CALIFORNIA STATE BOARD OF HEALTH. Vol. I. MONTHLY BULLETIN. Entered as second-class matter August 15, 1905, at the post office at SACRAMENTO, APRIL, 1906. No. 11. STATE BOARD OF HEALTH. MARTIN REGENSBURGER, M.D., President, STATE BUREAU OF VITAL STATISTICS. San Francisco Los Angeles N. K. FOSTER, M.D., State Registrar. Sacramento | GEORGE D. LESLIE, Statistician. STATE HYGIENIC LABORATORY. ARCHIBALD R. WARD, D.V.M, Director.. Sacramento University of California, Berkeley 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 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 coöperation 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., Sacramento. 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 fore taken up again by the human system, causes the disease. The prevailing custom of using the creek-bed for a sewer and repository of all rubbish is responsible largely for the spread of typhoid fever. This disposition of sewage is costly in lives and expense of sickness, but will probably go on until the whole question of sewage-disposal and watersupply is placed under some responsible head. Where typhoid fever exists all water should be boiled until a pure supply can be had. Flies, as a means of spreading the disease, must not be overlooked, for they are a strong factor. Lighting on the dejections of the sick they become loaded with the germs and fly to the table and infect the food. Much of the disease could be prevented if all discharges from the patient were destroyed-not emptied into the cesspool or sewer, but burned or thoroughly disinfected. To do the latter, cover all discharges with a five per cent solution of carbolic acid and allow it to stand for two hours. This solution is cheap, effective, and is generally easily procured. Health officers should insist that all cases be reported by physicians and that proper disinfection be practiced. DIPHTHERIA. Diphtheria is not especially prevalent in the State, but in the present disturbed condition, where many are changing localities and some wandering aimlessly about, there is danger of its being spread. All cases of sore throat should be closely watched. Each health officer should send to the State Hygienic Laboratory, at Berkeley, for a supply of diphtheria mailing outfits, and send a swab of each case of sore throat for examination. This will clear up any doubtful diagnosis and often save an epidemic. Antitoxin should be freely used both in treatment and as a prophylactic. It is harmless and effective if properly used. The utmost care must be exercised in disinfecting after the disease. An imperfect disinfection is worse than none, for while doing no good, it gives a feeling of security which is false. At the present time formaldehyde is more largely used than any other disinfectant, and in many respects it is excellent, but it must be used in sufficient quantities. Examinations at the State Laboratory show that the commercial article sold as a 40 per cent solution is often as low as 30 per cent and never to the full 40 per cent. This weakness makes it necessary to use more, and in no case should there be used less than one pint to every 1000 cubic feet of space to be disinfected. The room must be closed tightly and remain unopened for at least twelve hours. In diphtheria, as in typhoid, the agency of flies and other insects in carrying disease must not be forgotten, and the windows and doors should be thoroughly screened. CAMPING. The camping season is at hand, and many hundreds of Californians are planning trips to the mountains or sea coast. Nothing can be more conducive to health than a few weeks of outdoor life, if properly taken. It renews the vigor, and we come back to work with increased ability to cope with the problems before us. There are grave dangers, however, lurking in camp life, and many return sick, or at least weaker than when they started. Besides, campers frequently endanger the lives of those left behind by unwittingly polluting the water which flows by the camp to supply the towns. The healthful condition of the large camps in San Francisco should be a lesson to all campers as to their own safety. The water that looks so pure and which is drunk so freely may be badly polluted. It is well to examine the stream and see if some one is not camping above you and using it as a sewer. Possibly a corral or a farm yard may be just above. If pollution is found, either move, or boil for fifteen minutes all water used. Back from the creek you should dig a vault for a toilet, and all garbage should be either buried or burned. Allow no place to exist where flies can breed, for they are the carriers of disease. Uncooked vegetables are sometimes poisoned by the fertilizer used or by being irrigated with sewage water. If near mineral springs, don't drink too freely from them, for much harm sometimes results from this excess. Above all, don't pollute the stream and endanger the lives of those below who may want to use the water. "S. S. S." Dr. Ragan, Health Officer of San Francisco, claims to have made a great scientific discovery. It is nothing less than a "sleeping sickness serum." He warrants that one dose properly administered will remove all disposition to sleep and keep the patient at work for twenty hours a day. He says that the long hours of faithful work performed by the San Francisco Health Commission were due to its use. They certainly did the work, but we have an idea that the doctor's serum consists of a deep interest in the health of the people. At any rate, Doctor, the Bulletin is at your disposal to inform the world of the truth, and if you succeed in inoculating every health officer with the same energy and success as were shown in San Francisco you will gain the gratitude of the people of the State. MOSQUITOES AND FLIES. It is interesting to note that many cities and towns are taking an active interest in the destruction of mosquitoes, and the State Board of Health has reason to believe that its labor in this field is bearing fruit. The present Board has urged through its Bulletin, by letters, and by word, the danger of this pest. Health boards and the people are appreciating the fact that mosquitoes are not only an intolerable nuisance and carriers of disease, but that they can be readily destroyed by preventing their breeding. The common house fly is as great a nuisance and perhaps a greater menace to health. Bred in filth of the most revolting kind, flies become laden with germs and come to our tables to partake of and poison our food. Many obscure cases of contagious disease can be charged up to the account of the house fly. Laws will soon be passed making their breeding-place a nuisance. What California town will be the pioneer? |