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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.
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
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 ci 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
the reporting of contagious and infectious diseases. Diphtheria is reported from the largest number of places, 14; next in order comes influenza, 12; pneumonia and typhoid, 10 each; scarlet fever, 9; croup, 6; whooping-cough, 5; measles, 4. In the number of cases reported diphtheria is second only to influenza and exists in all parts of the State. A close watch should be kept by all health officers and all cases carefully isolated and thorough disinfection practiced.
PROTECT THE MILK. The Board of Health of Fresno is taking a step in advance in urging the passage of an ordinance requiring all milk sold in that city in quantities of less than one gallon shall be in sealed bottles. We often see the milkman take from the seat beside him the measure, where it has been exposed since his last customer was served, and in the face of a strong wind which has filled the air with all conceivable filth, pour out the milk that is to be used perhaps by a sickly baby. Few of us fully appreciate the dangers of dust, but the light is breaking in, and some time we will refuse to drink milk or eat food that has been unnecessarily exposed to it.
AN ACTIVE HEALTH OFFICER. Dr. Clark, the health officer of the progressive and prosperous town of Willits, is urging an extension of the sewer system and the installation of a septic tank. There is nothing that adds so much to the desirability of a town as a place of residence as a perfect sewer system, including the destruction of the sewage matter. Every one prefers to live where health conditions are good, and this can not be where the waste from toilets, sinks, or stables is allowed to spread uncared for on the surface or to collect in pools. A town can make no better investment than in a thoroughly up-to-date sewer system.
WOMEN AS MILK INSPECTORS. The latest thing in dairy inspection in California is that started by the club women of Los Angeles. The proposition is for the women to inspect the dairies which furnish them milk, and insist that they be kept up to the standard. If they will do this, making their requirements within the bounds of reason, and refuse the milk if they are not complied with, we shall see a great cleaning up, and better milk.
A SUBSTITUTE FOR THE OYSTER. “The importance of the oyster as a food and as a factor in the etiology of typhoid fever renders a possible substitute for it of medical interest. The abalone is a giant snail, weighing from one to two pounds, living in practically unlimited quantities in the deep waters of the ocean, and easily gathered along the entire coast of central and lower California. The flesh is a nutritious and wholesome article of food, highly esteemed by the Chinese and Japanese, but as yet very little used in the United States outside of California. The drying process and the original canning method yield a tough product, but a process has recently been discovered by which these giant snails can be canned and made as delicate as the oyster. They are used in a similar way for food, but have the decided advantage over the oyster that when gathered the viscera can be detached from the muscular parts by the single stroke of a knife. The source being on less populated coasts, offers less danger of typhoid contamination than does that of the oyster, and, further, we understand that there is no necessity for fattening the abalone in creeks, as is the case with the oyster. The points are in favor of the new mollusk and seem to give it large possibilities as a food product.”—The Journal of the American Medical Association.
The continued and increased pollution with sewage of the waters in which the oysters grow in California is a source of constant danger, and will, in the near future, cause that mollusk to be looked upon with much suspicion, if it does not drive it from the market. The condition is as bad, or possibly worse, in the East, and numerous epidemics of typhoid fever have been traced to this source. While in California no epidemic has resulted from the shell fish, no doubt many cases scattered throughout the State have come from them. If the abalone can be prepared so as to take the place of the oyster and clam, it may be the means of saving many lives.