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 53 of 58)
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naturally turn for guidance. If he finds a dirty, badly lighted, ill-kept
room, a place where he is uncomfortable, it will be pretty difficult to get
into his consciousness anything that will be for his well-being. After-
ward, when he grows up, he will wonder how any one had the nerve to
talk to him about sanitation, and teach him in such a place. The most
important way in which sanitation can be taught will be in a Avell built,
well lighted, well kept schoolhouse ; a well heated schoolhouse, provided
with adjustable desks, one where the desks will be placed rightly in rela-
tion to the lights, one with no blackboards between entering lights.
Sometimes we found that the blackboards were placed in accordance
with the teacher's comfort. Now, the eyes of all these little children are
more valuable than the eyes of one teacher.

If the child finds that small things of that kind are taken into con-
sideration by the board of education, he Avill have respect for their judg-
ment and will look up to them. If the teacher is impressed with the
fact that she can use the ordinary furniture of the room, its location,
the color of the wall, the seats, the floor, everything in the room, as
examples from which to teach sanitation without reference to any text-
book; if she can tell them how the things are situated, and why; if she
can go further and find clean grounds, a perfectly sanitary privy and
water supply, she will have all the text she needs to carry her pupils
through a long course of instruction.

So far as personal cleanliness is concerned, I have been in some schools
where the teacher was not making any great effort to make an impression
of personal cleanliness. I know that it is not easy to keep immaculately
clean in a dusty room, but the teacher herself can keep clean. When she
comes in contact with anything likely to soil her hands, if she will im-
mediately wash her hands, it will be an example to the children. If the
children are not permitted to become soiled and stay soiled, it will have
a very beneficial effect.

You all know that one of the greatest dangers in our schools is the
droplet infection that comes from the nose and throat. I have seen a



FIFTH AXXUAL SESSION.



17



school teacher sueeze in the faces of the entire school. I saw a superin-
tendent do it once. Such a thing may spread contagious diseases. If a
teacher is always careful to use a handkerchief, and urges the children
to keep handkerchiefs and to use them, she can cut down measles and
whooping-cough tremendously. There is not the slightest douht of that.
I think that the power of the school to teach by example is simply
enormous. There is no precept which carries weight unless impressed
by example. You must have the concrete thing to show in order to make
an impression on a young mind. There are so many, many efforts that
have been made to teach by precept alone, without furnishing the con-
crete examples. We have them all about us. "We all know how they
have failed. You must have something to show the eye and let the hand
feel. A little ingenuity, and a little exercise of this ingenuity, will fur-
nish in the schoolroom, from the ordinary objects of daily use and con-
tact, an enormous number of examples for sanitary instruction.

Dr. William M. Jones : This is one of the most important subjects
that will come before this meeting, if not the most important. These
two talks are now open for discussion, and I hope that it will be full
and free.

Dr. G. M. Cooper, Ealeigh : I would like to say, in the first place,
that I was especially impressed with Professor Foust's discussion of the
school problem. I think he has sounded the keynote. Dr. Foust said
that we threw the burden on the school teacher. It is customary, I know,
to throw the burden on them to as great an extent as we possibly can.
I was struck with his remarks about the prohibition question — that the
surface was not even scratched until the schools took it up in physiology
and hygiene.

I want to say, as a county health officer, that the best work done was
done by the aid of the teachers. When I got a teacher thoroughly inter-
ested, I had no further trouble. In a community where there Avere con-
tagious diseases, if the people did nothing to help us, I found that we
did absolutely nothing. I made the remark the other day to the teachers
that if the State JSTormal School and the Carolina Training School
turned out teachers with an interest in the subjects of sanitation and
hygiene, they could do no greater work. The Carolina Training School
particularly is giving its students something beyond the ordinary, every-
day interest we find in teachers, and I want to take this opportunity of
commending that institution for its work in this direction.

