring oftener to the Physician's Pocket Refer-
ence, copies of which have been supplied the profession.

The budget of the Bureau of Vital Statistics for this year will be in
the neighborhood of $16,000. After this year we believe this bureau can
operate on a budget of about $12,000 to $13,000, and, in seven or eight
years, through the revenue derived from fees for transcripts of certifi-
cates, the cost of the bureau to the State can be reduced to somewhere
between $8,000 and $10,000 a year.


The plans for this bureau, now in satisfactory process of execution,
call for a sanatorium, operating at present with 90 patients, and a cor-
respondence school for tubercular persons, the latter to shortly begin its


work. Dr. McBrayer was recently asked by Dr. W. S. Leathers, Director
of Sanitation of Mississippi, for complete details of our tuberculosis
policy, Dr. Leathers having in mind the North Carolina plan for his own
State. Dr. J. A. Hayne, secretary of the State Board of Health of South
Carolina, recently told the writer that in appearing before a legislative
committee of his State in behalf of an appropriation for tuberculosis he
quoted to good effect the pamphlet outlining our State policy. The
official attention which our tuberculosis policy is receiving in other
States increases our confidence in our plan of work.

The first year's work of the Sanatorium under the State Board of
Health was carried out under difficulties sufficiently formidable to test
the resourcefulness, patience, and faith of Superintendent McBrayer.
Starting with a maintenance appropriation of only $20,000, out of which
we were informed, when we accepted the responsibility for the institu-
tion, we would have to pay $4,000 on debts already incurred, we found
later that the institution owed $14,000. Satisfying insistent and some-
what incredulous creditors, and, at the same time, obtaining further sup-
plies on a very meager budget for from 75 to 90 consumptives, has not
made the position of superintendent during the last year a very enviable

N'evertheless, from June 1, 1914, to June 1, 1915, 341 patients have
been treated at the Sanatorium. Of this number, 5 have died, 336 have
returned to their homes, 55 arrested, 200 improved — all of them less dan-
gerous as conveyors of infection to their families and associates. During
this same time 125 suspected cases of tuberculosis have been examined
by the medical staff of the Sanatorium. Most of these patients were
referred by their physicians. Some came of their owti accord, while
others came of their oAvn volition after they had been pronounced non-
tubercular by one, two, and sometimes three physicians.

With the appropriation made by the General Assembly of 1915 the old
debts have been paid.

The contract for a new building of 50 beds, which will increase the
capacity of the Sanatorium to 150 beds, has been let. As there will
always be a number of patients at the Sanatorium whose condition re-
quires hospital facilities — patients who have recently arrived and who
have not been restored to their feet, and patients stricken with some com-
plication, as a hemorrhage or some intercurrent disease — the new build-
ing will afford facilities not found in the cheaper type of building, such
as shacks, cottages, and lean-tos. Dr. McBrayer's building plans con-
template using both types of buildings, the more convenient and ex-
pensive hospital type and the less convenient but more economical cot-


tage and leau-to type in the proportion o£ about one bed of the former
to two beds of the latter. This combination couples efficiency with
economy, and we hope will commend itself to thoughtful people.

The funds necessary for the enforcement of the act requiring the re-
porting of all cases of tuberculosis have just become available, and this
act, on which will be established the correspondence school for tubercu-
losis, will be put into effect immediately.

One of the most encouraging features of the antituberculosis work is
the sympathetic interest and support of the public as expressed through
the press and through the material assistance rendered the patients in
the Sanatorium by social, fraternal, and religious organizations and by
individuals. Miss Angie Gilbert of Saluda, IST. C, and Dr. J. C. Hoyt
of Washington, N". C, left bequests to the Sanatorium. The outlook for
donations from individuals and some definite work by the Federation of
Women's Clubs is reasonably certain. The law enacted by the last Gen-
eral Assembly which allows counties or towns to pay partially or wholly
for the treatment of their needy but deserving consumptives Avill un-
doubtedly furnish a source of revenue to the Sanatorium and prove
of mutual advantage to both the Sanatorium and the counties that be-
come interested.


To this division of the executive staff was intrusted the problem of
eradicating hookworm disease in particular, and of decreasing the preva-
lence of fecal-borne diseases generally. The work of this bureau termi-
nated May 1, 1915. As you recall, this work began in March, 1910, on
finances appropriated from the million-dollar Foundation given by Mr.
Rockefeller in the fall of 1909 for the eradication of hookworm disease
in the South.

During its existence this bureau has examined 267,999 North Caro-
linians for hookworm infection, a little more than one-eighth of the
population of the State. Of this number, 78,977 have been microscopic-
ally diagnosed as infected with hookworm disease, and 95,618 have been
treated. This work cost the counties $20,394.96; the State $15,119.11;
and the Rockefeller Sanitary Commission $68,653.28 ; a total of $104,-
064.37, making the cost per case treated $1,088.

