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CALIFORNIA STATE BOARD OF HEALTH.

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.

Vol. 2.

SACRAMENTO, MARCH, 1907.

No. 10

STATE BOARD OF HEALTH.

MARTIN REGENSBURGER, M.D., President,

F. K. AINSWORTH, M.D.

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

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

0. STANSBURY, M.D..

Chico
Sacramento W. LE MOYNE WILLS, M.D.

Los Angeles
N. K FOSTER, M.D., Secretary - Sacramento
HON. J. A. ELSTON, Altorney ---

Oakland
STATE BUREAU OF VITAL STATISTICS.
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

VITAL STATISTICS FOR MARCH.

Summary.—For March there were reported 1,986 living births; 2,680 deaths, exclusive of stillbirths; and 1,469 marriages. For an estimated State population of 2,001,193, these figures give annual rates as follows: Births, 11.7; deaths, 15.8; and marriages, 8.6. The corresponding rates for February were, respectively, 11.6, 15.0, and 10.5.

The number of marriages was highest in the following counties: Los Angeles, 311; San Francisco, 258; Alameda, 202; Sacramento, 63; and Santa Clara, 61.

The birth total was greatest for San Francisco, 433, next for Los Angeles city, 338, and next for Oakland, 152. The freeholders' charter cities with the next highest totals were: Pasadena, 46; Berkeley, 38; Fresno, 30; San José, 29; and Alameda, 28.

The death list was greatest for San Francisco, 595, followed by Los Angeles city, 392, and Oakland, 202. The cities next in order were: Sacramento and San Diego, each 65; Stockton, 44; San José, 36; Alameda, 34; Pasadena, 32; and Berkeley, 31.

The deaths reported for March were distributed by geographic divisions, as follows: Northern California--coast counties, 150; interior counties, 175; total, 325. Central California - San Francisco, 595; other bay counties, 387; coast counties, 182; interior counties, 391; total, 1,555. Southern California-Los Angeles, 547; other counties, 253; total, 800. State total, 2,680.

Causes of Death.-There were 412 deaths, or 15.4 per cent of all reported for March, from tuberculosis of the lungs and other organs, and 404, or 15.1 per cent, from pneumonia and other diseases of the respiratory system. Third in order, as usual, are diseases of the circulatory system, heart disease, etc., causing 375 deaths, or 14.0 per cent. Instead of typhoid fever, as usual, the most fatal epidemic diseases in March were measles and diphtheria and croup. There were 30 deaths from measles, 27 from diphtheria and croup, 24 from typhoid fever, 15 from whooping-cough, 8 from influenza, and 11 from all other epidemic diseases.

Detailed figures on causes of death in California appear in the table below, which shows the number of deaths due to certain principal causes for March, as well as the proportion from each cause per 1,000 total deaths for both March and February:

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SMALLPOX. Smallpox had been nearly eradicated from the State until a few weeks ago, when a case occurred in Richmond and was not recognized. From this case others arose, until it became quite prevalent in the locality, and from it one party carried the disease to Los Angeles, where fortunately it was quickly recognized and cared for. Many other towns niay have been or will be infected, and health officers should be on their guard. There is no great danger of a severe epidemic of smallpox. Vaccination will stop it, and in its presence even many of those who are violently opposed to our vaccination law hasten to get vaccinatedan act which does honor to their better judgment. The responsibility of the physician is strikingly shown in this case. The State law is definite in requiring physicians, nurses, and others having charge of cases of contagious disease to report to the health officer at once, and it is his duty to see that proper care is taken to protect the community. If he is in doubt about the diagnosis, the State Board of Health stands ready to help clear it up. It is far better to be on the safe side and

1 that some family should undergo the inconvenience of a temporary quarantine than that contagious diseases become epidemic.

