The news in this publi
cation is released for the
press'on receipt.
THE UNIVERSITY OF NORTH CAROLINA
NEWS LETTER
SEPTEMBER 7, 1921
CHAPEL HILL, N. C.
Published Weekly by the
University of North Caro
lina for its University Ex
tension Division.
VOL. VII, NO. 42
Editorial Board . B. C. Branson, S.H. Hobbs, Jr., L. H. Wilson, E.W. Knisht, D. D. Carroll .T R Riillitf „ „ „, „ ^ ~
* ’ * -Odum. ^titered as second-class matter November 14.1914, at the Postoffice at Chapel Hill, N. 0., undor the act of Augusts!, 1
PUBLIC HEALTH IN CAROLINA
SOME HEALTH ACTIVITIES
The State Board of Health of North
Carolina has, because of its achieve
ments and innovations, won both na
tional and international recognition. It
is a commonplace that we have one of
the best state health departments in
the Union and several state commis
sions have visited us to see just how it
is done so they can put our scheme into
practice. Missions have recently come
a defect and recommending that the
child be taken to a dentist or a special
ist or the family doctor, as the case
might be. Very little attention was
paid to this by the majority of the peo
ple, the children invariably suffering
the consequences of further neglect.
An Innovation
When the present department of
Medical Inspection of the State Board
of Health was organized, about 1917,
the director of the department deter-
from foreign countries to inspect our j mined that some effort at getting chil-
health work. We are known abroad as
a state with a health system that is
state-wide in its scope, that has big
plans afoot and in view, and that is
succeeding with its state health pro
gram. And the credit is due to the able
director who has remained on the job
in spite of big offers elsewhere, to the
body of able men and women that he
has picked to enable him to carry out
the program, and to the members of the
Board who are all far-sighted in their
visions. In this issue of the News Let
ter, alongside of the plan of organization
of the State Board of Health, we are
featuring just a few of its many activi
ties.
Free Clinical Service
Beginning early in 1915 the State
Board of Health through what is now
its Bureau of Medical Inspection of
Schools commenced a thorough survey
of several thousand children enrolled
in the schools of different counties in
widely separated sections of the State
of North Carolina with a view of ascer
taining the actual physical condition of
all classes and ages of school children.
These efforts established the appalling
fact that from 76 to 80 of every 100
school children were suffering from de
cayed teetli, or, what is worse, not over
6 per cent of them had ever visited a
dentist for preventive or reparative
work. There seemed to be no difference
with reference to localities .in which
these children lived, the teeth of children infirmaries have been opened in
from cities, small towns, and country
flren treated should be undertaken or
he would recommend the dissolution of
the department. As a result of this
determination, early in 1918, two specific
lines of endeavor were undertaken.
One was the employment by the de
partment, on a whole-time salary basis,
of a number of young dentists. These
men were sent out into the schools, in
the country districts especially, and, up
to the first of August of this year,
nearly 60 counties have had the privi
leges of service by the dentists. Their
services have been rendered only to
school children and the ages have been
from 6 to 12, because that is just when
most good can be done, and also when
work is needed. The work has been totally
free to the people and is the first effort
of its kind in the United States provid
ing service of this class wholly at pub
lic expense on an extensive scale as a
business proposition, entirely apart from
the realm of philanthropy and charity.
To August 1,. nearly 45,000 children
have been actually treated and at the
same time have been personally and
specifically instructed in the rudiments
of mouth hygiene and care of their
teeth. Private dentists in the state as
a result of this movement have report
ed many thousands of children having
further treatment. Each dentist is
equipped with a portable outfit and
some permanent reparative woi'k, of
course, is done, but the main stress is
laid on prophylaxis. Several permanent
alike being bad. These facts were well
borne out by the first draft figures.
For example, in one county where the
examining physician made careful rec
ords of the teeth of each man examin
ed, he found that out of 700 young men
between the ages of 20 and 30 years,
who were examined in 1917, supposedly
the best physical specimens in that
county, only 22 out of J-he 700 had re
tained all of their teeth, old men, near
ly all Of them, before 30! As it is an im
possibility for an individual to enjoy
perfect health without good teeth, the
question naturally is a big one from a
public health standpoint. These sur
veys also indicated that of smaller
school children there could not be less
than 40,000 or 50,000 suffering from the
very common affliction of diseased ton
sils and adenoids. For the worst of
these little sufferers, especially those
having bad heredity to ■ go on without
being treated means ill health, poor
school progress and an altogether un
happy outlook for life.