In 1914 the form of the work of the Hookworm Commission was
changed from the dispensary to what is known as the community plan
of work. The community plan of Avork consisted in selecting a rural
community of from 6 to 10 square miles, Avith from 500 to 1,000 citizens,
and attempting to install an improved privy in every home in the com-


munity. Fifteen communities, comprising a total area of 369 square
miles, with a total population of 11,378 people — an area and population
corresponding to half of an average county — have been worked. The
community work has cost the counties in which the communities were
located $847.77; the State $5,764.84; and the commission $12,862.95;
a total of $19,578.54. Seventeen hundred and ninety-six improved
privies have been constructed, making the average cost to the bureau
$10,901 for each privy improved.

Of course, the figures express only the tangible results of the work of
the Rockefeller Sanitary Commission in North Carolina, and not the
intangible results, Avhich must not be lost sight of. A privj- is a valuable
sanitary asset to a home; but what the privy stands for, the type of
family intelligence and refinement that it expresses, is a thing of much
greater value than the privy itself ; and this moral educational influence
of the commission's work in iSI'orth Carolina is over and above the story
told in figures. The influence of this work has been of great value in
molding public sentiment favorable to the extension of public health
activities along all other lines of sanitary endeavor. The State Board
of Health at this annual meeting has adopted suitable oflicial resolutions
expressing the appreciation of the State and the profession to the Rocke-
feller Sanitary Commission for its valuable cooperation during the past
five years.


To this division of the executive staff of the State Board of Health is
intrusted the work of developing intelligent local self-government in rural
sanitation in Xorth Carolina. Xinety per cent of the population of this
State is rural; North Carolina has a larger proportion of rural citizens
than any State in the Union ; efficient rural sanitation is an absolute
essential to any considerable reduction in this State's death rate. The
entrance of a county into cooperative fellowship with the State in its
effort to conserve human life is like the entrance of an Italy or Greece
on the side of civilization. To realize its object, the establishment of
intelligent local sanitary self-government, the bureau is following two
methods :

One method, Avell under way, is the employment of Avhole-time county
health officers by the counties. We now have, and have had for the last
thirty months, ten North Carolina counties employing whole-time health
officers. The ten whole-time men are men of more than average ability,
and to these men and these counties we look for the development and
establishment of an effective system of county health Avork if efficient
local sanitary administration can be developed in that way. The atti-


tilde of the State Board of Health to the whole-time county health officers
at present is one of watchful waiting, with, I should say, considerably
more confidence in the men in charge of the sanitary problems of these
ten counties than Mr. Wilson had in the officials of his southern neigh-
bor. We think it best to leave the whole-time health officers the widest
latitude of discretion in the experimental development of county health
administration, standing ready at all times to help them in every way
we can whenever they call upon us.

Another method just beginning, but already with such impetus as to
make its further prosecution more or less obligatory, is what we are
pleased to term the unit system of county health work. In this unit sys-
tem of county health work the Bureau of Rural Sanitation takes a defi-
nite county health problem, works out on paper every detail in its solu-
tion, attaches thereto the most economical and exact budget on which the
problem can be handled, submits these plans and specifications to the
county authorities and secures their agreement to defray the actual
expenses of the work as submitted. To illustrate : The bureau finds, and
has worked out in minutest detail, a method by which a six-weeks mov-
able county dispensary for vaccinating the people against typhoid fever
and educating those that attend the dispensary in sanitary matters can
be held in the average county of JSTorth Carolina at a cost to the county
of about $325 to $350 ; the plan is presented to the county physician for
his indorsement and then to the board of county commissioners, explained
to them in detail, and on the board of county commissioners agreeing to
place at the disposal of the State Board of Health the amount called for
in the budget, the work is carried out in cooperation with the county
physician through agents employed by the State Board of Health.

Another unit of county health work, which will illustrate the princi-
ple, and which will be carried out in several counties this fall and winter
Avhen the schools are in session, is the unit of school sanitation. This
unit couples medical inspection of the schools with community sanitary
instruction. We are now in position to offer, and will offer, to from four
to eight selected counties this fall the following definite proposition : In
consideration of about $450, $225 from the county commissioners and
$225 from the county school board, to be paid to the State Board of
Health, the board agrees to put an officer, specially trained in medical
inspection of schools and well equipped for giving illustrated lectures on
sanitation in the county, to perform the following schedule of duties :
To arrange for a school health day in each white school in the county;
to visit each white school in the county on the day observed by the school
as health day; to reach the school at 10 a, m. on the health day; to seek