The following is the law regulating the reporting of communicable diseases, and all health officers should see that it is enforced :

Section 2979n. It is the duty of each coroner, and of every county, city and county, city or town health officer, and every member of the local board of health, knowing, or having reason to believe that any case of cholera, plague, yellow fever, leprosy, diphtheria, membranous croup, scarlet fever, smallpox, Manila, Philippine or Cuban itch, dobe, bumps, typhus fever, typhoid fever, malignant pustules, anthrax, glanders, cerebro-spinal meningitis, pulmonary tuberculosis, pneumonia, dysentery, erysipelas, uncinariasis or hookworm, trachoma, dangue, tetanus, measles, chicken pox, whoopingcough, mumps, or any other contagious or infectious disease exists, or has recently existed, within the city, county, city and county, town, or township of which he is such officer, to take such measures as may be necessary to prevent the spread of such disease, and to report at once in writing such cases to the secretary of the State Board of Health at Sacramento. It is also the duty of every attending or consulting physician, nurse, or other person having charge of or caring for any person afflicted with any of said contagious diseases, to report at once in writing to the local board of health or local health officer the nature of the disease, the name of the person afflicted, and the place of his or her confinement. The State Board of Health, or its secretary, upon being informed of any such contagious or infectious disease, may thereupon take such measures as may be necessary to ascertain the nature of such disease and prevent the spread of such contagion, and to that end, said State Board of Health, or its secretary, may, if deemed proper, take possession or control of the body of any living person, or the corpse of any deceased person, and may direct and take such means as may be deemed expedient to arrest or prevent the further spread of such disease.

CEREBRO-SPINAL MENINGITIS. This disease has made its appearance in several parts of the State, and caused the death of fifty-eight persons during March. These figures do not include those dying from tubercular meningitis, but it is more than probable that they are not all from the contagious type. It is extensive enough, however, to cause the exercise of the greatest care. The State Board of Health is in receipt of inquiries from health officers regarding the infectiousness of the disease, and the steps necessary to be taken to prevent its spread.

The disease is undoubtedly infectious, and every case must be promptly reported to the health officer, the patient isolated, and all discharges from the body destroyed. The discharges from the nose and throat must be received on cloths and burned at once. After death, or recovery, everything connected with the patient must be thoroughly disinfected.

When the disease is found to exist in a community every doubtful case should be considered as positive and the same care exercised, for with the severe cases are always mild ones, some to a degree that it is impossible to be sure of the diagnosis. These mild cases, however, if true cases of the disease, are equally dangerous with the others, and when dealing with a disease that is so generally fatal no chances should be taken, but the utmost care exercised.

REPORTING TUBERCULOSIS. he attention of local boards of health is called to the law recently enacted by the State Legislature requiring that physicians, nurses, and others having charge of cases of pulmonary tuberculosis should report them in writing to the health officer. We would suggest that you include this disease in your regulation as a reportable disease, and send cards with a full printed list of reportable diseases to all physicians, on which they are to report. Quarantine or publication is not required, nor is it desirable in tuberculosis, but it is necessary that the health officer should know the existence and locality of each case, so that proper information for the protection of other members may be given the family, if needed, and the room thoroughly disinfected after death or removal.

THE RESPONSIBILITY OF PHYSICIANS. There is no position in life that is of equal importance and responsibility as that of the physician. He has a duty to his patient, for life and health depend upon his skill, but he has also a broader duty to the community, for upon his neglect, as well as want of skill, oftentimes depend the lives of many whom perhaps he never saw.

This thought is brought out by recent investigations of epidemics in the State. Very many of these epidemics are the result of ignorance or worse on the part of some one who passes for a doctor, and sometimes, unfortunately, he has a legal right to class himself with that highminded profession. Oftentimes the first case of smallpox, diphtheria, scarlet fever, or other contagious disease falls into the hands of such a person. He may fail to recognize its true character or more often at the solicitation of the family deny the true diagnosis, and disregarding the law conceal it from the authorities, and death and distress follow.

The physician's responsibility by no means ends when he gives the best skill he has to his patient. If that patient is suffering from a communicable disease, and he fails to report it, he is responsible for all cases arising therefrom. He has committed a misdemeanor and is punishable under the State laws for his neglect or willful disobedience. The difficulty is to convict him, for he takes shelter in ignorance and publicly declares his inability to recognize the disease. The only protection a community has against such men, men who for some personal motive will endanger them all, is to give their patronage to some one more reputable.

