The most notable contrast between the proportions for the two months is the rise from 115.7 for November to 155.3 for December in the proportion of deaths caused by diseases of the respiratory system, which includes pneumonia and bronchitis.

The table below gives for California, in December, the number of deaths from the leading specific causes, together with the proportion per 1,000 from all causes:

The leading specific disease, as usual, was tuberculosis, which caused over one seventh of all deaths. Next in order were pneumonia and heart disease, each of which caused about one ninth of the total deaths.

NOTES TO REGISTRARS.

New Numbers for Certificates.-The attention of Local Registrars is again drawn to the requirement of the registration law that new series of numbers be started for the certificates of births, marriages, and deaths filed with them each calendar year. The Local Registrar, having transmitted to the State Registrar the certificates for December, 1905, should begin with the number 1 for the certificates of births, marriages, and deaths, respectively, filed with him in January, 1906. Correct numbering of all certificates by calendar years facilitates the tabulations in the State Bureau of Vital Statistics and also expedites the approving of Local Registrars' quarterly accounts for fees.

Pre-Addressed Envelopes for Certificates.-County Recorders J. F. Johnson, Jr., of San Bernardino and I. S. Logan of Riverside have prepared pre-addressed envelopes for distribution to physicians, clergymen, subregistrars, and others required to mail them certificates of births, marriages, and deaths. Other County Recorders and City Health Officers should consider the advisability of supplying similar pre-addressed envelopes to physicians and others in their registration districts. The use of such envelopes prevents certificates from being missent in the mails and, especially by freeing physicians from all confusion regarding the person with whom they should register births, insures a complete registration of births in each district.

Printing Name of County and City on Certificates.-In some instances the certificates printed for certain counties and cities, instead of reading "County of ... and "City of ..... have had printed on them the name of the county or of both the county and city. This has been done, for example, on the certificates for the counties of Contra

Costa, San Bernardino, and San Diego, and for the cities of Los Angeles, Pasadena, Pomona, Santa Monica, Vallejo, and Woodland. The printing of the name of the county or of the county and city on the certificates saves individuals the trouble of writing the same name over and over again or of putting it on certificates with a rubber stamp, and also prevents the filing of incomplete certificates with the place of birth, marriage, or death carelessly left blank. Local Registrars, in ordering new supplies of certificates, would therefore do well to direct that the name of the county or in some cases of both the city and county be printed on each certificate under the heading Place of Birth, Place of Marriage, or Place of Death.

Looming up before the State of California, and but a very short distance ahead in the natural line of advance, is the momentous question of a right public policy in relation to tuberculosis. It does not appear that it will be possible to avoid meeting it, nor should we desire to do so when we stop to consider all that is at stake. Our only solicitude should be to meet it right, which means in the manner that will produce the largest results in proportion to the effort expended. The question of ways and means is one to interest every citizen and every taxpayer, because the battle for the extirpation of consumption will be a long one and the expense will be very great. On its medical side a question for physicians alone, tuberculosis also presents social, industrial, and financial aspects which are quite as well worthy of attention, and these must appeal to all classes of intelligent persons.

Without sufficient preliminary discussion, and in a state of the public mind altogether unpropitious for satisfactory decision of so large a question, the attempt was made at the last session of the Legislature to

commit us to the policy of a large State hospital for tuberculous patients. Two hundred thousand dollars was the amount of the appropriation proposed, and on the part of the advocates of the measure there appeared to be no possible doubt that this would be the wisest first step which could be taken. Indeed, there seemed to be, in some quarters, an easy assumption that if we could only have a State institution for consumptives the whole problem would be solved.

But for several reasons, and especially because of the financial one, the establishment of a new State institution is always a serious matter, and in a State already so overburdened with institutions as California is, it ought not to be undertaken until it has been made very certain that in no other way could the same amount of good be accomplished. It is not the initial expense which is to be dreaded, but rather the consequences which are to come after.

The fact that other commonwealths have established hospitals for consumptives does not of itself settle the question whether institutional treatment would be the best method of dealing with tuberculosis in California. What other States have done is experimental only, and no State has undertaken to care for all its consumptives in one hospital or in several. Most of these State experiments have been commenced on a small scale, and where there is one sanatorium established by the commonwealth, there are generally twenty which owe their existence to private enterprise or to municipal action. In our penal and reformatory efforts and in our attempts to care for the dependent classes, we have suffered a good deal from institutionalism in California, and it is not a good idea to encourage at the outset in dealing with the problem of tuberculosis.

Let us look for a moment at the dimensions of the problem as measured merely by the number of persons suffering from the disease. A careful estimate based on the latest figures of the State Board of Health gives as the number of deaths per year from tuberculosis in California an average of 3,500. The ordinary run of the disease is said to be three years, which renders it easy to figure out that the total number of persons who are at any one time afflicted with the disease and destined to die of it must be 10,500. But at least twice as many persons suffer from tuberculosis as actually perish of it, and therefore the total number of consumptives must be, at a moderate estimate, 21,000.

Of course no such number of patients could be accommodated in any one hospital, even if all consumptives could be compelled to leave their homes and undergo institutional treatment. The mere transportation of such numbers of tuberculous patients, in a State so large as California, would be a crushing expense, and their traveling would create additional and unnecessary dangers for the portion of the population not yet afflicted. At best, a State hospital for consumptives could be only a demonstration of methods-an illustration showing how the sanatoria conducted by private persons and by local authorities ought to be managed-and it has not yet been made clear that we need a State institution even for that purpose.

