Vol. 2. MONTHLY BULLETIN. Entered as second-class matter August 15, 1905, at the post office at SACRAMENTO, OCTOBER, 1906.. No. 5. STATE BOARD OF HEALTH. MARTIN REGENSBURGER, M.D., President, HON. W. I. FOLEY, Attorney. San Francisco Los Angeles STATE BUREAU OF VITAL STATISTICS. Sacramento STATE HYGIENIC LABORATORY. ARCHIBALD R. WARD, D.V.M., Director.... University of California, Berkeley NOTICE TO REGISTRARS. California a Registration State.-The Federal Census Bureau has added California to the few states from which death returns are accepted as being satisfactorily complete. There were but 11 registration states in 1900, and only 5 were added in 1906. Besides California, the 16 registration states now comprise Colorado, Connecticut, District of Columbia, Indiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, South Dakota, and Vermont. These include the populous New England and Middle Atlantic states, a few of the most progressive Western states, and California alone on the Pacific Coast. California is thus honored by being listed with the leading states of the Union because our 1905 law for the registration of deaths is based on correct principles, as recommended by the Federal Census Bureau and the American Public Health Association, and also because local registrars throughout California have coöperated with the State Registrar by enforcing the law in a reasonably satisfactory manner. However, this honor to the Golden State may no longer be enjoyed, if there should ever be any vital modification of the present excellent law or if there should be any failure to enforce it fully throughout California. Local registrars should therefore be vigilant in requiring undertakers to file death certificates with them that are filled out completely and satisfactorily. Age, for instance, should never be left unknown, but should be given as closely as it can be estimated from the appearance of the deceased. Especial attention must be paid to the proper statement of the cause of death. Where death results from any form of violence, coroners must be held to a strict compliance with their duty under the State law and in all such cases must be compelled to state specifically whether it was accidental, suicidal, or homicidal. When coroners investigate deaths not resulting from violence, they must not be allowed to credit the death merely to "natural causes," but must be required to comply properly with the law by reporting just what disease caused the death, as tuberculosis, pneumonia, heart disease, Bright's disease, etc. In all cases where a physician certifies to the cause of death, local registrars should withhold the issuance of the required burial or removal permit unless the cause of death is given in definite, satisfactory terms. Such indefinite expressions as "heart failure," "hemorrhage," "abscess," "fever," "marasmus" or "debility" (for adults), "dropsy," and "asthenia," are utterly unsatisfactory, and burial or removal permits should not be issued for death certificates with the cause of death thus carelessly stated. VITAL STATISTICS FOR OCTOBER. Summary. -For October there were reported 1,693 living births; 2,134 deaths, exclusive of stillbirths; and 1,376 marriages, the marriage returns being somewhat incomplete. The population of California in 1906, estimated by the Census Bureau method with slight modifications, is 1,882,846. For this population the October returns give the following annual rates: Births, 10.8; deaths, 13.6; and marriages, 8.8, per 1,000 inhabitants. As usual, tuberculosis was the leading cause of death, with diseases of the circulatory system a close second. Typhoid fever was the most fatal epidemic disease, causing 94 deaths, or 4.4 per cent of all. Causes of Death.-The following table gives the number of deaths due to certain principal causes in October, as well as the proportion from each cause per 1,000 total deaths for both October and September: In October, as usual, tuberculosis was the leading cause of death, but, as in September, diseases of the circulatory system (heart disease, etc.) were a close second. Altogether, 289 deaths, or 13.5 per cent of all, were caused by tuberculosis of the lungs and other organs, while 258, or 12.1 per cent, were due to various diseases of the circulatory system. Typhoid fever caused 94 deaths, or 4.4 per cent of all, in October, against only 2.9 per cent for September. There were 18 deaths from diphtheria and croup, 12 from malarial fever, 6 from whooping-cough, 5 each from scarlet fever and influenza, and only 10 from all other epidemic diseases. HEALTH OFFICERS OF SOUTHERN CALIFORNIA. The Southern California Medical Society will hold its next meeting December 5 and 6, in Los Angeles, and the section of Public Health and Hygiene will meet at 9:30 A. M. on December 6. Dr. Hoell Tyler, President of the Society, has kindly consented that the State Board of Health invite all the health officers of Southern California to meet and take part in this section, with the object of extending its usefulness and possibly to form an auxiliary association. Every branch of industry and all classes of people who are working along the same general lines, find it necessary, in order to accomplish the most work, to have an organization where questions pertaining to their work can be discussed. Health officers are no exception, and indeed, perhaps there is no calling where organization can do so much good, both to the members and to the general public, as with us. While the lines of the territory over which we have actual jurisdiction are well defined, the influence of our work is unlimited and knows no boundary. Disease will not respect territorial lines nor keep within the limits of any one officer's domain. Probably no health officer of any extended experience but has often been annoyed and perplexed at his inability to check the spread of disease that was endangering his district, but was outside of it. We have many prosperous cities and towns whose territory extends to unorganized country where health officers and sani-. tation are both unknown. The county may have such an official, but located so far away that two days would be required to get him there. With a proper organization composed of all health officers, uniform regulations could be adopted and enforced, and much valuable time saved, misunderstandings would be avoided, and good feeling and mutual aid established. All health officers are cordially invited and urged to attend this meeting and use their best efforts to organize in a manner that will command the respect of citizens, cultivate