Geographic Divisions.-The table below shows the number of deaths from main classes of diseases reported for January for the several geographic divisions of the State, including the metropolitan area, or 'Greater San Francisco," in contrast with the rural counties north of Tehachapi :

MEETING OF STATE BOARD OF HEALTH.

The adjourned meeting of the State Board of Health was called to meet at 11:00 A. M. February 1st. There were present at that hour Doctors Briggs, Regensburger and Foster. There being no quorum, the time was spent in a general and interesting discussion of the various subjects before the Board, and formulating work for the afternoon session, which was called to order at 1:30 by the President, Dr. Regensburger.

Present, Doctors Briggs, Hart, Regensburger and Foster.

Dr. Briggs moved the following resolution, which was seconded by Dr. Foster, and carried.

Resolved, By the State Board of Health of the State of California, that all Health Officers in the State of California, city, county, town, and city and county Health Officers included, be and they are hereby ordered and directed, immediately and continuously, to enforce and insist upon the enforcement of the provisions of the Act of the Legislature of the State of California "An Act to encourage and provide for the general vaccination in the State of California," approved February 20, 1889; and

That it is the fixed determination to insist upon the enforcement of said Act and the provisions thereof, and to prosecute all persons who shall violate the same.

Dr. Briggs moved and Dr. Hart seconded the following resolution: That the Secretary be instructed to arrange for a conference in San Francisco at an early date of the officers of the Marine-Hospital Service, State Board of Health, Boards of Supervisors and Trustees of the Bay Counties and all territory in water connection therewith; and

That the officers of the Marine-Hospital Service be requested to address the conference and instruct in the methods and importance of plague eradication, and in as far as possible afford them object lessons in the actual work of eradication; and

That the Secretary urge upon this conference the absolute necessity of providing in the next tax levy for sufficient funds to carry this work to a successful conclusion. Carried.

Dr Briggs moved and Dr. Hart seconded the following resolution: Resolved, By the State Board of Health of the State of California, that this Board deems it of the utmost importance that the law forbidding expectoration on the floors of public conveyances and on sidewalks be strictly enforced; and that this Board do and does hereby request the Citizens' Health Committee of the City and County of San Francisco to use every effort in its power to obtain in said City and County a strict enforcement of said law, particularly in the case of street cars. Carried.

Dr. Hart offered and Dr. Foster seconded the following resolution: Resolved, By the State Board of Health of the State of California, that, whereas, in the judgment of this Board, it is necessary to prevent the spread of contagious and infectious diseases,

It is hereby ordered, that no old rags, sacks, paper or other old waste, shall be shipped, transported or carried, from or into, any town, city, county, or city and county, in the State of California, unless the same shall first have been thoroughly sterilized by boiling or by steaming, and shall have been inspected by the local or Federal health authorities; and that no such rags, sacks or waste material shall be shipped, transported or carried, or received for shipment, carriage or transportation, by any person, firm or corporation, unless the same is accompanied by the certificate of such Health Officer or authority, that the same have been so sterilized

Carried.

Dr. Foster moved and Dr. Briggs seconded the following resolutions:

Resolved, By the State Board of Health of the State of California, that, whereas, a certain contagious and infectious disease, to-wit, the Bubonic Plague, now exists and has for a long time last past existed, in the City and County of San Francisco, State of California; and

WHEREAS, The said disease is most frequently communicated through the medium of rats and other vermin; and

WHEREAS, It has been ascertained by this Board, and it is the fact, that large quantities of manure have been and are being shipped out of said city and county and said County of Alameda, and into other counties of said State; and

WHEREAS, Dead rats and other vermin have been found in such manure and are frequently conveyed therewith; and

WHEREAS, Said disease has recently existed in the County of Alameda, in said State, and rats and other vermin infected with said disease are yet being found in said County of Alameda; and

WHEREAS, The danger of spreading said disease by and through the shipment of manure as aforesaid and infecting new territory is great; and

WHEREAS, It is in the judgment of this Board necessary to arrest the further spread of said disease;

