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“This infection is spoken of by some as a disease prone to originate in the poorer quarters of a city, but its presence there, I am persuaded, is due to the fact that many wage-earners in clubs, hotels, and like places are drawn from homes in such localities. Medical observation shows that after a time physical deterioration takes place among the employés most exposed to dust, and this is usually evidenced by coughs and other evidence of respiratory ailment.
"That insidious peril from such cause can lurk in the often luxurious furnishings of places of the kind mentioned is hardly thought of by those most liable to be affected, but the contention that they are real and formidable seeding places for tuberculosis can, I believe, be established as truth on sufficient examination by any one so disposed.”'
“Modern Methods of Cleaning.-If so much be conceded, the question then recurs as to the necessary measures of prevention, and it will readily be seen that these require the total banishment of broom and duster or any other implement or device by which dust is set afloat. If carpetings are to be retained, the adoption of mechanical appliances must follow, by the use of which no flying matter will be allowed to escape, this, if necessary, to be supplemented by the wiping of exposed surfaces and furniture with soft cloths.
"The use of the vacuum or pneumatic method of cleaning in every hotel, club, office building, theater, church, school, and business establishment should be made compulsory by law. This provision as a sanitary adjunct has become just as necessary a part of the house equipment as are those similarly supplied for heating, for ventilation, for fire protection, or fire escape.
Summary.—“1. Efforts toward the eradication of human tuberculosis will fail which do not take full account of household dust as a factor in the dissemination of that disease.
“2. Scientific tests have shown that the seeds of pulmonary tuberculosis, harbored within doors in the dried state, are capable of retaining their effective vitality for prolonged periods of time.
"3. Any method or procedure employed in inhabited buildings which causes dust to be disseminated must be considered as tending to spread the seeds of consumption.
“4. Hotels, clubs, theaters, office buildings, schools, churches, and business establishments generally should be required by law to introduce and operate dustless methods of cleaning; this part of their mechanical equipment being as necessary as provision similarly made for warming, ventilation, and for fire protection and fire escape. The employment of dustless methods in private residences is urged as being equally imperative for the control and suppression of all forms of tuberculous disease.”
THE MEDICAL MILK COMMISSION IN THE PURE MILK CAMPAIGN. Year after year evidence of a conclusive nature is being accumulated to show that milk is the most dangerous article of diet of mankind. As it is consumed raw, it may be the medium of dissemination of typhoid fever, diphtheria, scarlet fever, etc., from man to man, or it may transmit tuberculosis of the cow directly to man. In the handling of milk, uncleanliness alone leads to decomposition changes which make the product poisonous to the infant consuming the same.
Many states and cities have laws designed to protect the public from the dangers of milk. When enforced by proper sanitary inspection of the dairies and their products, such ordinances have produced marked improvement. Nevertheless, instances of such thorough measures as the suppression of the sale of the milk of tubercular cows are rare indeed, even in the smallest municipalities.
The great difficulty in the way of securing a perfectly satisfactory milk supply lies in the expense of production. Dairymen are unable to comply with modern sanitary requirements for milk production at the ordinary price, and the general public is unwilling to pay an advanced price. In general the machinery of our State and municipal health departments has proved inadequate to the task of enforcing the production of milk of such a quality suitable for a physician to recommend for infant feeding.
Recognizing these conditions, Dr. Henry L. Coit, of Newark, N. J., in 1893, originated the medical milk commission idea. He brought about the appointment, by the Essex County Medical Society, of a milk commission. This body drew up a set of rules for the production of milk of the highest sanitary quality and induced a dairyman to undertake the production of milk in accordance with them. The commission is informed of the conditions at the dairy and of the character of the product, by reports from its four experts-veterinarian, chemist, bacteriologist, and medical examiner of the milkers. The dairyman was compensated for the expense of the inspections and other items by the increased price obtained for his product. He of course relies upon the recommendation of the milk commission for his trade at the comparatively high pricetwelve to fifteen cents a quart. The arrangement enables the physician to prescribe the “certified milk” for his patients with confidence that it is produced under conditions necessary to insure its being a safe food.
