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CALIFORNIA STATE BOARD OF HEALTH.

Vol. I.

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.

SACRAMENTO, APRIL, 1906.

No. 11.

STATE BOARD OF HEALTH.

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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 APRIL.

Summary.-For April there were reported 1,113 living births, 2,386 deaths, exclusive of stillbirths, and 1,010 marriages, which, for an estimated State population of 1,882,483, give the following annual rates: Births, 7.1; deaths, 15.2; and marriages, 6.4, per 1,000 inhabitants. The relatively low rates are explained by the seismic disturbance in San Francisco and vicinity on April 18th. The great fire in the metropolis destroyed the statistical records for the first part of the month, and the deaths for the latter part, even including deaths recorded as due to earthquake and fire, fall short of the usual monthly total. Moreover, the disturbed conditions necessarily resulting prevented (or at least have postponed) the recording of marriages and births, especially the latter, in San Francisco and other counties.

Altogether 607 deaths were reported as due to earthquake and fire, 395 being in San Francisco and 212 in other counties. The bulk of the deaths outside the metropolis were at Agnews State Hospital and in Santa Rosa city, the rest occurring mainly among refugees from San Francisco dying of exposure or fright.

Of the normal deaths for the State outside the metropolis, tuberculosis, as usual, was the leading cause, followed by heart disease and pneumonia.. The principal epidemic diseases were typhoid fever, measles, influenza, and diphtheria and croup.

Causes of Death.-The confusion resulting from the great fire in San Francisco has delayed the transmittal of original certificates for that eity, so that only a brief summary of deaths there from April 18th to 31st is available. Accordingly, the following table shows the number

of deaths in April due to certain important causes only for the rest of the State:

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Altogether 607 deaths were due to earthquake and fire-395 in San Francisco and 212 in other counties, as follows: Santa Clara, 139; Sonoma, 55; Alameda, 12; Sacramento and Solano, 2 each; and Napa and Nevada, 1 each. The bulk of the deaths in Santa Clara County were at the State Hospital at Agnews, and all in Sonoma County were in Santa Rosa city. Most of the deaths in Alameda County and all in the remaining counties occurred among refugees from San Francisco, young children dying from exposure and elderly people from fright or heart disease.

Of the normal deaths in the State outside of San Francisco, tuberculosis, as usual, was the leading cause, 276 deaths being due to tuberculosis of the lungs and 36 to tuberculosis of other organs. The next highest number, 215, was for diseases of the circulatory system (heart disease, etc.), followed by 145 for pneumonia and broncho-pneumonia. The leading epidemic diseases in April were: Typhoid fever, 21; measles, 18; influenza, 16, and diphtheria and croup, 15.

THE CATASTROPHE IN SAN FRANCISCO.

On the morning of April 18th a severe earthquake visited San Francisco and surrounding towns. Chimneys and cornices were thrown down and buildings of poor construction destroyed. Houses on wooden foundations that had decayed went down, and brick structures built with mortar which was largely sand, collapsed.

In San Francisco fire immediately followed and, owing to the destruction of the water mains, swept over and destroyed a large part of the city, rendering homeless 300,000 people. The loss of life was severe. but not so great as in many other calamities. Reports which are nearly complete show a death list of 607 in the entire State.

The State hospitals were badly damaged, Agnews being almost entirely destroyed, and the Home for Feeble-Minded was injured to the extent of many thousand dollars. In this institution, however, no one was injured. There are lessons to be learned from the disaster, and if properly heeded, some time, after the personal sorrow and distress are passed, we will look upon it as a blessing.

Three-story brick buildings which are unsightly, unsafe, and expensive will give place in State hospitals to smaller buildings, where patients can be segregated and receive better care, and which are infinitely safer. More care will be given to construction, and poor work will not be accepted.

Sanitary laws should be strictly adhered to in rebuilding San Francisco. No unsanitary parts should be allowed. Chinatown was not the only filthy place; but they are all gone and must never be allowed again. All buildings should be made rat proof, especially in the business parts, by making basements, on bottom and sides, of cement or some other rat-proof material.

Sewers and sewer connections should be improved and tenement houses built so that sun and air can have free access to every room. Should this one thing be done the saving of life from tuberculosis alone, would soon far more than offset the loss by the earthquake and fire.

There is now every chance to make the city the most beautiful as well as the most healthful in the world. There is no city for which nature has done more, and with plenty of pure water, which can be easily secured, and rebuilt along sanitary as well as artistic and utilitarian lines, the new and greater San Francisco will far outshine the old. A better supply of water in safer pipes is also an urgent necessity for the San Francisco which is to come.

The disaster in San Francisco gave occasion for a quick and effective sanitary organization and an exhibition of marked executive ability. The health authorities recognized the gravity of the situation and that the sanitary problem was of the utmost importance. With 300,000 people thrown out of home and business; with almost no water in the houses left unburned, and what there was of more than a doubtful nature; with the sick freely mingling with the well; with camps established everywhere, and all without sewer connections; and with irregular food and scanty covering, there was justification of the fear that much sickness would result. The day following the commencement of the fire, a thorough organization for the protection of health was formed. Col. George H. Torney, Deputy Surgeon-General and a thorough sanitarian and organizer, represented the U. S. Army; Drs. James W. Ward (president), Simon, Harrison, Hassler, and Ragan, the City Health Commission; Drs. Martin Regensburger and N. K. Foster, the State Board of Health; and Dr. Sawtelle, the U. S. Public Health and Marine Hospital Service.

