The news in this publi cation is released for the press on receipt. THE UNIVERSITY OF NORTH CAROLINA NEWS LETTER Published Weekly by the University of North Caro lina for the University Ex tension Division. MAY 14,1924 CHAPEL HILL, N. C. THE DNIVEK3ITY10F NORTH CAROLINA PRESS VOL. X, NO. 2« Editorial Boards B. C. Braaaoo, 3. H, Hobbs, Jr.. L. R, Wilson, B. W. Knigrht, D. D. Carroll, Ji B. Bullitt, H. W. Odum. Entered as second-class raattor November 14.1914, at the Postofflce at Chapel Hill, N. C.. under the act of Auyost 24. 1911 HEALTH WORK IN CAROLINA Elsewhere in this issue will be found a table which ranks the states accord ing to the per inhabitant expenditures for public health by each state government daring the last fiscal year. The accompanying column shows the total expenditure by each state government. The table does not include appropriations for tubercu losis sanatoria, nor expenditures for the operation of county and city health departments, except where the state cooperates with such departments, as in North Carolina where 28 cooperating counties received $72,427 from the State Board of Health in 1923. Nor does the table include receipts from the Federal Government and the International Health Board which, for North Caro lina, totaled about $63,000 last year. Only three states rank ahead of North Carolina in State Government expendi tures for public health on a per inhab itant basis. Our expenditure averaged 16.8 cents per inhabitant, while the av erage for Delaware was 38 cents, Flo rida 19.4 cents, and for Maryland 18.6 cents. The average for all the states is around 8 cents per inhabitant per year. The total state government ex penditure on public health in North Ca rolina at the present time, as defined in the first paragraph is $460,000 annu ally and the amount is larger in only five states, all vastly richer and more populous than North Carolina. The average cost of 16.8 cents per in habitant per year to operate the state health work is less than the cost of a moving picture ticket in most towns in the state. It is less than the cost of a gallon of gasoline. Yet North Carolina ranks fourth from the top in per inhab itant state expenditures on publichealth. No state m the union has a better rec ord of achievement in the field of pub lic health work. Our State Board of Health and our county health depart ments, their activities and their ac complishments are known not only throughout the United States but in many foreign lands. Many delegations from other states and from foreign countries have paid visits to North Ca rolina to inspect our state health or ganizations and to study its methods, and to view the results. And in every case they have gone away with a firm conviction that looking after health conditions is a proper function of state government, and that no state is doing better public health work than North Carolina. County Health WorK On June 1,1911 the first county health department to be provided in the Unit ed States was established by Guilford county. To North Carolina goes the distinction of originating the county health department idea, and from the beginning North Carolina has main tained undisputed leadership in the field of county health work. According to the Public Health Bulletin from which most of the accompanying facts are taken, there are today thirty-one county health departments in as many coun ties in the state, serving around half of our entire population. The personnel consists of 36 medical officers, 6 non medical officers, 17 sanitary inspectors, 38 public health nurses, and 38 clerical assistants. The budget of these 31 counties last year totaled $317,898. North Carolina has more county health departments than any other state, and they are efficiently serving a greater percent of the population than are sim ilar departments in any other state. Of these 31 counties, 28 cooperate with the State Board of Health, and receive state-aid, while 3 counties, Dur ham, New Hanover, and Guilford, op erate independently of the State Board. In addition five cities maintain health departments independentiyjof the coun ties. These cities are Asheville, Char lotte, Greensboro, Rocky Mount, and Winston-Salem. Each of these cities has an efficient personnel, and the an nual budget totals around $140,000. The counties which cooperate with the State Board of Health are: Bertie, Buncombe, Beaufort, Bladen, Cabar rus, Columbus, Craven, Cumberland, Davidson, Edgecombe, Forsyth, Gran ville, Halifax, Henderson, Lenoir, Mecklenburg, Northampton, Pamlico, Pitt, Robeson, Rowan, Sampson, Surry, Wake, Wayne, Wilkes, Wilson, and Vance. State aid to these 28 counties amounted last year to $172,427. The State