Why the Defects
In its efforts to get back of these
conditions and ascertain the causes of
such conditions, the State Board of
Health concluded that this state-wide
neglect of common every-day physical
defects in practically all classes of the
children was due to several causes. In
the order of their importance the
causes may be stated as follows: (1)
poverty; (2) the morbid fear of the
words hospital, operation, dentist; (3)
ignorance of the consequences of neglect
and indifference; (4) a lack of specific
instruction in the public school curricu
lum along these lines, and especially a
lack of proper attention to teaching
these subjects to future teachers, es
pecially in the state institutions making
a specialty of teaching teachers; (5) ,
the undesirability of the average' child j
as a patient, especially from the stand
point of the dentist.
For several years past there have
been sporadic efforts made in medical
inspection of school children, presuma
bly for the purpose of locating t^efects
and at the same time trying to teach
a little personal hygiene. The whole
system, however, has been in the state
almost a total failure, on account of the
fact that no follow-up work was under
taken by responsible agencies. The pa
rents or guardians of defective children
Were simply sent notices stating that
such and such a child had such and such
TOWN AND COUNTY CON-
FEBENCE, CHAPEL HILL,
SEPTEMBER 19, 20, 21
The program for the first regional
National Conference on Town and
County Administration is about com
plete and will be announced in the
press next week. From present indi
cations the conference will be a good
one, continuing in cross section from
the work begun two years ago in the
State and County Council.
Among the speakers announced
are; Governor Cameron Morrison,
Hon. E. C. Brooks, Dr. W. S. Ran
kin, Mrs. Clarence Johnson, Hon.
Baxter Durham, Gallatin Roberts,
C. W. Roberts, T. B. Patten, T. B.
Elc^idge, James Cowan, James
Hines, Lionel Weil, J. W. Walker,
T. C. Painter, Dr. B. W. Kilgore,
W. C. Jones, W. A. McGirt, E. W.
Knight, E. C. Branson, Lindsay
Warren, and many other North Car
olinians.
From outside of the state there
will be the Hon. Arthur Pierson of
New Jersey, author of the New Jer
sey Municipal Finance Acts; Mr. H.
W. Dodds, secretary of the National
Municipal League, Mr. Morris
Knowles, City Planner from Pitts
burg; Mr. G. C. Grinalds, City Plan
ner from Baltimore, and others.
Greetings will be read from Hon.
Herbert Hoover, Hon. Newton D.
Baker, and others interpreting the
need for the study and practical
working out of problems of local
government.
Look for the program Jn full next
week.
ORGANIZATION
Secretary State Board of Health and State Health Officer.
Director Puijlic Health Education.
Superintendent State Sanitorium and Chief Bureau of Tuberculosis.
Director State Laboratory of Hygiene.
Deputy State Registrar.
Chief of Bureau of Medical Inspection of Schools.
Chief of Bureau of Engineering and Inspection.
Chief of Bureau of Venereal Diseases.
Chief of Bureau of Public Health Nursing and Infant Hygiene.
Director of County Health Work.
Chief of Bureau of Epidemiology.
County Health Officers.
Sanitary Inspectors.
Public Health Nurses.
Clinic Surgeons and Dentists.
Clinic Nurses.
Public School Teachers.
Midwives.
Functions
Tp maintain an office at the capital.
To look after the general health interests of the people and be health advisor to
the government.
To advise the government in regard to location, sanitary construction, and man
agement of state institutions.
To inspect such institutions, report condition, and advise trustees.
To have direct charge in case of certain epidemics.
To make diagnostic examinations of certain bacilli.
To make periodic analysis of water from sources of public supply, and from min
eral springs whose water is offered for sale. ,
To make microscopic examinations for tuberculosis, and certain other diseases.
To manufacture and distribute typhoid, diphtheria and other vaccines.
To maintain a bureau of tuberculosis.
To enforce the sanitation laws of the state.
To keep a record of vital statistics and to enforce the vital statistics law.
To enforce laws for control of contagious diseases, and for the prevention of
blindness in infants.
To administer the law for the prevention of venereal disease.