Unless the present writer-who is not an expert and offers these ideas merely as the suggestions of a layman-is greatly mistaken, the more one digs down into underlying reasons and causes the more he is likely to become satisfied that what we need for the solution of the

tuberculosis problem is not so much a State institution as a State policy. The main consideration is this: Tuberculosis is an ever-present problem with each community and with each family and individual. The specific origin of the disease may be one, but the causes of its prevalence are many and have a direct connection with all our social usages and habits. Tuberculosis is a form of punishment for many of our social sins-for unsanitary towns and bad rural dwellings, for crowded tenements and personal vices, for poverty and poor nutrition, for illventilated workshops and the greed of capital. But the master cause of all is lack of intelligence on the part of the people who put themselves in the way of this great danger. If this be so, and there seems to be no doubt of it, what is needed more than anything else is a campaign of education which will teach people to realize that they can not commit the sin and escape its penalty. It is a case in which the whole community must be aroused to mend its ways, and in the doing of this both voluntary effort and a well-directed State policy are needful.

No doubt there will and should be public sanatoria, and each county and city should be required to maintain its own under the regulation of State laws and probably subject to State supervision. In the long run the results will be better if each community is required to care for the victims of its own public sins. If such victims could be thrust off upon the bounty of the State, the community could, to a degree, evade responsibility and ignore the consequences of its criminal neglect; but it could not so well do it if those consequences should be kept continually under the eyes of its own people. Moreover, with public dispensaries and local hospitals, most of the patients would never leave their own homes for any long period of time, the necessary public expense would be kept at a minimum, and there would be avoided the great evil of creating a new class of the unemployed-the homeless discharged patients of a large State institution. The reports show that already this evil exists in connection with institutions for consumptives in other States.

But whatever our conclusions may be with reference to the establishment of a State hospital for tuberculous patients, there can be no denial of the public duty to take up and deal with the great problem whose existence has suggested the action proposed at the last session of the Legislature. Every State in the Union has cause enough to do something, but California most of all, for our reputation for climate has brought such a migration of consumptives that the death-rate from that disease has gone above the average, and upon the map of States showing where the scourge is worst California now appears as a very black spot. Every consideration of safety urges us to cleanse it.

UNDRAWN POULTRY.

The Trustees of Sacramento have passed, and the Mayor has approved, the following ordinance:

SECTION 1. It shall be unlawful for any person, firm, or corporation, within the limits of the City of Sacramento, to sell, offer or expose for sale, any slaughtered poultry, fish, game, or any animal, used for food purposes, refrigerated or otherwise, which has not been properly drawn and prepared by removing the viscera at the time of slaughter.

SEC. 2. Any person or persons, firm or corporation, violating any of the pro

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visions of this ordinance shall be deemed guilty of a misdemeanor, and upon conviction thereof shall be punished by a fine not exceeding one hundred dollars or by imprisonment in the city prison not to exceed fifty days, or by both such fine and imprisonment.

In doing this Sacramento has gained the distinction of being the first city of the State, if not in the country, to exclude from its markets, poultry, fish, game, or animals that have not been properly cleaned at the time of slaughter.

The Board of Health of Sacramento, to whom belongs the honor of securing this legislation, is trying to induce the other cities of the State to adopt the same or a similar ordinance. In this effort we sincerely hope it will succeed, and that it will soon be impossible, in California, for one to be served with flesh of any kind that has been allowed to retain the decomposing filth of its intestines.

Many tons of refrigerated poultry, spoiled by this decomposition, are destroyed each year, but many more tons are not found by the health officers and are sold and eaten. Much of this is consumed in 25-cent (or cheaper) chicken dinners, so freely advertised in the cities. That these are responsible for many deaths and much suffering no observant person can doubt. As soon as death takes place, the power of the digestive tract to resist the penetration of the putrefactive gases and ptomaine poisons which are generated therein is gone, and they at once enter the flesh. Refrigeration does not entirely stop the decay nor the absorption of its products, and as soon as the frost is removed both are renewed with increased vigor. There is no good reason why the viscera should not be removed at once. The bird may look a little plumper and may weigh more, but it will be no fatter nor have more flesh, and if properly cleaned and dressed will keep longer and better and be free from the dangerous poisons generated in the intestines.

As long as California cities allow the unloading upon them of the undrawn refrigerated poultry-poultry that has been bought when and where it was cheap and kept for months until the price is high-they will continue to have in the markets this decomposing, disease-breeding food. There will be plenty of people to sell it and plenty more to buy. It is the duty of the local governments to protect their people, sometimes from themselves, and this is one of the cases where the city government should accord such protection.

NOTICE TO HEALTH OFFICERS.

Health officers are urged to send, the first of each month, the report cards giving the number of cases of contagious or infectious diseases occurring within their jurisdiction.

The State law requires that each health officer make these reports, and it should be as conscientiously obeyed as any other law. It is the only means by which we can know the health conditions of the State. Carefully fill in spaces for "place" and "month," and always sign your name.

The space for "remarks" should always be used. There is something you can say about conditions existing, or work you are doing. These reports are kept on file and will be a history of the advance in hygiene of California.

Thirty-three health officers have reported on the cards sent them for