It is hereby ordered, That no manure shall be shipped, transported, taken or carried from said City and County of San Francisco, or from said County of Alameda or any city therein, to, or into, or received into, any other city, town, county, or city and county, of the State of California, unless such manure and the stable from which it is taken have first been inspected by a member or inspector of the United States Public Health and Marine-Hospital Service, and the said manure and stable found to be sanitary; that no person, firm or corporation, either as principal, agent or otherwise, shall ship, transport, carry, or receive for carriage or transportation, from said city and county, said County of Alameda, or any city therein, to or into any other city, county, or city and county, any manure unless the same shall have first been so inspected, and shall be accompanied by the certificate of a member or inspector of the said United States Public Health and Marine-Hospital Service; that all City and County, City, Town, and County Health Boards, Health Officers and authorities, are hereby directed to enforce this order within their respective jurisdictions; and that this order shall supersede all previous orders as to the same subject. Carried.

Resolved, That this Board favors and urges the immediate rat-proofing of the water fronts of all cities in the State as a means of preventing the introduction and

propagation of rats, and that the Secretary confer with the Governor as to the best means of attaining this object.

Carried.

Resolved, That the State Board of Health of the State of California invite the Surgeon-General of the United States Public Health and Marine-Hospital Service to call at an early date a conference of that Service with the State Boards of Health in San Francisco.

Carried.

FLEAS.

One of our exchanges, after quoting the article on plague in the last Bulletin, says: "Now if the Board will tell us how to quarantine against fleas when the open season arrives it will confer a still greater favor." Could we do this in its entirety much suffering could be prevented and many lives saved. Unfortunately, we know of no way to entirely keep rid of fleas, but very much may be done. The very means that will prevent rats from coming to our places will prevent fleas. A basement with a complete cement floor, which is kept clean and free from litter and rubbish, deprives the flea of the dirt in which it will live and breed. Floors and carpets should be kept clean and can be dusted with flea powder or sprayed with an insecticide which will destroy the fleas. Finely powdered air-slaked lime spread on floor or carpet and swept off will, it is claimed, drive them away.

They live and breed in the fur of animals, especially cats, dogs, rats and mice, and if they are allowed in the house fleas must be expected. There are on the market preparations which, sprayed into the hair of an animal, will kill the fleas. If animals must be allowed in the house these should be freely used, for animals are our most prolific source of fleas.

When we have learned to build our houses with concrete basements and foundations, to keep domestic and wild animals outside, banish carpets that can not be taken out and shaken each day, and have our floors built of some smooth material which can not harbor insects, we will have little trouble with fleas, but you can't quarantine the rascals. They have no respect for quarantine regulations, but by persistent effort and not allowing their breeding places to exist they can be kept away.

SMALLPOX.

Reports from all parts of the State show a great number of smallpox cases. Unfortunately, many of them are light and no attention is paid to it, the patient traveling at will about the State, scattering the disease broadcast. Again, the disease is often diagnosed chickenpox, with the usual result of multiplication of cases. There is but one way to check it,-vaccination. This is sure and safe. With the present methods of preparing the vaccine lymph there is no danger, providing it is put on a sterilized arm and kept clean. No person properly vaccinated ever had smallpox, nor did a person ever die with vaccinia. When death has resulted from vaccination it was because an impure lymph was used, or the arm was not properly cleaned and kept clean.

At the present time our vaccine lymph is certified by the United States Government and is pure, and it depends upon the doctor and

patient to do the rest to get absolute and safe protection. Quarantine will not stop the disease. It acts merely as a check, but the undiscovered cases and those purposely suppressed will continue to spread it until every one is thoroughly vaccinated.

Meanwhile, Health Officers should watch closely and insist that the State law, requiring that physicians and others knowing of any communicable disease, even if it be chickenpox or the so-called "Cuban itch," report the same to the health department, be obeyed. The common school authorities are much at fault for not standing straight on the law. They are not responsible for it, but have sworn to enforce it, and should do so, fully and conscientiously.

