the furniture absolutely needed. Carpets and draperies are unnecessary, and should be discarded. After the patient enters it nothing should be removed from the room until it has been disinfected. The attendants should be limited to the physician and nurse, and all visitors should be denied admission. All remains of food should be burned, as should rags or papers used to receive the expectorated discharges. It is not uncommon to see in the sick-room the bottle which contains the milk or cream as it came from the dairy. This should never be allowed, for it is liable to become infected and spread the disease.

The germs of diphtheria are readily destroyed by heat, boiling water killing them almost instantly, hence it is easy to disinfect at the bedside, where it should always be done. All towels, clothing, tableware, and in fact everything that moisture does not injure, should be immersed in boiling water before removing them from the room. Bed clothing that can not be boiled must be exposed during the general disinfecting. Books will require special care, and if used by the patient had better be burned; if not, they must be spread out when the room is disinfected, for if left closed no good will result.

Domestic animals must be excluded from the sick-room, for it is possible for them to carry the disease. Flies also must be remembered, for if allowed in the room they can easily, and almost surely will get the secretions from the patient on their feet and legs and fly to some other place where they can wash them off in milk or wipe them off on other food.

To the lasting shame of a few physicians, they do not report their 'cases. Their usual plea is, "Oh, they were light cases." The doctor who, for personal, political, or financial reasons, neglects to report cases of diphtheria is morally, and should be criminally, responsible for the sickness or death of any one contracting the disease from the unreported case. It is no friendship to the family to neglect this duty to the public, for the disease will linger in the house unless thoroughly disinfected, as is almost never done unless by health authorities. The physician well knows that from light cases there is a liability of malignant ones arising, and his neglect to report is a violation of a sacred

trust.

In all cases the patient should be isolated continuously until two examinations of the throat secretions, made twenty-four hours apart, show the absence of the diphtheria germ. Most cities have a laboratory where this is done, and the State Hygienic Laboratory for this purpose, free to all health officers of the State, is maintained at Berkeley. In case of death public funerals should not be allowed.

The disinfection of the room must be thorough. Too often dependence is put upon small sulphur candles or a mere sprinkling of formalin, and the cracks are left open. The same care as to sealing the room must be exercised, and the same amount of disinfectants used, as described for school-houses.

Sunlight and air are among our best disinfectants, and must always be used to the fullest extent. Get all you can of both in the sick-room. While they will not kill the germ like formaldehyde, it does not thrive in them. They invigorate the patient and attendants and add greatly to the resisting power of the body, which is our main defense against disease.

Antitoxin should be freely used upon the first appearance of the disease,

no matter if it is mild. Its use is free from danger, and good authorities claim that no child ever died of diphtheria where 3,000 units were used during the first twenty-four hours, and the dose repeated as needed. Larger doses than this are often necessary when the disease is more advanced, and in all cases the condition of the patient should be the criterion from which to judge. If no improvement is seen in twelve hours the dose should be repeated, and continued each day until the exudate has disappeared.

HONEST LABELING OF FOOD MATERIALS.

In view of some of the criticisims which have appeared in the press of the State, with reference to our analyses of "evaporated creams," it seems advisable to say a few words regarding the object of the work.

It is well known, as stated by the writer', that "there are, in the main, two methods of adulteration employed: the one harmful and sometimes poisonous to the human system, and the other the deceptive and fraudulent, but not generally injurious to the health of the consumer.

"In those states where enforcement of pure-food laws is carried on, most of the work is devoted to the detection of the harmful and injurious preservatives, while the second method, just mentioned, has been investigated but to a very limited extent, and there are even certain frauds which do not come within the pale of laws now exercised.

"The first method referred to above does not require any extended discussion, because all will agree that no food should be manufactured or sold which contains harmful or injurious ingredients. It would seem that, in the light of our present knowledge, it would be far safer to prohibit the use of preservatives in foods or food materials. If, later on, science can show, as some claim it will, that the small addition of certain preservatives is harmless, then the laws can be modified accordingly. Still it must not be forgotten that the results of experiments made on healthy subjects can not be expected to be applied to the invalid and convalescent or dyspeptic, for whom many of the foods now containing preservatives are prescribed or recommended.

"With the second method, the deceptive and fraudulent, etc., the case is very different. No one should be prohibited from manufacturing or selling any admixture of foods or food materials, provided the package is honestly labeled, thus insuring the sale of the materials for just what they are.

"Several forms of mislabeling can be enumerated, among which the following are the most conspicuous: (1) False statements concerning the nature of the contents of packages of foods or food materials; (2) False statements regarding the nutritive value of the different manufactured and prepared foods; (3) False statements or inferences relating to the weight of foods or food materials in any package.