to interest and assist the teacher in the teaching of sanitation; to ques-
tion the children on a health catechism previously supplied them, and
to distribute prizes for excellence in knowledge of the catechism ; to
make a thorough medical inspection of the children for the common de-
fects, and to notify, by an official card, the parents of defective children
of the condition of the child ; to file with the State Board of Health the
addresses of the parents of defective children in order that the central
office may keep in touch with the parent, through a system of correspond-
ence, until the child is properly treated ; and, lastly, to give several illus-
trated lectures on the significance of the common defects and other sani-
tary subjects to the parents and children (these several lectures to be
separated by the reading of compositions on sanitary topics by the chil-
dren and entertainment features), as previously announced for the even-
ing of the day on which the school is visited. A full program for the
Board of Health official, but not too heavy Avhen he gets two days a
week, Saturday and Sunday, for rest. He can make five schools each
week and complete an entire county with forty-five schools in nine weeks.

There are many other units of county health work which will have
their plans and specifications thoroughly worked out by the time we can
use the plans. You may be interested to know that we have discussed
this unit system with the Federal Children's Bureau, and it is not im-
probable that the bureau and the Board of Health Avill cooperate in the
development and launching of a unit of county health work dealing with
infant mortality, a factor next in importance to tuberculosis in the death

We began the unit system of health work in April of this year. Our
first move was to get ten counties to put on the typhoid vaccination unit
this summer. We have ten counties already. The ten counties have
made a total appropriation of $4,100 for this work.

The unit system gives the people an absolutely definite health problem,
carefully planned and carried out under expert supervision; it is the
scheme by which we hope to bring into active and effective cooperation
with the State forces the ninety counties that are not employing whole-
time county health officers ; it is a plan that will tend toward the system-
atizing and standardizing of local health work; it is a plan that will
liberate the whole-time county health officer from work that rightfully
belongs, with the fees that go with it, to the practicing physicians. I
refer to medical practice for county institutions, to other charity cases,
to autopsies, to examinations for lunacy, and expert court opinions, by
which the whole-time man is often tied up to a court and caused to lose
a whole week from real needed health work.


As compared, the two methods, the whole-time county health officer
method and the unit system of county health work nietliod, diifer in
important particulars. The whole-time health officer method proposes
to a county the means to an end; the unit system proposes an end — a
definite health i)roblem with plans, specifications, and budget. The
whole-time health officer is a full dose^ — a $3,000 to $4,000 dose— of
health work; the unit system is health work in broken doses; counties
whose financial stomach is too weak for the former may accept and
retain the latter. With the whole-time health officer method, the county
does its own health work; with the unit system, the county pays the
State, the wholesaler in sanitary wares, to do its health work for it at a
price mutually agreed upon. Both methods are now on trial. We shall
see their advantages and disadvantages.

The Bureau of Kural Sanitation is the youngest bureau — the baby of
the board. We are crazy over the baby. We are confident of its future.
And why shouldn't we be, when the baby has for its nurse Dr. G. M.
Cooper, the nurse that raised Sampson !

Dr. W. R. Kibk, Hendersonville : I would like to ask Dr. Rankin if
the matter has ever been settled about the registration of nonresident
deaths. We took up the matter in Henderson County, and it has been
agitated in Buncombe. The situation is like this : We have a great many
people coming from a distance to our county. They die there, their
deaths are recorded there, and Henderson County has those deaths
against her record. What we want to do is to separate these nonresident
deaths from the resident deaths, so that we shall know exactly the num-
ber of deaths for which we are responsible. We are willing to shoulder
the responsibility of our own deaths, but not of the deaths of persons
coming from the outside. I should like to know if anything has been
done about this matter.

Dr. J. W. McISTeill, Fayetteville : It seems to me that we should not
let this opportunity pass by without commending Dr. Rankin for the
zeal and enthusiasm with which he has carried out this work, and the
great amount of work that he has done. I think we should thank him
for his work in this line.

Dr. Oscar McMullan, Elizabeth City : I should like to ask one ques-
tion. Is tuberculosis a reportable disease, and, if so, to whom should we
report it?

Dr. W. S. Rankin, Secretary: I will reply to the questions in the
order in which they were asked.

As to the registration of nonresident deaths : In the first place, the
only value vital statistics have is their comparative value. That the


death rate of ^ortli Carolina is 15 means absolutely nothing unless you
know the death rate of the other forty-eight States. It is the comparison
which makes statistics valuable. Now, if we are going to compare birth
or death rates of one State with another, as we have to do, the method of
collection and tabulation of these statistics must be uniform throughout
the United States. Therefore, it is the function of the United States
Government to standardize the methods of statistical practice, and that
is what is done in the model law. The United States will not accept sta-
tistics from this State unless we employ the same methods as are em-
ployed in other States. The statistics otherwise would be valueless to
the world.

