not know that the milk is above suspicion, boil it. Allow no flies around; they are one of the great causes of infection. Avoid unnecessary contact with the afflicted, and if contact is necessary, wash at once. Live as much as possible in the open air and get all the sunshine possible into houses and disposition. Don't be afraid of the disease, but absolutely refuse to be exposed without cause, or to use infected milk, water, or vegetables. Clean up and destroy all accumulation of dirt, manure, or garbage; they are a breeding place for vermin. Have no open cesspools or broken sewers. Insist that your city fathers furnish you pure water, and that they cease polluting the supply of others. All cases should be reported at once to the health officer, who should see that all precautions are taken to prevent the spread, and hunt out and eradicate the source of infection. Don't wait until an epidemic exists; catch the first case and stop it there. The careless handling of this one may mean the death of many. Last year 425 died of typhoid fever in California, many of them among the most valuable citizens of the State. During the five years when plague existed in the State 113 died of it; the whole country was shaken with horror and hundreds of thousands of dollars were expended in the successful effort of wiping it out of existence. With a death-rate of forty times as great and a disease more easily eradicated, we sit complacently by and see it go on. The responsibility is general and the work must fall on many. Every physician should report his cases and see that all discharges are absolutely destroyed. This is primary and imperative. The health officer should see that this is done, and examine water, milk, and vegetables and any other possible source. The family must recognize the possibility of carrying the disease on their person or clothing, and act accordingly; and lastly, the patient must remember that when apparently well, he is still a producer of germs, and exercise care not to scatter them and endanger others. SMOKE NUISANCE. As the wet season approaches, the atmosphere, already heavily laden with smoke and unconsumed carbon from manufactories, will be made still more unbearable by the smoke of thousands of private houses. This question is getting to be one of importance to California, and one that the Legislature, at no distant day, will have to face. As manufacturing industries increase, the cities and surrounding country will become unpleasant places in which to live, prices of property will materially decline, and, of more importance than all, the general health of the community will suffer. While smoke itself may not carry the germs of disease, it produces conditions that favor their development. It makes ready the soil, and there is plenty of seed with which it is planted. California, with its equable climate, where life in the open air is a joy for twelve months in the year, where fruits and vegetables are always fresh and in abundance, and where all the necessaries and comforts of life can be secured more easily than in any other State, should be one great sanatorium. Thousands are yearly coming here and are bringing the fortunes. made in other states, for investment. The desirableness of this State as a place of residence consists in its healthfulness and pure air. Shall we destroy these essential elements of our growth and drive from our midst such a desirable class of inhabitants? It is not necessary to curtail manufacturing or to hamper it in any way. Science has provided ways to consume the smoke, and with no very great expense. Legislative action, however, is necessary, and should be had at the coming session of the Legislature. The necessity for such action from the standpoint of public health is well shown by the following article from the Journal of the American Medical Association: THE RELATION OF SMOKE TO SICKNESS. In connection with certain statements recently made in these columns concerning the relation of wind to sickness, it may be well to call attention to the rôle that smoke plays in producing sickness, especially, of course, of the respiratory tract. As is largely the case with dust in general, the particles of carbon and other matter contained in the smoke with which the atmosphere of our large cities is polluted so extensively do not produce disease directly, but rather prepare the lungs for tuberculosis and other infections. That the inhalation of smoke (and dust in general) is unhealthy can not well be questioned. Statistics show an increase in the mortality from acute pulmonary disease in manufacturing districts where much smoke is generated and also in mining districts. Tuberculosis is said to run a more rapid course in smoky than in smoke-free districts. While the factors that must be considered in order to explain the increased morbidity in these localities are numerous and complex, we can not neglect the evil influence of smoke and of carbon particles in the dust. In the first place, examination of the anthracotic lung of the miner and of the dweller of smoky cities shows changes often so marked as by themselves to cause symptoms of chronic respiratory disease. The blocking of the lymphatics and of the lymph nodes by masses of coal dust can not but interfere with the physiologic functions of these structures. In the second place, Ascher found that of animals experimentally infected with tuberculosis those that were made to inhale smoke died more rapidly than the controls. Further, he found that animals that inhaled small quantities of smoke for some time beforehand acquired pulmonary inflammation on inhaling aspergillus spores, whereas the control animals did not. The results of clinical and experimental observations consequently speak in favor of the harmfulness of smoke. In view of the prevalence and fatality of lobar pneumonia in our large cities, it would be appropriate to seek to place some of the responsibility therefor on their smoke- and dust-laden atmosphere. Fighting "the smoke nuisance" should be made part of the general plan of the campaign now in progress against tuberculosis and pneumonia. ADULTERATED AND IMPURE MILK FOR CHILDREN. That many people die each year as the result of using impure milk none will deny. It is equally true that all of these are sacrificed either to greed or ignorance. Desire for undue profit on the part of a few milk producers or handlers is a great element of danger, and their "doctored" products are responsible for many deaths and much sickness. Laws prohibiting the adulteration of milk should be enforced, and all violators should suffer the scorn, contempt, and loss of patronage of the people. The trouble is not, however, caused entirely by the greedy dealer. There is a class of milkmen who have been