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Au article on “Mental Health of School Children," appearing in the July Bulletin, called forth a great deal of criticism pro and con. This criticism is sufficient to prove that the subject is one of vital interest to the State and one which should be kept before the public.

Nothing is of more importance than the proper rearing of our children who are so soon to take our places in the management of affairs. The future prosperity of our State depends upon them. We seldom find a healthy, resourceful mind in a weak and sickly body; therefore, in the management of our affairs, it is only by having the best minds in the soundest bodies that we can hope to reach the high civilization to which we aim.

A perfect system of education should be symmetrical, developing mind and body at the same time. A person full of facts which he can not make use of is not as well educated as the man who can not read but who can build a brick wall. We do not want the coming generation to be merely living encyclopedias, full of facts but with no power to apply them, any more than we want a race of uneducated giants. We do want strong, healthy men and women with minds well stored with ideas and with the power and will to use their knowledge.

That the present school system tends to a one-sided development is believed by many, among whom are some of our best educators, and as a reason for their belief they point to the children who each year leave school broken down in physical or mental health. That these form even a large minority no one claims, but taken collectively there are in the State a large number of such children- far too large to be neglected. How to remedy the fault we do not pretend to say. We believe we see the danger, and would call the attention of those in charge of the schools to this danger. Our duty lies in lessening the evil results by protecting the health of the children and putting them in the best possible physical condition.

Every physician of extensive family practice can readily call to mind many cases of breakdown in children due to the cramming process in vogue in our schools and to the intense nervous excitement attending the approaching day of promotion. These children are probably not the robust ones, but no school system should force the weak to follow a course laid out for the strong. And just here is the pith of the article in question: "The medical inspectors should be a part of our school organizations."

There is no doubt that the physically and mentally perfect child can stand the pressure of school work without detriment, but how many answer to this roll-call. Even the average child may show no marked evil effects; but how about the great number that are below the average, some of whom suffer great harm and none secure the benefits due them? It is from this class that we get the discouraged boy or girl, who leaves school in disgust or breaks down in an attempt to do work beyond his mental or physical strength.

A teacher, every minute of whose time is taken up with work for the class, is not, and can not be expected to be, a diagnostician. The child may droop and show symptoms which to a physician would mean the beginning of serious trouble, but which would pass unnoticed by the teacher, or, if noticed, would be put down to no more serious cause than laziness.

While in school, it is very important that steps looking to the health of the child should be taken, if the well-being of our future citizens is to be considered. If defects in a child's organism are allowed to go unheeded by our school authorities, serious trouble is sure to follow ; but if such defects are properly looked after, the child's health will be preserved and he will obtain a better education. This can be done by having attached to our schools a regular physician, whose duty it is to thoroughly examine all children. Such examination should be made at least yearly, upon the entrance of the child to school. Not only the eyes, ears, nose, and throat, from which so much trouble arises, but also all other organs should be examined and defects carefully noted. Throughout the term the physician should be in close attendance and teachers should freely consult him. Any want of attention in a child usually attentive, or any unnatural irritability or drooping, should at once be referred to the doctor, and his decision should be final. If the trouble is acute, an epidemic might be prevented and many lives saved. If caused by overwork and a general breaking down, equally good results would follow.

The school examining physician is no new idea. Such an official is already installed in some of our California cities and in many Eastern states, and is giving excellent service. Our children are too precious to be sacrificed or to be measured by a money value, and the expense seems to be the only objection to the plan.

When our State and local governments, as governments and not as individuals, fully appreciate the value of physically perfect men and women, and that such are almost never among the criminal class, no effort will be too great or expense too much to bring our children to that condition.

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San Francisco San Francisco A. C. HART, M.D.

Sacramento WALLACE A BRIGGS, M.D., Vice-President,


Sacramento W. LE MOYNE WILIS, M.D.

Los Angeles
N. K. FOSTER, M.D., Secretary. Sacramento
Hon. W. I. FOLEY, Altorney..

Los Angeles

N. K. FOSTER, M.D., State Registrar. Sacramento | GEORGE D. LESLIE, Statistician..---



University of California, Berkeley

STATISTICS OF DEATHS: 1905-1906. Summary.-In the first year covered by the new law requiring the proper registration of deaths prior to the issuance of burial permits, returns from all fifty-seven counties of California give a total of 27,026 deaths, exclusive of stillbirths, 12,385 being for the last half of 1905 and 14,641 for the first half of 1906.

For an estimated State population of 1,784,521 in 1905, the 27,026 deaths in 1905-1906 give a rate of 15.1 per 1,000 population.

The death-rate is 11.5 for Northern California, 15.1 for Central California, and 17.6 for Southern California.

The death-rates are only 12.0 and 11.1, respectively, for the coast and interior counties of Northern California, but the returns were not particularly complete for some counties in this part of the State.

The death-rate is highest, 17.9, for Los Angeles, and next, 17.1, for the other six counties of Southern California, being swollen in each case by the many deaths of recent residents, especially from tuberculosis.

The death-rate is also above the State average for the coast counties of Central California, 16.4, and for San Francisco, 15.6, where fatalities in the April earthquake and fire increased the mortality appreciably.

The rate is below the State average, 15.1, not only for the coast and interior counties of Northern California, but also for the bay counties other than San Francisco (14.5), and for the interior counties from Yolo, Sacramento, and El Dorado to and including Kern (14.4).

The rate is 15.2 for the metropolitan area, against 13.6 for the rural counties north of Tehachapi.

