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CALIFORNIA STATE BOARD OF HEALTH.

MONTHLY BULLETIN.
Entered as second-class matter August 15, 1905, at the post office at
Sacramento, California, under the Act of Congress of July 16, 1894.

Vol. I.

SACRAMENTO, FEBRUARY, 1906.

No. 9.

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,

O. STANSBURY, M.D..

Chico
Sacramento W. LE MOYNE 'WILLS, M.D.

Los Angeles
N. K. Foster, M.D., Secretary Sacramento
HON. W. I. FOLEY, Altorney..

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 FEBRUARY. Summary.--The vital statistics reported for February are as follows: Living births, 1,762; deaths, exclusive of stillbirths, 2,223; and marriages, 1,231, or 2,462 persons married. On the basis of an estimated population of 1,853,561 for the State, exclusive of Humboldt County not yet reporting, the returns for February give the following annual rates: Births, 12.9; deaths, 15.6; and marriages, 8.6, or 17.2 persons married, per 1,000 inhabitants. The corresponding rates for January were: Births, 12.4; deaths, 17.4; and marriages, 9.9, or 19.8 persons married. So February, as compared with January, shows a slight increase in the birth-rate, with decreases in the rates for deaths and marriages, especially for deaths.

As usual, tuberculosis was the principle cause of death in California. While in January pneumonia led heart disease for second place, in February the proportion of all deaths caused by diseases of the respiratory system was considerably less than that for diseases of the circuiatory system.

Causes of Death.- The following table gives the number of deaths, by principal classes, reported for California in January and February, respectively. For convenience in comparison, the proportion from each class per 1,000 deaths from all causes is likewise shown:

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In each month, especially February, the proportion is highest for other than epidemic general diseases, the class which includes tuberculosis. In January, the proportion for diseases of the respiratory system (pneumonia, bronchitis, etc.) was much higher than that for diseases of the circulatory system (heart disease, diseases of the arteries, etc.). In February, however, conditions are reversed, the proportion for diseases of the respiratory system being considerably less than that for diseases of the circulatory system. This indicates that with the passing of winter there comes a falling off in the deaths due to pneumonia.

PUBLIC HEALTH ASSOCIATION. The Sixth Session of the California Public Health Association will be held in San Francisco on April 16th. The committee has thought best to devote the time largely to a discussion of the water supplies of the State. As much of the pollution of the streams arises from sewage which is conducted into them, its disposal is entirely germane to the question.

An hour will be devoted to questions and answers, and much good should be derived from this hour, where each can give and take.

Governor Pardee, who is always interested in the sanitary advancement of the State, will be present and will deliver an address. It is expected that at least one of the addresses will be illustrated with lantern slides.

Since this meeting comes the day before that of the State Medical Society, it will be possible for members to get the reduced rates on the railroads accorded to those attending the meeting of the latter society.

All health officers should come, and come loaded with suggestions for the betterment of our State.

CALIFORNIA PUBLIC HEALTH ASSOCIATION

SIXTH SESSION
BOARD OF HEALTH ROOM, CITY HALL, SAN FRANCISCO

APRIL 16, 1906

PROGRAM 10:00 A. M.-Greeting by the President, DR. E. von ADELUNG, Oakland. 10:30 A. M.--"The Condition of California Water Supplies,” Dr. N. K. FOSTER, Secretary

of the State Board of Health.

NOON RECESS.

1:30 P. M.- Address, “Advantages of Organization,” by Hon. GEORGE C. PARDEE,

Governor of California. 2:30 P. M.—"The Sanitary Quality and Purification of Public Water Supplies," by

PROF. CHARLES G. HYDE, of the University of California. 3:30 P. M.-"Sanitary Disposal of Sewage,” by GEORGE L. HOXIE, City Engineer of

Fresno. 4:30 P. M. -One hour devoted to questions and answers.

Each paper will be open for general discussion immediately after its reading. T discussion of the “Sanitary Disposal of Sewage” will be opened by DR. CHARLES F. CLARK, of Willits.

Members of the Association will meet at the banquet board in the evening, when short addresses of a general character will be indulged in.