We should all consider that if the doctor will cover up a communicable disease to please us, he will to please our neighbor, and that our children will be exposed by his act.

Almost every epidemic we have starts from a neglected case, too often not reported to the health officer. The law requiring the reporting of all cases of communicable disease extends to all parts of the State, outside of cities as well as in, and every one, whether doctor, nurse, or friend, commits a misdemeanor who has charge of such a case and does not report it.

PUBLIC HEALTH ASSOCIATION MEETINGS. The Central California Health Officers' Association held their annual meeting at Hanfurd, March 11th.

Dr. R. W. Musgrove, Health Officer of Hanford, read a very interesting paper on "Septic Tank System of Sewage Destruction," with special reference to the one in operation in that city. He explained the bacterial action by which the organic matter in the sewage is destroyed, and the necessity that conditions be such that this bacterial life can exist. The author is strong in the belief that a city should have separate systems for house sewage and storm water. In cities with oiled streets and where oil is largely burned it gets into the sewers and destroys the bacterial action to a great degree. Manufacturing wastes, especially from wineries, should be kept out, for the same reason.

The discussion was general and interesting.

At the business meeting the following officers were elected: President, Dr. R. W. Musgrove, of Hanford; Vice-President, Dr. S. W. R. Langdon, of Stockton; Secretary, Dr. Mary R. Butin; Treasurer, Dr. George L. Long, of Fresno.

The time and place of the next meeting will be determined by the executive committee.

All of the members present were delightfully entertained by Dr. Musgrove at his home, where was found in his charming wife one strong element of the doctor's success in his profession.

The attendance was not what the extent of the territory represented, the intelligence of the health officers, or the importance of the meeting warranted us to expect. Various causes contributed to this—bad condition of the roads, other business engagements, and possibly from a certain want of interest. That this should be so is greatly regretted, for the information, enthusiasm, and love of the work which are gained by those who attend these meetings redounds both to the honor and the profit of the participants. There is something in the plea that health officers get very little

pay for the amount of skill and work required, and that they can not afford to spend the money and time required to attend these meetings. The municipality or county should pay the expense, for they secure the benefit. This is done in some places, and should be in all. The pay of health officers is ridiculously small in most places. No other kind of professional work gets such little pecuniary recognition. They can, however, regulate this themselves, if they only will, and organization and union are the best means, for “in union there is strength."

We must get the respect of the people, and show to them our efficiency and power for good, and the first step to gain that respect is to respect ourselves. We must study the problems involved in guarding the public health, and be able to meet any question that may arise. Unity of action and methods, ard a constant search for the best is necessary. Sanitary science is rapidly advancing, and he who thinks because he has served for years in his office, plodding along in the same old path, that he is doing the best possible work for the public is mistaken. Giving no better work than he did years ago, there is no sensible reason to the average man why he should receive better pay; but let the public see that the health officer understands the many means of protecting and safeguarding life and health, and is earnest and impartial in enforcing these means, and they will willingly pay the price for the better work.

*

The eighth semi-annual session of the California Public Health Association was held at Monterey, April 15th. The President, Dr. William Simpson, of San José, called the meeting to order and delivered the following excellent address:

Cicero said: "Nothing brings men nearer to the gods than the giving of health to their fellow creatures."

Prior to the middle of the nineteenth century the practice of medicine was largely tentative, always indefinite and often heroic. This period was followed by an interim of skepticism, minimism, and expectancy, and this again has been followed by what now may be truly termed the period of scientific medicine, for drugs have been tested and labeled until their efficacy and place in the practice of medicine are fixed, expectancy has its own corner and knows and keeps its place, the skeptic leaves the practice of medicine for other fields, and the minimist, who believes there is so little in his work that it is hardly worth doing, simply hangs on the outer edge and is the horrible example that stimulates his conferees to better work.

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