The medical milk commission scheme for providing clean milk has proven a success and commissions patterned on the general lines of the parent one have sprung into existence. At present twenty-two are to be found scattered through the country from Massachusetts to California. The movement in the State of California is represented by the Oakland Home Club Milk Commission and that of the San Francisco County Medical Society.
On June 3, 1907, a conference of delegates from all the milk commissions in existence was held in Atlantic City. In addition to those officially connected with milk commissions there were present others who are prominently identified with the campaign for better milk. A national organization of milk commissions was accomplished and reports of the work of the various commissions were made by the delegates. Action was taken to define matters relating to the organization, scope of milk commissions, and to unify the requirements to which dairymen must comply. The one meeting of the organization has been of immense benefit to the pure milk movement by unifying the various agencies concerned
The facts brought to light at the Atlantic City meeting give assurance that the milk commission movement has passed out of the experimental stage into an era of rapid expansion. Enough has been done to encourage more county medical societies to appoint medical milk commissions and to impress dairymen with the financial practicability of producing pure milk.
DR. ARCHIBALD R. WARD, Director of State Hygienic Laboratory.
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.
STATE HYGIENIC LABORATORY. ARCHIBALD R. WARD, D.V.M., Director..
University of California, Berkeley
VITAL STATISTICS FOR JUNE. Summary For June there were reported 1,994 living births; 2,343 deaths, exclusive of stillbirths; and 2,366 marriages. For an estimated Stạte population of 2,001,193, these figures give the following annual rates : Births, 12.1; deaths, 14.2; and marriages, 14.9. The corresponding rates for May were 11.7, 14.9, and 10.6. The notable rise in the marriage-rate is due to the fact that June is a favorite month for marriages.
The following counties led in the number of marriages : Los Angeles, 562; San Francisco, 384; Alameda, 310; and Santa Clara, 123. Next in order were Sacramento, 98; Marin, 83; Orange, 76; Fresno, 70; San Diego, 53; and San Bernardino, 52.
The freeholders' charter cities with the highest number of births were: San Francisco, 434; Los Angeles, 354; and Oakland, 203. Next were: Berkeley, 56; Pasadena, 49; Fresno, 36; San Diego, 29; Alameda, 28; and Sacramento, San José, and Stockton, each 26.
The cities with the greatest number of deaths were: San Francisco, 526; Los es, 304; and Oakland, 169. Next in order were: San Diego and Stockton, each 47; San José, 43; Sacramento, 36; Berkeley, 35; San Bernardino, 30; Fresno, 28; Long Beach, 27; Pasadena, 26; and Alameda, 25.
The June deaths were distributed by geographic divisions, as follows: Northern California-coast counties, 85; interior counties, 170; total, 255. Central California-San Francisco, 526; other bay counties, 335; coast counties, 175; interior counties, 352, total, 1,388. Southern California, Los Angeles, 475; other counties, 225; total, 700. State total, 2,343.
Causes of Death.-The number of deaths in June was highest, not for tuberculosis, as usual, but for heart disease and allied ailments. There were 349 deaths, or 14.9 per cent of all from diseases of the circulatory system, against 329, or 14.0 per cent, from tuberculosis of the lungs and other organs. Third in order were diseases of the respiratory system, causing 219 deaths, or 9.3 per cent of all. There were 55 deaths from meningitis and 188 from other diseases of the nervous system, apoplexy, etc.
Typhoid fever, as is almost invariably the case, was the most fatal epidemic disease in the month, the per cent of total deaths from this disease being 1.5 for June, against 1.1. for May. The deaths from epidemic diseases in June were as follows: Typhoid fever, 36; diphtheria and croup, 25; measles, 24; whooping-cough, 21; scarlet fever, 12; influenza, 10; malarial fever, 6; and all others, 15.
The following table gives the number of deaths from certain principal causes for June, as well as the proportions from each cause per 1,000 total deaths for both June and May:
Proportion per 1,000.
Cause of Death.