To superintend public health nursing in the state, and to give information in the
pre- and post-natal care of infants.
To supervise county health officers in counties cooperating with State Board of
^ Health. ^
I To direct the physical examination of the school children of the state, and nro-
I vide clinics for the treatment of diseased tonsils and teeth.
illustrated by a quotation taken from ; To publish a monthly bulletin and other educational literature, and to make such
the state as a result of the move, the
most successful of these being the ones
at Durham, Winston-Salem and Salis
bury.
Tonsil and Adenoid Clinics
the Harnett County News of last June,
written by a committee of citizens af
ter a clinic had been held in Harnett
county, each of whom had children in
the clinic. The resolution states in part:
“Those who accepted the state’s offer
have received more than a saving in
the expense of operation. It was an ed
ucation. Children of lawyers, school
superintendents, manufacturers and ev
ery trade lay together, received the
same careful attention and hospitality.
Every father and mother felt the
reports as may be required by law.
COUNIY HEALTH WORK
County health work with a whole
time county health officer is a unique
department of our state health organi
zation. We have been leading all the
states of the Union in this feature of
health work for several years. The work
began nearly a decade ago with three
counties employing whole-time doctors
The matter of getting surgical opera
tions done for children in remote sec
tions was a great deal more difficult
problem; but, beginning in the same
year, namely, 1918, experiments were
made through the grouping up in clubs
of several children needing these oper
ations badly and a specialist from a
nearby city was requested to go and
hold the clinic. A school building, a new
courthouse, sometimes a local hospital
or any suitable place was equipped as
an emergency hospital. Nurses em
ployed by tlie department were placed
in charge and every care possible has
been placed about these children.
The plan has proved immensely popular,
has been successful in the fullest meas
ure. To August 1, more than 3,000
school children have had operations
done with only one death, a record that
has never been surpassed in any hos
pital of the United States, with the
single exception of Rochester, New
York, Tonsil and Adenoid Clinic, mod
eled after our own plan. The children
who are operated on in these clinics
have repeated examinations beginning
with teachers on through to nurses,
frequently the family physician’s exam
ination, and winding up with the assist
ant physician in the clinic and the spe
cialist who does the operating. An
emergency hospital equipment is pro
vided with every facility that it is pos-’
sible to provide for the safety of the
children. Clinics have been held to date
in more than 40 counties, from Chero
kee in the west to Gates in the east.
Every class of people has been inter
ested in the clinic, and has been reach
ed through this method. More than 700
of the operations have been done totally
free of charge. Others have paid a
small fee toward helping defray the
actual cost of the work. The dental
work has been totally free. The one
motto of the whole organization at all
times has been to leave no effort un
tried to reach neglected children, the
children .on the mountain side, in the
caves, and at the head of the creeks,
the children who otherwise could not
have a chance.
A Big Success
That the efforts of the department have
been successful in that respect may be would rest.
whose business it was to look after the
joy ^ public health, sanitation, and disease
of finding new neighbors to serve and ! prevention in these counties. The ex
share with. It is the essence of true j periment proved a success from the be-
Such work should and will
democracy,
receive the
every thinking man who sees with his
own eyes. To those sections of the state
which are yet to be visited by this insti
tution we are offering in behalf of the
clinic our unqualified endorsement.”
Tangible Results
The officials and directors in this work
down to the last clerk, including the
nurses, the dentist, and everybody con
cerned, have labored long and faithful
ly in order to iron out the difficulties
and to actually reach these children.
The whole plan is simply follow-up
work for the medicial inspection of school
children. Instead of being content to fol
low the routine, the director of the work,
as stated in the beginning, has made an
honest effort to do something about it,
and for the children who need the service
all over the state. It would have been
much easier to have followed the usual
plan and specialize in advice and harp
on the intangible educational value,
but, as in the past, little could have
come of it all. Like any other mighty
human agency that ameliorates the con
ditions of mankind this work has arous
ed some antagonism on the part of,
special and private interests, -but the
great mass of the people of the state
have heartily endorsed the work and,
by their coopeation, have made it a pro
nounced success
How To Secure It
Any county can get this service by get
ting (1) the county superintendent of
schools and the teachers of the major
ity of the schools and the county physi
cian or, better, the whole-time health
officer interested in really doing some
thing for the children and getting the
above named agencies to cooperate with
the Bureau of Medical Inspection of
Schools of the State Board of Health.