AN AWAKENING.

Since August last, when it became evident that plague had secured a foothold in San Francisco, the Federal, State and Municipal Health Departments have been active in their efforts to eradicate it and to arouse the attention of the people to the necessity of a general sanitary crusade and the destruction of rats. These departments felt and knew that complete success in stamping out the disease could be accomplished only through the intelligent aid of the householder, but their calls fell upon deaf or heedless ears, and the newspapers referred to them as "political doctors" who had to get up an excitement to hold their jobs, and refused to speak of plague where it was possible to avoid it. The result was entire apathy on the part of the public, and the danger grew.

The Council of the State Medical Society took up the work and called a public meeting for January 18, 1908, which was attended by a few business men. They learned, probably for the first time, the real conditions and at once began to work. On January 28th a well attended mass meeting was held, and a Public Health Committee of twenty-five appointed which went to work, with the result that San Francisco is thoroughly alive to the situation. Meetings of the different trades and occupations, of civic and religious bodies and social organizations are being held, where the dangers and the means of averting them have been explained. Circulars containing directions as to what to do have been sent to all householders, and the large employers of labor have had lectures delivered to their employés.

This is work that will tell and if it can be kept up plague can be stamped out. It is necessary, however, for other cities and towns to follow the lead and waken up, for the rat infection is outside that city and no one knows just how far. There is evidence of this awakening, and the cities across the Bay are beginning to hold similar meetings.

The State Board of Health called the representatives of the County, City and Town governments and Health Officers surrounding the Bay to meet in San Francisco for the purpose of adopting uniform ordinances and providing means to carry on a campaign of sanitation. This meeting was a success and a good deal of interest was shown. Nearly all the counties were represented and a permanent organization known as the Central California Sanitary Commission was instituted. Model ordinances were presented for discussion and committees appointed to perfect them. The Association meets again on Thursday,

February 20th, when the completed ordinances will be presented both for city and county. Copies of these will be furnished to any place in the State that desires them. Many have already applied and we earnestly urge that all over the State the work of better sanitary laws be taken up.

HEALTH ASSOCIATION MEETING.

The San Joaquin Valley Health Officers' Association will hold its semi-annual meeting at Tulare, at 9:00 A. M., March 10, 1908, and have the following excellent program:

Professor of Bacteriology and Director State
Hygienic Laboratory, University of California.

Some Thoughts Regarding the Cause and Prevention of Tuberculosis,
DR. C. C. BROWNING, Monrovia.

The last will be a stereopticon lecture.

The Association is fortunate to secure the presence of these men, all experts in their departments. The meeting will be of exceptional interest, and all health officials and others should attend.

INTERNATIONAL CONGRESS ON TUBERCULOSIS.

The following letter from Surgeon-General Wyman has been sent to all health officials and should be kept in sight. Every one interested in this branch of public health, and who is not, should, if possible, attend, but if not, become a member so as to receive the published transactions. They will be worth many times the five-dollar membership fee.

TREASURY DEPARTMENT, WASHINGTON, December 26, 1907. SIR: The prevention of tuberculosis is engaging the increasing attention of public health authorities and philanthropists throughout the world. There is certainly no more important public health question demanding the activities of sanitary officers at the present time, and it is desirable that our people generally recognize its importance and enlist in the campaign against tuberculosis.

The diffusion of knowledge with respect to the disease is no doubt one of the most important measures that can be instituted by public health officials. With the view to this end, an International Congress on Tuberculosis will be held in Washington, D. C., September 21 to October 12, 1908. At this Congress all phases of the problem will be considered, a number of eminent specialists from abroad having signified their intention to participate in the deliberations.

Section VI will be devoted to the national, state, and municipal control of the disease, and it is urged that all public health officials atend its sessions, participate in the benefits to be derived from discussions of the governmental responsibilities and activities, and as a result be better prepared to assist in a systematic campaign against the disease throughout the country.

Respectfully,

WALTER WYMAN,
Surgeon-General.