Dr. B. K, Hays, Oxford : I am new in this work, and I am here to
learn. I was intensely interested in the talks that were made, but I want



18 HEALTH officers' ASSOCIATION,

to ask, if it will be in order for me to do so, that tlie gentlemen in their
talks tell us their results and how they were obtained. -We know that
the conditions are bad, we know they are rotten, from Murphy to Man-
teo. I hope that we shall not have to spend the day in hearing how bad
they are. Tell us how you get results, how you reduced the number of
flies, etc.

I regard the weekly talk that I make in the school in my town as the
greatest work I do. Since we have no examination on this health work,
and since the pupils have to be examined on their other subjects and
naturally we do not want to take much time from them, I made a bargain
to review them on history one week if they would listen to me talk on
sanitation the next week. So one week I told them about "night air,"
about mosquitoes, etc. The next week, in accordance with my promise
to review them on history, I told them about De Soto, and how he died
from being exposed to night air, and the children laughed. That laugh
was the best result that I have obtained during my brief term of office.

Dr. D. E. Sevier, Asheville : The first work we have to do is to secure
the cooperation of the board of education and of the teachers of the
county. I believe it is the first duty of the health officer to go before
the teachers at the first meeting held in his county and deliver to those
teachers a hygiene and sanitation talk, explain to them that you are
coming to them as their assistant; that while you are asking for their
help, you will relieve them from a great many burdens. At the same
time, carry with you a little pamphlet or booklet outlining the duties of.
a teacher in regard to the infectious or contagious diseases which may
be found in the schoolroom during her term. Teach her along these
lines, and you have laid a foundation for your health work that cannot
be equaled in any other way.

I went before the teachers of Buncombe County at their first meeting
and talked to them along these lines. I extended an invitation to them
to make my office their headquarters when in Asheville. In so doing, I
won their confidence, and they have carried out my instructions almost
to the letter. When I go to a school, the teacher meets me with the glad
hand. The pupils, of course, watch her every move. When you have
instructed the teacher as to the lighting, the ventilating, etc., and then
talk to the pupils, they will carry out your directions, not only in the
schoolroom, but in the homes as well.

I would like to say that Ave have some very good school buildings in
Buncombe County. One at Black Mountain, in particular, has running
water, two drinking fountains in the front yard, and two separate toilets
in the building. This building is elegantly lighted, well ventilated, and



FIFTH A:s"xrAL SEssioisr. 19

kept in a perfectly sanitary condition. This is due mostly to the efforts
of the Ladies' Betterment Society, assisted by one of the teachers, Miss
Anderson. They collected $300 to i^ut in these fixtures, and afterwards
the general public made up the amount to pay what they had borrowed.

You can also instruct the teacher Avhat to do when a child is sick, and
what kind of note to send to the parents. The parents will not fall out
with the teacher for sending a child home, because if it is done with one,
they will know that you are looking out for the welfare of all.

I believe that the teachers, if treated in a courteous manner by the
health officers of the various counties, will do more in public health work
than it would be jiossible for all the physicians in that county, even if the
physicians lend their assistance.

Dr. J. E. Malone, Louisburg : I am not a whole-time health officer.
I am one in spirit and in pride in the work, but not financially.

I have made it a point, since I have been superintendent of health,
which has been for a good many years, to go around and make health
addresses in six of the larger schools. Every week I have something to
say about health in the county paper. I make it a point to see five
people each day and talk to them fiA'e minutes on health. I give them
instruction and give them literature.

Another thing I am working harder on noAV than anything else is the
installation of sanitary privies. We are trying to get the very simplest
kinds. I was out inspecting on the watershed several weeks ago, and a
negro w^oman for whom I used to practice asked me to come to dinner.
Well, I went. Wear by there was a privy. I asked her husband for a
handful of flour, and scattered it over the flies under the privy. Soon
after we sat at table — food covered with white flour-backed flics. "'To'
Gard !" said the husband. "Doctor, Avhar dem flies comes frum ?" *'You
know," said I. ''Wall, doctor, fur de Lord's sake, tell me how to git shed
uf 'um." I put him on to the simple 5-foot deep by 2 feet square hole in
the ground sanitary privy, and almost the entire population in that com-
munity folloAved John Smith's example. Another good object lesson.