Board of Health is this year put ting $2,600 into each of thirty counties. Services Rendered The county health departments serve the people in a great variety of ways. The officers are charged generally with looking after hygienic conditions in the respective counties. The main job of county health department is to keep the people well. If the first person with a contagious disease can be isola ted an epidemic may be averted, untold s^affering prevented, and likely many lives saved. The officers in the 28 coop erating counties last year quarantined a total of 37,166 persons with contag ious diseases. While it is of prime importance to control contagious diseases, it is of far greater importance to prevent their occurrence, and this is the main job of the county health officials, to keep the county as free from sickness as is pos sible. Three contagious diseases, typ- hoiu fever, diphtheria, and smallpox, can be prevented by vaccinations. The officers of the 28 cooperating counties last year vaccinated 61,609 persons a- gainst typhoid, 45,251 against smallpox, 16,837 children were given immunizing treatments of toxin-antitoxin to pre vent diphtheria and 1,397 children were vaccinated against whooping cough. A total of more than 114 thousand people were vaccinated or treated to prevent the occurrence of diseases that are high ly contagious once they develop. Venereal diseases are far more prev alent than is generally recognized, and treating the 2,440 cases which were re ported to these officers took a large part of their time. Looking after the tubercular is still one of the biggest duties of the public health officers, and although the death rate from tubercu losis has been cut half in two in North Carolina during the last 12 years, the deaths from this disease are exceeded only by deaths from heart disease and pneumonia. Other activities of the county health authorities are instructing expectant mothers, instructing mothers about the care of babies, giving courses to mid wives, and in other ways caring for the lives of mothers and infants. Igno ranee is largely responsible for the more than 10,000 children who last year in this state were either born dead, or died during the first year after birth A well informed and well cared for mother seldom loses her child. The bulk of infant mortality occurs in the homes of people who are ignorant and whose children do not have proper med ical attention. Another great service is rendered through the examination of thousands of school children and the treatment where found of defective tonsils, ade noids, teeth, eyes, and other ills. The health officers look after sanitary con ditions in county homes, jails and con vict camps. They give examinations to prisoners in jail, physical examina tion for certificate to obtain marriage license, physical examinations to teach ers, cooperate with the public welfare officers, prosecuting the violators of state and local health laws and in many other ways they are constantly render ing public service. In the performance of their many duties these 28 county health officers and other members of their depart ments last year traveled a total of 424,310 miles, or 17 times around the world! A Million for Health Public health work in North Carolina has undergone remarkable expansion during the last twelve years. In 1911 the total expenditure for health pur poses by the state and local units with health departments amounted to about $65,000. Twelve years later the single county health department had^grown to 31, the city departments to five, and the total expenditure had increased to more than a million dollars a year, more than $600,000 of which comes from state government appropriations, while a- bout $386,000 is contributed by the 31 coun,ties and the five cities with health KNOW NORTH CAROLINA North Carolina has the enviable rec ord of having provided the first coun ty health department in the United States in the Guilford department, established on June 1, 1911, Yakima County, Washington, was the second, that department being established on July 1, 1911, following a most severe epidemic of typhoid fever in that county. The lead thus taken has been continued, for today North Carolina has more county health de partments than any other State in the Union, and is efficiently serving a greater percentage of its popula tion. Remarkable as ■ has been the growth and development of the State in agriculture and industry, no less remarkable has been its growth and development in the safeguarding and promotion of its public health. —Ronald B, Wilson, in The Health Bulletin. departments. An additional $65,000 comes from the Federal Government and from the International