"With reference to No. 1, it may be said that the fraud, in most cases, is of a pecuniary nature. Cheap materials are added to more expensive ones, thus bringing cheap and inferior products into competition with those from the hands of the honest manufacturer. While the addition of mustard or cottonseed oil to a salad will not have any appreciable effect on the health of the consumer, still there is the pecuniary fraud

1 California State Medical Journal, June, 1904.

which should be prevented. At the same time no one should be denied the right to buy the cheap oils. But those who wish to purchase pure olive oil should not have to remain in doubt as to its purity and quality, as at present they so often have to do. The enforcement of proper labeling would obviate all of these difficulties. Again, no prohibitory restrictions should be placed upon the manufacturer who wishes to make a jelly consisting of a mixture of apple and currant, or a cornstarch and fruit jelly, or a butterine made up of butter and oleomargarine, etc., nor, in fact, any compound from the admixture of two or more food materials each of which may possess different nutritive and pecuniary values, provided the proper statements are plainly in evidence on the label.

"In many cases the nature of the main contents of the package is plainly printed, but the type used for the name or names of the adulterants is so small, and often so concealed in the "foliage" of the label, that unless one is very careful he is led to believe that the contents consist entirely of the material indicated by the large type. This is particularly true of honey. There are cases where the words 'Pure Honey' have a prominent position on the label, but only after careful search will one find the statement, '20 per cent honey and 80 per cent glucose.' Thus the manufacturer has complied with the law in name, but, as far as the consumer is concerned, has decidedly evaded it in spirit. There should be no objection against the manufacture of a butter containing 20 per cent of water, if such be stated on the wrapper and the butter be subjected to a discount; because the purchaser should not be obliged to pay for 8 to 10 per cent extra of water at the price of butter fat.

"Prominent among the deceptions practiced under the second form above mentioned may be noted several proprietary foods, infant foods, cereal breakfast foods, coffee substitutes, and 'evaporated creams.' The 'evaporated creams' are excellent food, to which no objection can be raised, but they should be honestly labeled for just what they are. These materials are seldom, if ever, admixed with any poisonous or harmful adulterants."

FOOD LABORATORY, UNIVERSITY OF CALIFORNIA.

M. E. JAFFA.

N. K. FOSTER, M.D., State Registrar..Sacramento | GEORGE D. LESLIE, Statistician.......Sacramento

STATE HYGIENIC LABORATORY.

University of California, Berkeley

ARCHIBALD R. WARD, D.V.M., Director

VITAL STATISTICS FOR OCTOBER.

Summary. For October, vital statistics were reported from all except four of the fifty-seven counties in California. The population in 1905 has been estimated conservatively according to the Census Bureau method by adding to the population in 1900 five tenths of the increase between 1890 and 1900, except that for the few counties showing decreases between the last two Federal censuses the population in 1900 has been taken for 1905 and for some leading cities arbitrary estimates have been made because of their exceptionally rapid growth. For fiftythree counties with a population, thus estimated, of 1,678,124 there were reported 1,873 living births, 2,117 deaths exclusive of stillbirths not tabulated, and 1,464 marriages, or 2,928 persons married. These figures represent an annual birth-rate of 13.1, a death-rate of 14.9, and a marriage-rate of 10.3, or 20.6 persons married, per 1,000 ponulation. In "Greater San Francisco, or the metropolis together with Oakland, Berkeley, and Alameda, the proportion of all deaths caused by such complaints as heart disease and diarrhoea and enteritis is considerably above the average proportion for California as a whole. For the rest of the State, on the contrary, the proportion of all deaths due to certain causes is above the general average for epidemic diseases, nervous diseases like meningitis, apoplexy, and paralysis, and deaths from various forms of violence-suicides, drowning, and accidental injuries.

In October, as usual, tuberculosis was the leading specific cause of death in California. It is significant, however, that about one ninth (11.4 per cent) of the victims of this disease had lived in the State less than a year. Of the native Californians who died of tuberculosis, about one third were less than, and two thirds were at least, 15 years old.

Causes of Death.-The table below gives the number of deaths reported for October, by main headings of the International Classification, for California as a whole and also for "Greater San Francisco" or the metropolitan area (San Francisco and the three transbay cities) in contrast with all the rest of the State. For convenience in comparison, there is likewise shown the proportion of deaths from each class per 10,000 from all causes:

The table shows that in California as a whole about one fourth of all deaths were due to other than epidemic general diseases, the class. including tuberculosis and cancer, and about one eighth were caused by diseases of the digestive system, including diarrhoea and enteritis. The next largest proportions were from diseases of the circulatory system, violence, diseases of the nervous system, of the respiratory system, of the genito-urinary system, and epidemic diseases, in the order named. There are marked differences between "Greater San Francisco" (the metropolis together with Oakland, Berkeley, and Alameda) and the rest of the State in the relative importance of the different classes of diseases. Thus, considering only the most striking contrasts, one finds that in the metropolitan area the proportion of deaths was much above the average for California as a whole for diseases of the circulatory system and of the digestive system, in which the principal specific diseases are respectively heart disease and diarrhoea and enteritis. In the rest of the State, on the other hand, the proportion was above the general average, especially for epidemic diseases such as typhoid, malaria, whooping-cough, and diphtheria and croup, for diseases of the nervous system, including meningitis, apoplexy, and paralysis, and for violence, comprising suicides, drowning, and accidental injuries.

The following table shows for California as a whole the number of deaths from the leading specific diseases, as well as the proportion per 10,000 from all causes: