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CALIFORNIA STATE BOARD OF HEALTH.

MONTHLY BULLETIN.

Vol. I.

SACRAMENTO, AUGUST, 1905.

No. 3,

STATE BOARD OF HEALTH. MARTIN REGENSBURGER. M.D., President,

F. K. AINSWORTH, M.D.

San Francisco San Francisco A. C. HART, M.D.

..Sacramento WALLACE A. BRIGGS, M.D., Vice-President,

0. STANSBURY, M.D..

...Chico Sacramento W. LE MOYNE WILIS, M.D. .Los Angeles

X. K. FOSTER, M.D., Secretary Sacramento
HON. W. I. FOLEY, Attorney..

.Los Angeles

STATE BUREAU OF VITAL STATISTICS. N. K. FOSTER, M.D., State Registrar. Sacramento | GEORGE D. LESLIE, Statistician... Sacramento

STATE HYGIENIC LABORATORY. ARCHIBALD R. WARD, D.V.M., Director.

University of California, Berkeley

VITAL STATISTICS FOR AUGUST.

Summary. -A total of 1,134 living births were reported for August from forty-five counties, including fourteen freeholders' charter cities. There were 11 sets of twins, and 10 children were at least the tenth born to their respective mothers.

Altogether 1,067 marriages were reported for August from forty counties. In 809 cases, or 75.8 per cent of all, the marriage performed was the first for each party, both groom and bride being single. ' In 110 instances it was the first marriage of the groom, but not of the bride, and in 76 it was the first of the bride but not of the groom, while in 72 cases, or 6.8 per cent of all, both parties had been married before. Somewhat more grooms than brides had not been previously married, 86.1 per cent of the grooms, against 82.9 per cent of the brides, being single.

A total of 1,844 deaths, exclusive of stillbirths not tabulated, were reported for August from forty-nine of the fifty-seven counties in the State, including seventy-three cities and incorporated towns. Reports that no deaths occurred in the month were received from one County and twelve City or Town Registrars. The principal causes of death were general diseases (especially other than epidemic diseases), diseases of the circulatory system, of the nervous system, and violence. About one death in seven was due to tuberculosis, though many such decedents were only recent residents of the State. The next most important specific causes of death in August were heart disease, cancer, apoplexy, and pneumonia.

Causes of Deatli.—The table below shows the number of deaths from the main classes of diseases reported for California in August and July

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About one death in seven was due to tuberculosis, and one in eleven to heart disease. One in sixteen was caused by cancer, one in twenty by apoplexy or pneumonia, and one in twenty-five by old age, Bright's disease, or diarrhea and enteritis.

SYNOPSIS OF REGISTRATION LAW. The main points of interest to the general public in the present law for the registration of vital statistics in California may be summarized as follows:

The County Recorder is the sole Local Registrar for marriages. The Local Registrar of births is the City Health Officer in the few cities having freeholders' charters, and the County Recorder everywhere else. For deaths, the Local Registrar in cities having freeholders' charters is the City Health Officer; in other cities and incorporated towns, the City or Town Clerk, and for the remainder of each county, the County Recorder. When public convenience requires, the County Recorder as Local Registrar may, with the approval of the State Registrar, appoint Subregistrars for designated portions of the county. Registrars are required to furnish without charge a sufficient number of copies of the proper certificate to each person upon whom is imposed the duty of certifying to a birth, marriage, or death. The chief duty of each Local Registrar and Subregistrar, however, is to enforce the vital-statistics law in his registration district.

The law applies particularly to clergymen, physicians, and undertakers. Every priest, minister of the gospel, justice, or judge who performs a marriage in this State, must within three days after the ceremony file with the County Recorder as Local Registrar a certificate properly filled out for the marriage performed by him.

Every physician, midwife, nurse, or other person assisting at a birth in California, must within five days thereafter file a certificate of birth with the Local Registrar, who is the County Recorder, except in the few cities having freeholders' charters, where the City Health Officer so acts. In case the child is not named when the certificate is filed, the Local Registrar will deliver to the person reporting the birth a supplemental blank for report of the given name, which must be filled out by the parents, next of kin, physician, or midwife, and returned as soon as the child shall be named, the name being then added by the Local Registrar to the certificate previously filed with him.

Every undertaker engaged for a funeral is held responsible for obtaining and filing a certificate of death with the Local Registrar or Subregistrar, and securing a burial or removal permit prior to any disposition of the body. The Local Registrar for deaths is the City Health Officer in cities having freeholders' charters, the City or Town Clerk in other cities and incorporated towns, and the County Recorder for the remainder of each county, while Subregistrars may also be appointed for designated portions of counties. Ordinarily the undertaker will obtain the personal and statistical particulars required over the signature (or name) and address of a relative or friend of the deceased, though the information may be given by any person, including the undertaker or physician, qualified to supply the facts, Besides the personal and statistical particulars, there is also the medical certificate of death, under which heading the physician certifies to the length of time the deceased received medical attendance, and also to the date and cause of death, including both the primary and immediate and the contributory causes, if any, and the duration of each. Special information is also required for hospitals, institutions, transients or recent residents. In all cases where death occurs away from the former or usual residence, that residence must be given, together with the length of time at the place of death, and a statement of where the disease was contracted.