The same principle applies to a county, and we have to consider the
jSTational Government in the collection of statistics from the county. It
is undoubtedly true that in certain places in the United States the appar-
ent death rate is much greater than the real death rate, i. e., the total
death rate as composed of the death rates of residents and nonresidents,
i^onresidents dying in Henderson County are charged to that county;
the deaths of residents of Henderson County dying in other places are
not charged to Henderson County.

The American Public Health Association has a section on Vital Sta-
tistics, one of the ablest committees that it is possible to get together,
Avhich is to deal with the method of scoring nonresident deaths. That
committee is now at work, and will report this fall. Something has to
be done about the reporting of nonresident deaths, and in time a policy
will be worked out. In the meantime, the only thing a town or county
can do is to point out on its charts the number of deaths of residents and

As to the reporting of tuberculosis, the profession will receive an
oificial notice from Dr. McBrayer within the next thirty or sixty days,
calling their attention to the necessity of reporting tuberculosis.

In reply to Dr. McXeill's kind remarks, I wish to call attention to the
fact that the work of the State Board of Health is the work of a whole
staff, and if the State Board of Health deserves any credit, it is due to
the selection of the right kind of men, and the kind of work that Mr.
Booker, Dr. Shore, Dr. McBrayer and the others are doing.

Dr. Way : I wish to announce that Dr. F. R. Harris of Henderson has
been elected by the State Board of Health to fill the unexpired term of
Dr. Kent. Dr. Harris's high professional standing and his great interest
in everything that concerns the organized medical profession, the State
and the peoj^le are well known to you, and I feel sure that he will make
a valuable addition to the board.


I also have pleasure in announcing to you the reappointment, to suc-
ceed himself, as member of the State Board of Health for a term of six
years, of Col. J. L. Ludlow, and I may with truth say of him, as I did of
Dr. Harris, that he needs no introduction to this body, having served
with honor to himself and credit to the State two terms of two years each
by appointment of Governor Scales and Governor Fowle from 1S89 to
1893, and as a member of the board continuously since his appointment
in 1901 by the beloved Governor Charles B. Aycock. In addition, the
Colonel enjoys the unique distinction of being the only lay member of
this society, an honor conferred by unanimous vote several years since.

I desire further to announce to you that at an official meeting last
night of the State Board of Health the board elected as secretary, to suc-
ceed himself, for a term of six years. Dr. Watson S. Rankin.

I want to thank Dr. MclSTeill for his kindly remarks in regard to the
work Dr. Rankin has done. Every word he said is true, and only par-
tially tells the story of Dr. Rankin's splendid and successful endeavor.
But without detracting from the work of Dr. Rankin, I want to say that
the work is the result of the united efforts of the men on the staff. Dr.
Rankin, Dr. Shore, Dr. McBrayer, Mr. Booker, etc., and also to their
subordinates and assistants.

I wish also to remind you that this board is peculiarly responsible to
the people. In no other State are the medical boards so controlled by the
profession, as in the State of Worth Carolina. The members of the State
Board of Health are appointed by you and by the Governor. The per-
sonnel of the State Board of Medical Examiners is appointed solely by
the society. These are your boards. I am glad there is such an intimate
and close relation between these boards, and between them and the prac-
titioners of North Carolina. Public health work owes its genesis pri-
marily to the research and advances of medical men. It will succeed or
fail in any community by just so much as it has the support and coopera-
tion of the medical practitioners of that community. I want to empha-
size this latter thought, and ask that the work of the State Board of
Health continue to have, as I feel that it now has, the cordial sympa-
thetic support of the members of this society and of the members of the
profession in our State.

Wow, one other matter. Several years ago, amid the jibes and face-
tious comments of the press on the matter, a large sum of money was
appropriated by the Rockefeller Sanitary Commission for hookworm
work in the South. Worth Carolina received her pro rata share in this
work and of that money. The money was expended under the direction
of the State Board of Health during the last five years, and I believe I
am safe in saying that great good was accomplished thereby — good not


only ill directing the attention of the people to intestinal parasites, and
in eradicating them thereby, hut, in addition, in quickening public senti-
ment to all forms of sanitation and public and private health work. I
may say in passing, as a matter of record, that the work done in Xorth
Carolina in the eradication of hookworm disease was so wisely, so care-
fully, so thoughtfully, so well done by Dr. John A. Terrell, a member of
this body, that when the work was concluded the International Health

Online LibraryMedical Society of the State of North Carolina. AnTransactions of the Medical Society of the State of North Carolina [serial] (Volume 62 (1915)) → online text (page 44 of 58)