I have two negro health societies in my county, and am going to have
more. We have some white ones, too. I have two societies on the water-
shed, one on each side of the river. We meet once a month for discus-
sion of health questions, and it is the most interesting thing you ever
heard. Once I offered a prize of an Ingersoll watch to the one who made
the best talk on health. I have taken an automobile some nights, with
a crowd from Louisburg, and have gone out to hear these discussions.
You would be surprised to see the interest and enthusiasm manifested by
the negroes. Negroes travel a good deal night and day, visiting, hunt-



20 HEALTH officers' ASSOCIATION.

ing, and fishing. They have opportunity to inspect the watershed for
dead animals and have them removed, hurned, and report to me every
Saturday. Thereby the watershed is respected.

On the inspection of the watershed I visit sixty-four houses, and it is
a big job. I am doing a whole-time county health officer's work on half
pay. At first we got a man to inspect the watershed at $-i.50 per day,
but he broke down on it. I did not want the Morehead City incident
repeated, so I told the authorities that I would inspect it myself, so I do
it now, and send in the report every quarter. The negro assistants are
a great help.

I think that thing of talking to five people every day about health, for
five minutes, is a small thing, but it is carrying the thing around the
county, and they are going to do something for a whole-time county
health officer one of these days.

Dr. E. F. Strickland, Winston-Salem : I enjoyed the papers by Mr.
Foust and Dr. Nesbitt exceedingly, and I simply speak, as most of those
who have preceded me in the discussion have done, more particularly
concerning my individual experience in my county.

In regard to teaching school children by example : We meet the teach-
ers in the annual and quarterly meetings and in their educational con-
ventions. My experience in the last few years in its varied forms, in
meeting with the teachers and in the visitation of schools, has shown me
that we get the cooperation, the very hearty cooperation, of a majority
of the teachers. In some instances we fail to get the cooperation that we
seek and that we would be so glad to have.

I believe it was Dr. ISTesbitt who said something about the superin-
tendent of public instruction being, as it were, between the devil and the
deej) blue sea. I believe it is sometimes the case, and I can say it from
experience.

In our county the cooperating teachers meet me with a glad hand on
my visitations to the schools. They cooperate, they are glad to have
instructions, and they are glad to put into execution the instructions
given them. They make health work a living, vital force in the school
term. In a minority this is not the case. For example, during the past
winter season I visited a school. I think it had an enrollment of about
seventy-six, with two 'teachers. At the conclusion of my talk I asked
for voluntary vaccination against smallpox. The two lady teachers were
first to volunteer, and I vaccinated every child in that house that was
not already immune — every child. In another section of the county I
visited a school. Let me say here that we find many and varied condi-
tions in the same county, almost in the same eastern or western or north-



FIFTH AiVNUAL SESSIOX. 21

erii or southern section of the same county. In ahuost adjoining town-
ships you find such a difference in sentiment. Well, I visited this school.
There had been a case of smallpox two miles from it, and so there was
some cause for uneasiness. There had been no cases near the other
school. I gave a talk on sanitation and health, and at the conclusion
asked those in the school to be vaccinated. It was a one-teacher school,
and I think there were about forty or fifty pupils present. I told them
of the dangers of smallpox, and of the absolute safety in vaccination,
then asked how many had been vaccinated. ISTot a hand went up — not a
hand. I told them there was smallpox not far away and that there was
danger. Then I asked how many Avould submit to vaccination. N'ot a
hand went up. I saw that the children's eyes were fixed on the teacher,
and that caused me to turn to him. I asked if he had been vaccinated.
He said he had not. I asked him if he would allow me to vaccinate him,
and he said, "iSTo, not today." "Well," I said, "there is not much hope
of the children's being vaccinated. I have done you all the good I can,
except to say that I hope that you will clean up this schoolhouse and get
it looking a little better. There are a good many papers around, and
that is dangerous." Then I bade him goodbye and left.