Health Board. The progress, has been remarkable, so remarkable that today North Caro lina’s leadership in public health work is recognized throughout the world. The million dollars spent on promoting public health in North Carolina returns larger dividends than any million dol lars the people of the state could pos sibly spend in any other way. It is an investment to prevent sickness, to check disease, to promote intelligence, to pre vent unnecessary deaths, to make North Carolina the healthiest state in the Union. Every county in North Caro lina should have its dounty health de partment. No state and no county can afford not to protect the health and life of its,]yeople. Some Results For many years North Carolina has led the states of the union in birth rates. However, until recently our death rate, especially of infants and children, was very high. Due largely to the work of the State Board of Health and the county health depart ments the death rate is now below the average for all the states. Most re markable reductions have been made in infant mortality. During the last 12 years the general death rate has been reduced from 18.2 to 11.6 per 1,000 pop ulation, while the reduction for all the states has been only 2 per thousand of population. Instead of about 49 thou sand people dying in North Carolina in 1923, as would have been the case had the death rate of 1911 prevailed, only about 31 thousand people died. The death rate from tuberculosis has been reduced from 266.2 per hundred thousand of population in 1911 to 97.6, and our rate is now below the average for the United States, even though many stricken people from other states seek renewed health in our mountains and elsewhere in the state. The death rate from typhoid fever has dropped from 69.3 per hundred thousand of population in 1911 to 11.2 in 1922. These 'are merely a few of the results that have been accomplished. Igno rance is the one great cause of prevent able sickness and death. The state and local health departments have made North Carolina a healthy state because they have been educating the people a- bout the causes of diseases and sick ness, and how to prevent them. The results accomplished in this state bear witness to the value of public health work. And the total cost of all public health work, state, county, and city, averaged only 39 cents per inhabitant last year, while to operate the State Board of Health, which has made North Carolina famous around the world, we spend annually just 16,8 cents per in habitant per year. North Carolina is naturally a healthy state, one of the healthiest in the union. When, through the efforts of state, county and city health depart ments, the intelligence of our people comes to be on a par with our natural con ditions North Carolina will be the health iest state in the union.—Jr. CLASSES IN PEDIATRICS The University Extension Division will conduct twelve extension classes for practising physicians on the subject of Pediatrics beginning the week of June 9 and closing the last week in August. It is believed that these courses in children’s diseases will do much toward improving the general health and cutting down infant mor tality throughout the state. When the same course was given in 1916 one of the doctors in High Point stated that this one class was worth a million dol lars in health to that community. George B. Zehmer and Chester D. Snell, directors of the University Ex tension Division are now busy organiz ing the classes which will be held in the following cities: Western circuit— Rutherfordton, Shelby, Gastonia, Char lotte, Concord, and Lincolnton; Sand Hill circuit—Durham, Sanford, Carth age, Hamlet, Lumberton, and Fayette ville. The instructors for these two circuits this year are from Dr. McKim Marri ott’s Pediatrics clinic at Washington University, St. Louis. Dr. Jean V. Cooke, Associate Professor of Pedia trics will be in charge of the Western circuit and Dr. Phillip C. Jeans, Sen ior Associate Professor of Pediatrics, assisted by Dr. Alexis Hartmann, will have charge of th^ Sand Hill circuit. There will be one meeting each wedk in the twelve towns mentioned above. Each meeting will consist of an hour lecture followed by an hour of clinical work. Application blanks have been sent to all the physicians on both of the cir cuits and officials of the Extension Di vision request that these applications be filled out and mailed immediate ly- While only twelve cities are to have classes this year, last year the Exten sion Division gave postgraduate medi cal courses in twenty-four cities and nearly every doctor in the state had an opportunity to attend. Over 380 phy sicians took advantage of the three courses in