Dr. Ward, as President of the City Health Commission, was given. full power to control sanitary measures, and the control could not have been put into abler or more willing hands. Long before the fire was out, headquarters were established in Golden Gate Park, hospitals started, the city districted and each put under a responsible chief, the camps were patroled and inspected, toilets were established, and plans formulated for concentration in a single camp. As rapidly as

possible a house-to-house inspection was made, all garbage cleaned up, people removed from unhealthful localities to those better adapted to their needs, and instructions issued about how to protect the healthfulness of the individual and camp. Cleanliness was insisted on and an earnest effort made to prevent the pollution of the soil.

The Medical Department of the U. S. Army, the U. S. Public Health and Marine Hospital Service, and the State Board of Health all worked in harmony with the city authorities, and all have the satisfaction of knowing that the quick active work was effective, and now, after a month's time, there is no more than the normal amount of sickness in the city.

This exhibition of sanitary work-a work that is unparalleled in effectiveness-could not have been accomplished had it not been for the active cooperation and hard, earnest work of the doctors of the city. With their offices and contents burned, and oftentimes with all they had on earth except their courage gone, they gave their time and best endeavors to succor the stricken city. They toiled in whatever place or position it was necessary to relieve suffering, and no history of the great catastrophe will be complete that does not fully recognize their noble work.

SMALLPOX.

In the last two issues of the Bulletin we have called attention to the existence of smallpox in the different parts of the State, and to the necessity of prompt isolation and vaccination. The need of this is intensified by the fire in San Francisco. As reported last month, smallpox was quite extensive in that city. Owing to the dread of quarantine there is always a certain number of cases that are never reported to the health officers. Most of these are light cases and have no physicians. They are, however, as dangerous as a more severe case, and those contracting the disease from one of them is just as liable to have a severe attack. Some of the non-reported cases are attended by physicians, who, for reasons of their own, do not report them. Under normal conditions some of these take reasonable care, remain isolated until all danger of spreading the disease ceases, and are careful that proper disinfection is practiced. Many-yes, most-do not, and in this way the disease is kept alive.

In an accident like the recent burning of San Francisco they are all driven out and are mixed generally with the people. The sick and those who had been exposed have spread out over the surrounding country, and, as was to be expected, we have now many points of infection and undoubtedly more will appear. Under these conditions it is absolutely necessary for the local health departments to exercise the greatest care. Physicians should report all cases, even those in doubt. It is better to keep a few quarantined until the nature of the disease can be established than to let any be exposed unnecessarily. Vaccination should be urged in all cases, and the State law in regard to vaccination in schools should be enforced. To quarantine all those who have been exposed to smallpox oftentimes works a hardship, and is really unnecessary. Vaccination will stop the disease-nothing else will. All contacts should be vaccinated and disinfected, if it is possible that their clothing may have received the contagion, after which they can be allowed to go

to their usual employment, provided they can be under inspection by the health department; should they become sick they can be isolated before there is danger to others.

While the greatest care and firmness must be exercised, we must remember that we are facing a condition in the State never before experienced in this country, and temper our acts accordingly. We must protect the health of the community, sometimes with what may seem arbitrary measures, but no unnecessary restraints should be imposed.

MEETING OF THE PUBLIC HEALTH ASSOCIATION.

The sixth semi-annual session of the California Public Health Association was held in San Francisco, April 16th. Each session has increased in interest, and this was no exception. The day was given to papers and discussions on the water supplies of the State and on the disposal of sewage.

The first paper, "The Condition of California Water Supplies," by Dr. N. K. Foster, was a description of the polluted condition of many of our streams, and also called attention to the danger of wells located so they could receive the drainage of toilet or corral.

Prof. Chas. G. Hyde, of the University of California, read a paper on "The Sanitary Quality and Purification of Public Water Supplies." He explained the needs of pure water for domestic and manufacturing purposes, and said that the clear, sparkling water was not always pure, nor the turbid one always unhealthful. He compared the typhoid ratio in Massachusetts and Pennsylvania, as showing the good results of carefully guarding the streams.

Mr. George L. Hoxie, City Engineer of Fresno, read a paper on "Sanitary Disposal of Sewage," advocating strongly the disposal of sewage on land, either direct or after treatment in the septic tank, and describing fully the new disposal system being installed in Fresno.

Dr. Charles F. Clark, of Willits, read the last paper, on "Sewage Disposal," giving in detail the process of bacterial destruction and showing the dangers of sewage pollution of land and water.

The discussions that were brought out were of great interest, and an effort will be made to have the whole proceedings published.

The following officers were elected for the coming year: President, Wm. Simpson, M.D., San José; Vice-President, James W. Ward, M.D., San Francisco; Secretary and Treasurer, N. K. Foster, M.D., Sacra mento.

The next meeting will be held in San José, at the call of the Executive Committee.

TYPHOID FEVER.

Typhoid fever is reported from several parts of the State, and in some it is quite severe. In those parts where the disease is severe, the water supply is under suspicion and is doubtless the cause, as in most cases the pollution is plainly to be seen, and in all there is a possibility. Typhoid fever is a preventable disease and should not be allowed to exist; it is a disease of filth, for it is only communicated through the excreta of the diseased person. This excreta, being loaded with the germs of typhoid, and finding access to our food and drink, and there

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