OFFICERS:

President, - DR. EDWARD VON ADELUNG.
Vice-President, Dr. WM. SIMPSON.
Seoretary,

Dr. N. K. FOSTER.

EXECUTIVE COMMITTEE:
Dr. J. W. Ward, Dr. Wm. Simpson,
Dr. C. C. Browning, Dr. D. F. Ragan,
Dr. E. N. Ewer, Dr. W. C. Hassler.

SUMMER SCHOOL OF SANITARY SCIENCE. The State University has issued the following bulletin in relation to a course on Public Health and Sanitary Science, to be given at the coming Summer Session, providing sufficient interest is shown:

Public Health and Sanitary Science will be made a special department of the next Summer Session of the University of California, from June 25 to August 4, 1906, if sufficient applications are received before April 1st to warrant the undertaking.

The important problems in water supply and the disposal of sewage which constantly confront physicians and public officials will be the subject of a course offered by Charles Gilman Hyde, C.E., Assistant Professor of Sanitary Engineering, and recently a member of the engineering staff of the Massachusetts State Board of Health, which is charged by law with the inspection of the water systems and sewage plants of that commonwealth.

The bacteriology of infectious diseases will be discussed by Archibald R. Ward, Assistant Professor of Bacteriology and Director of the State Hygienic Laboratory. Students will have the opportunity of daily laboratory work in bacteriology and in the microscopical examination of specimens received at the State Hygienic Laboratory. An effort will be made to suit the laboratory work to the individual needs of individual students.

This undertaking means much for the advancement of sanitary science and tủe protection of public health. Will you coöperate by informing others interested in such work of the opportunities offered by the University of California ?

It is earnestly requested that all persons who would hope to come to Berkeley for these courses should at once write to the Dean of the Summer Session, University of California, Berkeley.

An effort will be made to so arrange the work that should a physician find it possible to attend the Summer Session only for two or three weeks, he would be able to get the information which would concern him most. The fee for the Summer Session is $12.

This offers an exceptionally good opportunity for health officers and others interested in sanitation to get in touch with the most recent advancement in this important field. The health and life of the people are in no small degree in the hands of the health officer. On his knowledge and ability to correct wrong conditions is placed the hope and expectation of avoiding preventable disease. As a rule, health officers are able and willing workers, but many have had no special training for the position and labor under a great disadvantage, and it is a hopeful sign to see this interest shown by the State University. It is a step in the direction to what must surely come, a law requiring every health officer to attend for a few days each year a sanitary school where everything new, and much that is old, can be gone over and the useful taught in a way that will make it possible of application by the health officers.

As the city or town gets the advantage of these schools in improved methods and effective work, it should by right pay the necessary expense.

We sincerely hope that there will be many in attendance, for the character and ability of the men conducting it is sufficient guarantee that the course will be replete with interest and usefulness.

SMALLPOX. Smallpox has been reported from so many parts of the State that it can be considered epidemic, and health officers are warned to be on their guard against it. There is so much activity in railroad building all over the State, and as several of the camps have become infected, it behooves the health officers of the localities where such camps are

located to watch closely. The men are constantly moving from one to the other, and are particularly apt to move on when a case of smallpox appears. One case has come to our attention where the party left the camp he was in for another, after he began to feel the symptoms of the disease. It is quite possible that the move cost him his life. The present form of the disease is by no means light, quite a large percentage dying.

The law requires that health officers report all cases at once to the State Board of Health, and that means be taken to control it. This should be observed closely, as the fear that knowledge of its existence will cause notoriety and injure the locality is foolish. It is bound to be known, and at the present time what people want to know is, that every effort is being made to control it. If it is they are satisfied, but if there is an effort to suppress the fact of its existence they are at once suspicious, and the imagination multiplies the cases.

As far as we are informed, and our information reaches most of the cases, none having the disease were ever vaccinated. In one town a physician who had never been vaccinated is down, while the others who were equally exposed are free.

This emphasizes the need of universal vaccination, and it may not be amiss to review briefly the advantages of the operation, the amount of good it has done, and the small danger attending it.