It is a misdemeanor for the State Registrar or for any clergyman, physician, undertaker, or other person, to fail, neglect, or refuse to perform any of the duties imposed upon him under the law for the registration of births, marriages, and deaths. It is also a misdemeanor for any Local Registrar, Deputy Registrar, or Subregistrar to neglect or fail to enforce the provisions of the registration law in his district. At the instance of the State Registrar, the prosecuting attorney or other proper officer of any county or municipality shall forth with initiate and promptly follow up the necessary court proceedings against parties responsible for alleged violations of the law.

NOTES TO REGISTRARS. Promptness in Reporting Births.—The experience of registration officials in other states teaches that the longer the period allowed for reporting births, the smaller is the number actually reported. This explains why the California law requires physicians to register births within five days after they take place. Though at that time the child may not yet have been named, all the other personal and statistical particulars called for on the certificate are then known. The information sought can be obtained from the parents at the time of the birth, much more conveniently than afterwards, when the physician's visits have become less frequent or have ceased altogether. While the child's

does not of course affect the statistical tabulations, it is needed for the sake of certainty in the legal records of the birth. The name of the child can be reported to the Registrar on a supplemental blank, filled out by the parents or physician as soon as the child shall have. been named, and the Registrar will then add the given name to the certificate previously filed, thus making the record of the birth legally complete.

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Complete Registration of Marriages.—This will be insured if the County Clerk, when issuing a marriage license, will also hand a blank certificate of marriage to the parties. They should be directed to furnish the personal and statistical particulars required and leave the certificate with the priest, minister, justice, or judge performing the ceremony:

He will then have to fill out the remainder of the certificate: and file it with the County Recorder. (or Registrar) within three days thereafter. The adoption of this arrangement accounts for the excellence of the returns from several counties.

Definite Statements of Causes of Death.-It often happens that Coroners are required to investigate deaths not caused by violence, but merely occurring without medical attendance. In such cases they should make the investigation thorough enough to be able to certify to some definite cause of death, as tuberculosis, cancer, pneumonia, etc. Deaths reported as due merely to "natural causes” have to be tabulated as "unknown," and therefore, yield no information of value to the statistician.

Names and Addresses of Subregistrars.-County Recorders (or Registrars) who have not yet reported to the State Registrar all their appointments of Subregistrars are requested to do so now, in order that the names and addresses may be put on the mailing list for the Monthly Bulletin.

Registrar's Accounts for Fees.- These should be presented to the State Registrar for approval quarterly, on the special blanks being sent to Local Registrars in the various counties, cities, and towns.

YELLOW FEVER.

The question is often asked if there is any danger of yellow fever in California. The answer to this must be, that there is danger, although it is not great. Yellow fever is spread by a certain species

of mosquito, and that mosquito has never been reported in California. If not here now, it might be brought in ships or cars, and so become naturalized, when we would soon have plenty of them. The mosquito is harmless unless it has bitten a person suffering with yellow fever, so, should the mosquito develop here, no bad results would follow unless a case of yellow fever should be imported and the mosquitoes allowed to bite the patient. Our safety consists, first, in preventing the introduction of mosquitoes and destroying all their breeding-places; second, in keeping all cases of yellow fever protected from mosquitoes. Ships and cars from infected ports are fumigated to destroy the mosquitoes, and a close watch kept for any case of the fever. However, every health officer, physician, and citizen has a duty to perform. We know the cause and can control it by united effort, and can take a valuable lesson from the intense suffering endured and great expense entailed by New Orleans during the past summer. The city was not properly sewered or drained, and had 70,000 cisterns all above ground, many of which were open and therefore breeding-places for mosquitoes. It has been an expensive fight, but one fought on scientific grounds, and science is winning out. Had all the citizens and physicians been prompt in reporting cases and accorded the health authorities an active support, the victory would have been more complete. The hiding of cases in this epidemic, as in all epidemics of contagious diseases everywhere, has been the cause of much of the suffering. Some time people will find that health authorities are working for their good.

MOSQUITOES.

The theory of a few years ago that mosquitoes were the chief active agents in the dissemination of malaria and yellow fever has been scientifically proven to be true. This opens up a new and extensive field for sanitary effort - a field that in the past has been almost entirely neglected. Further investigations will undoubtedly show that other diseases are transmitted by insects, and that the mosquito is not the only guilty one.

Insect life has been looked upon merely as an annoyance to existence-something that while capable of making life miserable was to be dreaded only for its annoyance. This is all changed now. While insects are none the less annoying, we know they spread the germs of disease.

There is now a double incentive to destroy them---to rid ourselves of the terrible nuisance, and of the danger of disease. The spread of yellow fever and malaria is not caused by the same kind of mosquito, but by two separate and distinct species—the Stegomyia for yellow fever, and the Anopheles for malaria. Neither of these mosquitoes is dangerous unless it has recently bitten a person suffering from the disease it carries; but having bitten such a person, the germs develop in the mosquito and its bite will then give that disease. As far as reported the yellow-fever mosquito has never been found in California, but should it be brought here there is no doubt it would adapt itself to conditions and multiply.

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