taught and believe that certain preservatives are harmless, and use them with good faith, honestly believing they are doing right and conferring a favor upon the consumers. It is easy for them to believe what is to their advantage, and the many articles by so-called scientific men extolling the use of preservatives naturally have this effect. These dealers can be reached by education, and a rigid enforcement of the law against adulteration is the best lesson. But the responsibility for impure milk is not all, by any means, with the dealer or producer. The housekeeper is as often to blame. How frequently we see pitchers or pails standing out to be filled with milk when the wagon comes around. Sometimes they are within the reach of domestic animals, and most always where flies and dust can settle in them. After the milk is taken to the kitchen it is far from being safe from contamination. The pans or bowls to receive it are not always washed and scalded as the regulations of cities rightly require the milk producers to wash and scald their utensils. Sometimes flies have free access to it, and occasionally mice take a sip from the pan. Too close proximity to other food, some of which a heedless cook allows to stand until outlawed by age, does not enhance its value as food for the baby. Some doctors even go so far as to say that fond mothers occasionally feed to their children this same milk from bottles that are not properly washed, and then are so unreasonable as to blame the milkman. The milkman has his full share of faults, and none of them should be minimized, but too often a supply of good milk is spoiled at home. Milk is a most excellent food and should enter fully into the diet of children. It is, however, extremely sensitive to pollution, and is one of the best culture mediums for germs. They grow and develop in it with great rapidity, and any of the many sources of contamination may be the means of causing sickness in the consumer, especially if it is a child. The State and municipality should insist that pure milk be furnished, and then the housewife's duty and interest is to see that it is kept so. Many of them little appreciate the danger that lurks in milk thus polluted at home, and are too free to blame the wrong source for the sickness that evidently follows its use. They should always receive the milk in a vessel that has been thoroughly scalded, and keep it entirely free from dust. A cloth cover is excellent, but this must be washed daily in boiling water. The ice box is the best place to keep milk, but it should have a separate compartment so the milk would not come in contact with other food. If ice is not used, even greater care should be taken and the coolest possible place selected, where the air has free circulation. If no dirt or pollution of any kind is allowed in the milk from the time it is drawn until consumed, many of the troubles of childhood would be avoided. "Deaths due to good sanitation at Panama, has been the startling explanation of the mortality of Jamaica negroes employed on the canal. It is seriously stated that they have cramped lungs due to generations of overcrowding in small, tightly closed, dirty huts, and that they can. not withstand the fresh air and cleanliness of the 'model' houses built for them. It is doubtful whether any sanitarians suggested this remarkable explanation, for they must know that the negroes are not living in a proper way if it kills them. The causes must be discovered. There is considerable evidence that the houses are not safe, although airy, bright, and clean. The tropical native, as well as tropical animals, go to great extremes to darken their houses or hiding-places to escape the sun's rays, and have survived, perhaps, because they did hide from this danger. Sunlight may kill bacteria, but its excessive use in phototherapy is destructive of all other tissues also." -American Medicine. CALIFORNIA STATE BOARD OF HEALTH. Vol. 2. MONTHLY BULLETIN. Entered as second-class matter August 15, 1905, at the post office at SACRAMENTO, NOVEMBER, 1906. No. 6. STATE BOARD OF HEALTH. San Francisco F. K. AINSWORTH, M.D. MARTIN REGENSBURGER, M.D., President, Sacramento W. LE MOYNE WILLS, M.D. N. K. FOSTER, M.D., Secretary - HON. W. I. FOLEY, Attorney.. STATE BUREAU OF VITAL STATISTICS. San Francisco Los Angeles 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 NOTICE TO REGISTRARS. New Numbers for Certificates.-Local Registrars are reminded of the provision of Section 9 of the death registration law requiring them to number original certificates "in consecutive order, beginning with number one for the first death in each calendar year." After transmitting to the State Registrar certificates for deaths to December 31, 1906, including certificates received by County Recorders from their subregistrars for deaths to the end of the year, each Local Registrar should start a new series of numbers by putting the figure 1 on the first certificate for a death in 1907 filed with him or received from a subregistrar in January. Since the death certificates are copied for statistical tabulations made by the Federal Census Bureau, it is desirable that the certificates for each calendar year be kept quite separate in numbering, as specifically required by our State law. The same requirement as to the starting of new series of numbers in 1907, of course, applies also to the numbering of certificates of births and marriages in the order in which they are reported to Local Registrars. VITAL STATISTICS FOR NOVEMBER. Summary.-For November there were reported 1,839 living births; 2,585 deaths, inclusive of stillbirths; and 2,158 marriages. For an estimated State population of 1,882,846 in 1906, the November returns give the following annual rates: Births, 11.7; deaths, 16.5; and marriages, 13.8, per 1,000 inhabitants. In November diseases of the circulatory system, instead of tuberculosis as usual, caused the largest number of deaths, though tuberculosis was a close second, with pneumonia third. Typhoid fever, as before, was the most fatal epidemic disease in the State. Causes of Death.-The following table gives the number of deaths due to certain principal causes in November, as well as the proportion from each cause per 1,000 total deaths for both November and October: Diseases of the circulatory system (heart disease, etc.) caused 355 deaths, or 13.7 per cent of all, in November, against 342, or 13.2 per cent, for all forms of tuberculosis, which is usually the leading cause of death in California. The total is next highest, 249, or 9.6 per cent, for pneumonia and broncho-pneumonia. Typhoid fever caused 115 deaths in the month against 34 for diphtheria and croup, 12 each for malarial fever and measles, and only 20 for all other epidemic diseases. |