Internal Medicine and the one course in Pathology. BUILDING AND LOAN North Carolina is one of the few southerm states in which building and loam associations have made gratifying progress. This is the more remark able im view of the fact that we have mo large cities, and very few cities of evem moderate size. According to tables carried in the Manufacturer’s Record North Carolina had 236 building and loan associations in 1923 with a total membership of 65,000 and assets of $44,898,834. While the assets of alV associations in the United States have doubled since 1918, the assets of North Carolina associations have nearly treb- bled. North Carolina has more building and loan associations than any other southern state, and only seven states in the Union outrank us in the number of associations. How ever, due to the smallness of our towns , seventeen states rank ahead of us in total membership and in total assets. Yet considering the fact that only four states have a larger rural population ratio, and the additional fact that our towns are small, our rank of eighth in number of associations and seven teenth in membership and assets speaks well for the thrift of the small towns and cities in this state. As we have said before the building and loan plan of saving for a home is an American idea. It is a most excellent and economical means of laying aside for a home, and also it is an excellent way to save money because the asso ciations pay high dividends on install ments in the form of accumulated in terest and savings are tax exempt. And as we have said before the same plan which is now used so extensively and successfully by city people can be used by the farmers of North Carolina as the laws of the state provide for the organization and operation of rural building and loan associations. Local groups of farmers should look into the possibilities of such associations for the plan will work for them just as well as it works for urban dwellers. The farmers of Ohio have been operat ing building and lojin associations for several years. STATE HEALTH EXPENDITURES Total and Per Inhabitant by States, 1923 The following table, based on Federal Public Health Reports and private correspondence, shows the total and per inhabitant expenditures by states for state public health work for the last fiscal year. The table includes only ex penditures on the part of state governments, and does not include county and city expenditures, appropriations for tuberculosis sanatoria or other institu tions, except hygienic laboratories. Nor does it include receipts from the Fed eral Government or other agencies. Total state government expenditure for public health work in North Caro lina in 1923 was $450,000 or a per inhabitant expenditure of 16.8 cents. The state spent in addition $200,000 for the operation of its tuberculosis sanatoria. The budget, exclusive of state-aid, of the twenty-eight counties cooperating with the State Board of Health, and the three counties operating independently totaled $246,271, while the budget of the five cities with separate health departments totaled $140,000. Net total expenditure in North Carolina in 1923 for public health work $1,034,000, or 39 cents per inhabitant. S. H. Hobbs, Jr. Department of Rural Social Economics, University of North Carolina Rank State Expend. State Total Per Expendi- Inhab. ture cents 1 Delaware 38.0 $ 87,600 2 Florida 19.4 203,000 3 Maryland 18.6 280,497 4 North Carolina .. 16.8 460,000 5 Maine 13.6 105,000 6 Connecticut 12.0 177,600 7 Massachusetts.... 11.7 471,860 8 Rhode Island 11.6 71,662 9 Nevada 11.4 8,800 9 Vermont 11.4 40,000 11 New Hampshire.. 11.0 62,250 11 Pennsylvania.... 11.0 1,000,000 13 New York 10.9 1,178,000 14 Michigan 9.6 377,800 14 Montana 9.5 67,916* 16 New Jersey 8.9 298,800 17 Kentucky 8.8 217,362 18 Ohio 8.6 631,471 19 Alabama 8.6 205,000 19 Oklahoma 8.6 183,070 21 Wisconsin 8.1 220,820 22 Colorado 8.0 79,640 23 Mississippi 7.8 140,000 23 South Dakota.... □ 7.8 60,800 * Plus unspecified fees Rank State Expend. State Total Per Expendi- Inhab. ture cents 26 New Mexico 7.6 $ 28,500 26 California 7.3 277,318f 26 Illinois 7.3 497,366 28 South Carolina... 7.1 123,497 28 Virginia 7.1 169,174 30 Arizona 6.6 24,656 31 Idaho 6.4 30,010 32 Minnesota 6.3 167,600 33 Wyoming 6.8 1^,260 34 Indiana 5.6 170,000 36 West Virginia.... 5.6 85,800+ 36 Utah 6.2 , 24,996 37 Nebraska 5.1 68,000 38 Kansas 4.9 88,200 39 Oregon 4.8 40,000 40 Louisiana 4.7 87,600 41 Arkansas 4.6 82,000 42 Missouri 4.2 146,900 43 Iowa 3.8 93,900+ 44 Tennessee 3.6 85,106 46 Georgia... 3.6 91,481 46 Washington 3.2 46,416 47 Texas 3.1 164,217 48 North Carolina.... 2.4 16,274 + Plus unspecified appropriaUon for clerical help.