a mutual acquaintance and coöperation, and make more effective their work in the cause of public health. STAMPING OUT CONTAGIOUS DISEASE. Madera has lately had quite a severe epidemic of scarlet fever. There is nothing uncommon in this; many other towns have had the same, but the means taken to stamp it out are worthy of note. When it became evident that the disease was epidemic, Dr. Mary R. Butin, the very efficient health officer of that city, took the work in hand, and soon had it under control. The schools were all visited and each scholar examined for evidence of the disease. Each absentee was also seen and examined. If there was sore throat, fever, eruption, or scales, the child was at once sent home and isolated. The school-rooms were closed and thoroughly disinfected. This effective work soon accomplished the end sought and the epidemic ceased. Sporadic cases will probably occur for a few weeks, owing to the fact that it is almost or quite impossible to catch all the cases. If Dr. Reinhardt, Health Officer of Berkeley, in coöperation with the Superintendent of Schools, has adopted similar methods to stamp out diphtheria. In the school of that city where it exists they are having a culture made from the throat of each pupil and of each absentee. the diphtheria bacilli are found the person will be isolated until such time as the throat is free from disease. It is easy to foresee the result. Diphtheria will vanish from the school. These are long steps in the direction we must surely go if we expect to check contagious disease. Disinfection of rooms and things, properly done, after the persons are entirely free from the disease, is all right and should be attended to, but done before all persons are well is a waste of time, money, and energy, and worse than useless, as it gives a feeling of security that is without basis. The danger is from partially recovered patients who are still swarming with bacteria, and from others equally dangerous, who, while not sick enough to feel the necessity of employing a physician, are still producers of the disease germ. Schools should be carefully examined every morning in order to catch early cases of disease. This should be done by a physician; but the teacher could learn the early symptoms of disease, and, if her suspicion was aroused, call the physician who had been assigned to that school. The saving of money, health, and life, if this were done, would be incalculable. We wish to congratulate the communities who have health officers with the amount of efficiency necessary to take such steps. TYPHOID FEVER. The more than common prevalence of typhoid fever in the State is a cause of no little anxiety. While the country around San Francisco Bay is perhaps more affected than any other part of the State, there is no portion exempt. The State Board of Health has taken up the investigation of the causes through the State Hygienic Laboratory and the coöperation of Dr. Snow of the Hygienic Department of Stanford University. Necessarily investigations are slow when the area is so large, and meanwhile every one should exercise the greatest care to avoid contracting the disease, and those affected against giving it to others. Certain facts in relation to the disease can not be too frequently or strongly impressed upon the people. First and foremost, every one should remember that typhoid fever is a communicable disease and that every case comes from some preceding case. The means of communication are the discharges from the bodyfeces, urine, and sputa. These contain great quantities of the germs, and if taken into the mouth of another, either in water, food, or from infected hands, dishes, insects, or any other thing, that party may contract the disease. This points at once to the way to prevent the spread of typhoid fever. Destroy absolutely all discharges from the body of the patient. All sputa should be received on cloths or paper and burned at once. Discharges from bowels and kidneys should be received in a vessel with a plentiful supply of a strong antiseptic solution and allowed to stand for two hours, and if the feces are hard they should be broken up. They can then be buried or put into the sewer. following solutions are good for this purpose: Carbolic acid, 7 ounces to gallon of water. Chloride of lime, 10 ounces per gallon of water. The It should be remembered, in this connection, that a patient after apparent recovery from typhoid fever will sometimes produce the germs for weeks and months, and that others who have the disease and produce the germs are never sick enough to go to bed. In these cases it is impossible to take the foregoing precautions; but they can and should be careful, as should every one, not to pollute any stream of water or allow flies to have access to the discharges. All clothing or cloths coming in contact with the patient should be boiled before leaving the house, and no person having charge of a patient should in any way have to do with a dairy or any food products. Flies should be excluded, for they, if allowed on any of the discharges, will carry the disease germs to others by alighting on food, or on the hands or face of the person. All domestic animals should be kept from the sick room. The following are some of the ways in which the germs pass from one to another: Probably the principal way is through water into which infected human sewage has passed. The water is polluted by towns sewering into creeks or rivers; drainage from cesspools or vaults into wells; infected dust blowing into reservoirs; by insects, birds, or domestic animals which have become polluted with infected excrement getting into tanks; by people camping on banks of streams and using them as sewers. Green vegetables, eaten raw, which have been fertilized with human excrement. Flies lighting on the discharges from a typhoid patient and then on food. Milk becoming infected by washing cans in infected water, and the possible dilution of milk with the same. Milk may also become infected by a person caring for a typhoid patient, a patient recovering, or a light case working in a dairy. Clothing worn by a typhoid patient or the bed linen will also carry the disease to another coming in contact with them. Personal contact, as shaking hands, or otherwise handling a patient, is a frequent cause. In case typhoid exists in one's vicinity, great care should be taken to prevent contracting it. All water should be boiled before using. Ordinary filtering removes dirt, but not germs. Eat no raw vegetables. Drink no soft drinks; they may be made from polluted water. If you do |