I have thought of the conditions there a good many times since then.
I spoke of the matter personally to the superintendent of education, and
I have spoken of it to the board of education. I asked them what they
thought of that teacher, and they said he was a good teacher. Somebody
said recently that he is all right in politics, and is a pretty good fellow.
I said that I did not think he is fit to teach school — public school.

JN^ow, will the boards of education continue to recognize the certificates
of persons to teach in the public schools who are so derelict of their dutj''
and so utterly unmindful of the common laws of health and of the sani-
tary conditions that should be the environment of every school? It is a
question ; it is a problem. A man is not licensed to practice medicine in
iSTorth Carolina unless he can give other evidences of substantial charac-
ter and qualification than that of answering a few questions put to him
on the day of examination. I believe this should be so with other public
servants. I believe the county boards of education and health should
get together more closely and work together more harmoniously for the
safeguarding of the public health and of the health of the children. It
is time thro'wn away for us and for the pupil and all concerned when
there is not a satisfactory understanding in the matter of the employ-
ment of cooperative teachers in the public schools.

Professor Foust : I have only a word to say. Dr. Hays asked for
examples, and I can give one. When the health work was started in



22 HEALTH officers' ASSOCIATION,

Guilford, I think there was not a single school in the county that had
individual drinking cups or sanitary fountains. N'ow at least 80 per
cent of them have either drinking cups or sanitary fountains. The chil-
dren bring cups from home and keep them at the school.

Dr. Strickland spoke of a teacher that would not be vaccinated, and
wanted to know w^hat we ought to do. Smallpox broke out in this
county. A teacher laid down the law to the children in her school; told
them that if they Avould not be vaccinated she would quit the school.
Dr. Jones went over there and vaccinated the children. Then he turned
to the teacher and asked her to submit to vaccination, but she said no,
and she would not. So we left. On Monday morning I got a telephone
message that she had left the school. The people got after her for mak-
ing the children submit to vaccination and not being vaccinated herself,
l^ow, I have thought over that incident, and if that teacher is employed
by a committee this year, I shall veto the appointment.

Dr. Nesbitt spoke of the county superintendent's being between the
devil and the deep blue sea, because of his interlocking relations. J
hope I am not in that position, and I am a county superintendent. If
a single suggestion has come from the health officer which has not been
approved, I do not know it. The board of education has not only sanc-
tioned his requests, but has done all it could to further his work. This
problem depends too much on the joint sympathy and action of the two
boards, and I hope the conditions in New Hanover will be remedied.
I can see this, that the board of health might ask for a great big appro-
priation that could not be given, and the board of education might be
obliged to scale it doAvn. But if the board of health knows the financial
condition of the board of education, and knows that that board is work-
ing in sympathy with it, they ought to get along all right; and if they
do not, something should be done to get them together.

Dr. ISTesbitt : I did not mean to convey the impression that the board
of education and the board of health in JSTcav Hanover County had been
indulging in controversies of any sort. The results prove that the boards
have been working in harmony.

In speaking, if I remember correctly, of the superintendent of schools
being between the devil and the deep blue sea, I was speaking very
broadly of the conditions throughout the State as created by the statutes,
and of the possibility of a man's being in that predicament. In our
county we have gotten on very well. It has been possible to make a great
many improvements. There is, of course, a viewpoint quite at variance
between the board of education and the board of health. The board of
health is insisting on changes necessary for the health of the children



FIFTH ANNUAL SESSION. 23

and the efficiency of the schools ; the board of education is charged with
getting the most out of its appropriation, but while, of course, there is
this great variation in the viewpoint, there never has been any friction
between the two boards in New Hanover County.