The principal cause of death in California is tuberculosis, which caused 15.5 per cent of the total deaths. The death-rate for tuberculosis of the lungs and other organs is 234.4 per 100,000 population.

Next to tuberculosis come diseases of the circulatory, respiratory, and nervous systems, which caused respectively 12.6, 10.8, and 9.8 per cent of the total deaths. Or, from another point of view, the deathrate per 100,000 population, is 191.3 for diseases of the circulatory system, heart disease, etc., 163.6 for pneumonia and other diseases of the respiratory system, and 147.8 for meningitis and other diseases of the nervous system.

The proportions are next highest for diseases of the digestive system (diarrhea and enteritis, etc.), violence other than suicide or public calamity, cancer, Bright's disease, and early infancy.

The most fatal epidemic disease was typhoid fever, causing 425 deaths, or 1.6 per cent of the State total. Next were diphtheria and croup, influenza, whooping-cough, measles, malarial fever, scarlet fever, and smallpox.

There are 709 deaths known to have resulted directly or indirectly from earthquake and fire, distributed as follows: San Francisco, 463; Santa Clara, 141; Sonoma, 72; Alameda, 12, and other counties, 21. The deaths in Santa Clara county were mainly at Agnews State Hospital, and in Sonoma county mainly in Santa Rosa city. Most of the deaths in Alameda and other counties occurred among refugees from San Francisco suffering from fright or exposure.

Analysis of causes of death in different localities reveals marked contrasts between the several geographic divisions in the relative prevalence of various diseases.

In the coast counties of both Northern and Central California, as well as in the six counties of Southern California other than Los Angeles, relatively high proportions of all deaths are due to diseases of the nervous system, the explanation being the presence of State hospitals in these three geographic divisions.

The interior counties of both Northern and Central California have high proportions of total deaths due to malarial fever, typhoid fever, and other epidemic diseases. The present low death-rates for these geographic divisions could be further reduced by stricter enforcement of the health laws.

In San Francisco, and to a less extent in the other bay counties, the proportion is very high for diseases of the circulatory system, heart disease and kindred complaints.

In Los Angeles, as well as the other counties of Southern California, the proportions are very high for tuberculosis, on account of the many deaths occurring among newcomers from the East.

Tuberculosis caused 4,183 deaths, or 15.5 per cent of the State total. The per cent ranges from 22.2 for Los Angeles, and 20.8 for the other counties south of Tehachapi, to 11.9 for the bay counties other than San Francisco, and only 10.6 for the interior counties of Northern California.

However, deaths from tuberculosis in Southern California occur largely among newly arrived consumptives. Thus, 27.8 per cent of the tuberculosis victims in Southern California had lived in the State less than a year, and altogether 58.2 per cent had lived here less than ten years, the corresponding per cents for the entire State being 13.3 and 33.2, and for Northern and Central California together being 4.6 and

18.2 respectively. In fact, of all who died of tuberculosis in Southern California, 3.5 per cent had been in the State less than a month, altogether 10.8 per cent less than three months, and altogether 18.4 per cent less than six months.

In Northern and Central California, on the other hand, considerable numbers of native Californians and old-time residents fall victims to the "great white plague.” The per cent of native Californians among tuberculosis victims is 37.3 for Northern California, and 36.9 for Central California, as compared with only 14.1 for Southern California, and 28.4 for the State as a whole. Similarly, the per cent who had lived here at least ten years is 33.7 for both Northern and Central California, against 19.5 for Southern California, and 28.4 for the entire State.

Gengraphic Divisions.--For convenience in tabulation the fifty-seven counties of California have been grouped in three main and eight minor geographic divisions. The three main divisions are Northern, Central, and Southern California. The line between Northern and Central California has been drawn at the southern boundary of Placer, Sutter, Colusa, Napa, and Sonoma counties, or the northern boundary of El Dorado, Sacramento, Yolo, and Marin counties. This dividing line extends irregularly from Lake Tahoe to the Pacific Ocean somewhat north of San Francisco Bay. The line between Central and Southern California has been drawn at the southern boundary of Inyo, Kern, and San Luis Obispo counties, or the northern boundary of San Bernardino, Los Angeles, Ventura, and Santa Barbara counties. This line is familiarly located by Tehachapi pass.

In both Northern and Central California, divisions have been made between the coast and the interior counties. In each case the coast counties include some counties not actually contiguous to the Pacific Ocean but yet on the westward side of the Coast Ranges. Moreover, in Central California, San Francisco, and the other bay counties (Alameda, Contra Costa, Marin, and San Mateo) have been made minor geographic divisions. Similarly, in Southern California, Los Angeles has been made a minor geographic division in contrast with the other six counties south of Tehachapi. The counties included in each geographic division have been shown before in the Monthly Bulletin (Vol. 1, No. 8, p. 55, January, 1906).

Death-rates.—Under the law of 1905 requiring the proper registration of deaths prior to the issuance of burial permits, returns of varying completeness were received in the fiscal year 1905–1906 from all the fifty-seven counties in the State. In order to calculate death-rates the population of California in 1905 has been estimated conservatively according to the Census Bureau method by adding to the population in 1900 five tenths of the increase between 1890 and 1900, except that for the few counties showing decreases between the last two Federal censuses the population in 1900 has been taken for 1905, and for the three principal cities arbitrary estimates have been made because of their exceptionally rapid growth. The estimate for San Francisco in 1905 is 450,000, for Los Angeles 180,000, and for Oakland 90,000.

The following table shows the population as thus estimated in 1905, the deaths, exclusive of stillbirths, reported for 1905–1906, and the

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