Before the introduction of vaccination smallpox was the worst scourge in existence. It was conservatively estimated that in Europe alone over 200,000 died each year from it, and that great numbers were left blind or otherwise maimed for life. It was a disease of childhood and few attained to adult life without having had it. The protective influence of vaccination was first made known in 1798 and more or less extensively adopted during the next few years. Immediately following this there was a sudden decrease in the extent and mortality of the disease. This has often been credited to the improved sanitary conditions; but the fact that other contagious diseases, and especially filth diseases, decreased only in a very limited degree, proves this ground to be not well taken. Indeed, in cities where the growth was large and sanitary conditions worse, the mortality from smallpox decreased in the same ratio as in places where better sanitation prevailed.

Fortunately, careful records were kept in various countries, and from these it is easy to prove the effect of vaccination.

In Sweden, during the twenty-eight years preceding vaccination, 2,050 died annually from smallpox in every million population; during the forty years following vaccination, only 158 per million. In Prague, for the seven years before vaccination, one twelfth of the total deaths were from smallpox; during the thirty-five years after, the ratio was only 1 to 457. in Copenhagen, for fifty years before vaccination, the smallpox death-rate was 3,128, and for the fifty years after, 286. In Berlin, for twenty-four years before, the smallpox death-rate was 3,422, and for the next forty years only 176.*

Figures might be multiplied, but it is useless, for the experience of almost all physicians and all hospitals proves the protecting power of vaccination. That the protection in all cases extends throughout a long life is not claimed, but even if later in life the disease is contracted, it is much lighter and is seldom fatal. Every one, however, should be re-vaccinated, when the protection is almost perfect.

*Figures taken from Welch and Schamberg's “Acute Contagious Diseases." (Philadelphia and New York, 1905.)

The danger attending the operation is very small, and when compared with the danger attending the disease, sinks into insignificance.

Every wound, no matter how slight, may become infected with disease-producing germs unless proper care is taken to prevent such an occurrence, and it is almost entirely from this cause that deaths occur after vaccination. In Germany Voight estimated but one death in 65,000 vaccinations, and in his own practice of five years he vaccinated 100,000 people with but one death. Compare this with the deathrate before vaccination, when from one in every twelve to twenty died with smallpox, and the life-saving effect of vaccination will be evident.

The dangers from vaccination may be classed as follows: 1st. Careless operation. 2d. Impure virus. 3d. Wound infection.

To avoid these, 1st. Employ none but a careful physician, who does his operation in an aseptic manner. 2d. Use only virus which is produced by manufacturers whose products are known to be pure or are examined and certified by the United States Government. The danger from impure virus is, at the present time, very small. Almost no humanized virus is used, and only healthy calves are used to produce the bovine virus. They are tested for tuberculosis and other diseases, and the virus produced is carefully examined by making cultures before it is sold. 3d. The wound must be kept clean and aceptic. In this class of wound-infection come almost all the deaths. Frequently no care whatever is taken of the wound. It is left to be rubbed and irritated by the clothing which may be none too clean, and often the child is allowed to play in the dirt of streets and stables. When dressings are put on, not infrequently they are allowed to become dirty and a source of danger. Nature does her best to protect the sore by a scab, but this is often scratched or rubbed off by the clothing, thus leaving a most excellent chance for infection. The scab should always be carefully guarded and never removed until it drops of itself.

There is also occasionally a case where the child or person is in such a physical condition that no careful doctor would care to vaccinate. These, of course, should not be vaccinated until the disease causing the disability has been removed.

It is often charged that vaccinia produces other diseases. This is as impossible as it would be to inoculate with measles and produce scarlet fever or plant corn and raise potatoes. That other diseases follow at once after vaccination is due to coincidence only. Among the millions vaccinated, it would be strange indeed if in some cases it did not immediately precede the development of some other disease, not as a cause, but merely by chance. With humanized virus it might be done, with pure bovine virus never.

The conclusions reached by a vast majority of medical men, and especially by those who have had exceptionally good chances of observation and study, are:

1st. That vaccination and re-vaccination will protect from smallpox, and that the lessened mortality and the changing from a disease of childhood to one of adult life is the result of this operation.

2d. That if proper care is observed the evil results of vaccination will be almost nil.

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