Xew Hanover County is very fortunate, I think, in having a compul-
sory vaccination regulation. All school teachers and pupils, and all
janitors and others who work in or about schools, are obliged to be vac-
cinated. The school children are examined, and we accept no certificates
of vaccination except the scar of a successful vaccination. In that way
Ave have kept the county practically free from smalli^ox, except for occa-
sional cases from other counties. In winter we have an influx of negroes
from other counties to work about the wharves and cotton presses, and
now and then we have a case of smallpox. We use each case as a reason
for vaccinating everybody in the neighborhood, and usually each case is
the means for vaccinating two or three hundred people. In that way we
get around over the county pretty well. The case, of course, is isolated.
We use both measures very rigidly.

Dr. Hays wanted to know about the methods we use in the schools.
In our county we do a great deal of personal instruction in the schools.
Dr. Thames does most of that work. In addition, we have organizations
of mothers, and we make stated visits to the schoolhouses- and try to
make the school a sort of community center from which beneficial influ-
ences radiate. We get the mothers interested in discussion among
themselves on how to care for their children. The teachers are very
carefully instructed, and in giving that instruction we lay some stress
upon the possibility of the teacher's being infected from the children.
We find that a good thing to do. We impress upon them that with plenty
of air and sunlight and the use of the handkerchief there is little danger.
We teach them to look for the signs of approaching illness, flushed face,
bright eye, etc. We tell them, when they notice these signs in a child,
to send that child home at once and to report to us, so that we can look
it up and see Avliat is the matter with it. This year Ave are putting in
nursing service in the schools of Wilmington, and Dr. Thames and I Avill
probably supply a good part of the medical Avork, in addition to the other
AA'ork, and also try to keep up the work in the country schools.



24 HEALTH officers' ASSOCIATION.



THE RURAL SEWAGE PROBLEM.



John A. Ferrell, M.D.. New York City.



The rural sewage problem is probably tlie most important single
activity in wbicb liealtb officers are engaged. It affords work that can
be done throughout every month of the year and that is needed in practi-
cally every country of the globe.

The cities and towns have been forced much earlier than the rural
districts to provide adequate and reasonably safe methods of sewage dis-
posal. The smaller towns and villages, while not generally able to install
sew^erage systems, have endeavored to adopt what seemed the next best
and most practicable method with the funds and facilities at their com-
mand. The rural districts, constituting the bulk of this and most other
countries, have been last to attempt to provide for safe sewage disposal.
Here it becomes a family and not a community matter, so far as the
actual work involved is concerned.

Failure to properly dispose of sewage in a sanitary way is very largely
responsible for typhoid fever, hookworm disease, tuberculosis, diarrheas,
dysenteries, and other enteric diseases. These are filth diseases, and they
afford an excellent index as to the filthiness or cleanliness of a com-
munity.

In discussing methods for checking soil pollution, especially in rural
districts, too much time has been wasted in recent years in an effort to
determine by theory rather than by practice what is the best type of
privy for the rural districts. Fortunately, during the last year or two
real headway has been made in getting installed some of all the types
that have been recommended. I am not prepared to say what type of
closet is best, and no one else is, so far as I know. It is still an open
question, but it is in a fair way now to be settled soon. Actual experi-
ence with the various types will soon eliminate from general use those
wdiich are not practicable.

There are health officers here representing the State Board of Health
and the county boards of health who have had actual experience with
the people in campaigns directed to privy building. They are the ones
who should speak on this subject. If they have reached any conclusion
they should instruct us. I think we might well afford to hear Dr.
Cooper, Dr. Jones, Dr. Kibler, and Dr. Steele, who have had such expe-
rience.



FIFTH AXNUAL SESSION. 25

As a representative of the International Health Commission, the selec-
tion of a type of privy is not a subject for me to discuss. The Commis-
sion as an agency is not doing work in its own name. The State boards
of health and their auxiliaries are the responsible and accredited work-
ing agencies. Where the commission cooperates with a State it does
not seek to settle such matters, but merely to strengthen the local boards
of health so that they can carry the work through the experimental
stages to a point where it Avill receive adequate support locally. For
this reason I have decided not to present the paper I have prepared. If
the local health officers, in solving the rural sewage problem, or other



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 53 of 58)