6 24 12 21 25 10 15 278
51 127 84 55 188 349 166 53 75 27
2.6 10.2 5.1 9.0 10.7 4.3
6.4 118.6 21.8 54.2 35.9 23.5 80.2 149.0 70.8 22.6 32.0 11.5 47.4 57.2 10.2 38.0 19.2 91.3 52.9
2.8 11.0 6.3 5.9 7.5 1.6
2.4 124.8 24.0 48.8 29.1 24.4 0.3 133.8 89.0 27.6 24.4
8.7 59.1 57.5 10.6 35.8 18.5 100.0 55.5
NOTICE TO UNDERTAKERS. The State Bureau of Vital Statistics furnishes the United States Census Bureau at Washington with a copy of each death certificate filed in its office, and from these the United States Census reports of vital statistics are made out. The efficiency of the California statistics was considered perfect enough to warrant the State being accepted as a registration state, a position attained by only fifteen other states, and they, with the exception of Colorado and South Dakota, all east of the Mississippi River. Two states during the past few years have been dropped from the list of registration states because of their failure to keep up to the standard.
The Census Bureau has been investigating the California returns and find many deaths not reported. The result, if this continues, will be to drop California from the list of registration states, which will be an announcement to the world of the inefficiency of the State to properly do its duty. The duty of making out death certificates is upon the undertakers, and it is a misdemeanor to bury or otherwise dispose of a dead body without properly filling out a certificate and securing from the registrar or sub-registrar a burial permit. This law must be respected, and whenever a violation is discovered it will be reported to the legal department for prosecution.
MEETING OF STATE BOARD OF HEALTH.
The regular quarterly meeting of the State Board of Health was held in the office of the Secretary in Sacramento on Friday, July 12th..
The main subjects of discussion were, “The education of the people as to the best means of curing and preventing tuberculosis,” and “The location of the Pure Food Laboratory and selecting its Director."
The last Legislature appropriated $2,000, which the Board is to use in disseminating knowledge in regard to the best means of preventing and curing tuberculosis. The State is so large, the subject so extensive and important, and the sum so relatively small, that it is difficult to expend it with any very extensive hopes of apparent results.
Maryland requires the registration with the State Board of Health of every case of tuberculosis by the attending physician, and when this is done, furnishes the patient an outfit of spit cups, paper napkins, disinfectants, etc., and full instructions as to care so as not to infect · others. The physician is paid $1.50 for reporting and seeing that instructions are properly understood. The law requires that secrecy be maintained, and the officers are not allowed to talk of the cases except among themselves.
Good results are following this method, but it is impossible for the California State Board of Health to follow the plan, for two reasons: First, physicians are loath to obey the State law requiring the reporting of cases of tuberculosis; and second, the cost would be prohibitive with our small appropriation.
The idea of an illustrated lecture delivered throughout the State, with the distribution of short, terse slips of reading matter, was considered with a good deal of favor, and steps are being taken to study its advisability.
The Pure Food and Drug laws passed by the last Legislature are in effect so far as to make it unlawful to manufacture impure food or drugs. The establishment of the laboratory and examination of samples do not, however, go into effect until January 1, 1908, and until that time the same laws, or want of them, exist as before, and we can expect the foam on our soda water to be made from soap bark, and our raspberry jam from apples—we hope nothing worse.
The Board decided to locate the laboratory at the State University laboratory in Berkeley, and appointed Prof. M. E. Jaffa as Director. No assistant has as yet been appointed. It is the object of the Board to do earnest, honest work for the State; to limit as much as possible the production and sale of impure products, and to protect the honest manufacturer and dealer. The appointment of Professor Jaffa, who has a world-wide reputation as an expert food chemist, is a guarantee that the work will be done in an efficient and honest manner, for his reputation for integrity is equal to that for ability.
“Oscar Tomie, aged 24, native of Finland, occupation given as a sailor, and employed upon the 'tug‘Wizard,' was taken ill on May 24th and admitted to the U. S. Marine Hospital at San Francisco. On the