It is a work of wonderful possibilities
for the children of the coming genera
tion and if carried on to the logicial
conclusions another draft ten years
from to-day would show an entirely
different type of young men upon whose
shoulders the defense of the country
I ginning, and the State Board of Health,
heartiest endorsement of-| desiring to' have more such officers, in
augurated a cooperative scheme be
tween the state and counties in 1917.
Under the new system the state em
ployes a superintendent of county health
work with headquarters in Raleigh. At
the present time he has working di
rectly under him 23 whole-time county
health officers while four counties have
whole-time health officers independent
of the State Board of Health. Thus we
have at present 27 whole-time county
health officers in North Carolina.
But there are seventy-three counties in
the state which have failed to catch the
new vision of disease prevention, or
if they have caught it they are not wil
ling to invest their dollars. It is very
much to be desired that these 73 coun
ties, which at present have nothing
but a quarantine officer, who as a rule
does practically no health work,
will soon begin a campaign to employ
a full-time doctor to look after health
conditions and disease prevention;
How They Can Do It
Although the county health officers in
23 counties are cooperating with the
State Board of Health, as a matter of
fact they work practically as if there
were no supervision. The cooperative
feature is mainly financial. For instan
ce if a county wishes to employ a full
time doctor, it can appoint whomever
it chooses and secure a flat one thous
and dollar supplement from the state.
If the county chooses wisely, that is, if
it hires an efficient officer, it may get
an additional fifteen hundred supple
ment, a total of ?2,500.
The State Health Board risks its first
$1,000. It has worked out a unit cost plan
and if a doctor is fully on the job and
turns in enough work above a minimum
he can secure the full $1,500 supple
ment to the county treasury. The coun
ty is paid its pro rata share of the ex
tra $1,500 solely on the efficiency of the
health officer. The state has nothing
to say as to whom the county shall em
ploy but it does reward a county which
makes a wise choice. Not only that,
but the new plan makes it possible for
any county, however poor or small, to
employ a county health officer, if it
only has the desire for such an officer.
Disease Prevention
The old idea of a doctor’s business
was to cure sick people. The new
idea in medicine is to prevent dis
ease by eliminating the cause. The
work of a county health physician is
not with sick people so much as it is
with preventing people from getting
sick and preventing the spreading of
contagious diseases. 'Where they have
tended a few cases of sickness they
have kept thousands, well and able to
pursue their daily tasks. A county
doctor is an investment that pays big
dividends and those counties that see
it that way are the ones which are
paid.
What They Are Doing
A county physician’s work is largely
seasonal. For instance at present all
the 27 county officers are busy vaccina
ting against typhoid fever. In the
winter months they are busy with
smallpox and diphtheria prevention and
! at all times they are sentinels on the
lookout for every sympton of seasonal
and non-seasonal diseases and using
scientific methods to prevent both their
occurrence and spread. Their work
covers the field of communicable dis
ease control such as the control of
measles, smallpox, dipthheria, typhoid,
scarlet fever, chicken-pox, veneral dis- _
eases and tuberculosis. One of their
impornant tasks is to teach people
simple ideas about sanitation around
the house, the lack of which is the main
cause of our sickness. They are busy
in infant and maternal hygiene 'work,
school hygiene, adult and home hygiene
and care of the sick. In addition they
do a great deal of microscopic work in
their laboratories, making tests of all
kinds as occasion demands. The public
health officer is beyond doubt one of the
busiest men in the county.
The director of the county health work
states that the average county doctor
in the typhoid season will vaccinate 2, -
500 people. During the winter months
he will vaccinate upon an average 1,-
000 people against smallpox and a good
ly number against diphtheria and a
score of other preventable diseases for
which vaccines have recently been dis
covered.
Only a short time ago the county offi
cer for Sampson county left Clinton at
one .o’clock in the afternoon, traveled
63 miles and»was back at eight o’clock.
In the meantime he had vaccinated 901
patients against typhiod. If this is not
a record, it is a good afternoons’s work
and we are betting that Sampson gets
her full $2,600 from the state treasurer.
And every county in the state has the
same chance. The county officer has
proven his value. He is here to stay.
If you haven’t employed one it is time
to begin looking for a good one for he
is probably the best investment any
county can make. —S. H. H., Jr.