Entered as second-class matter February 21, 1922, at the post office at Sacramento, California, under the Act of August 24, 1912. Acceptance for mailing at special rate of postage provided for in Section 1103, Act of October 3, 1917. Vol. II, No. 38 What is the New Public Health? "What is the new public health? How does the new public health differ from the old? The new considers you from your skin in; the old considered you also, but from your skin out. In other words, the old concerned itself very largely with the surroundings-the environment-of people. The new concerns itself chiefly with people them selves. this world really. Evolution showed that man really is just as much part of nature as any insect or plant, just as much part of nature as a horse or an elephant; not an after thought at all, but a real product, based and rooted in all the universe; not something different, not for this world; but on the contrary that something extra, not something unfitted man is 'the heir of all the ages' in a most literal and realistic physical and mechanical sense, a real natural outgrowth of nature itself. The savage looked upon himself, even This does not at first sight seem such more earnestly than we used to do, as a tremendous change, but it is, never-something different.' To him all nature theless; for it has already revolutionized was foreign, antagonistic, filled with methods, and has already achieved evil forces (evil spirits, he called them), results on such a scale as to make it evident that we are turned in the right direction now instead of the wrong. If you want to go to the North Pole, but are headed south, merely turning half round is not such a tremendous change, except that now you may reach the North Pole whereas, as you were headed before, you never would! Why this change from working on the environment to working on the individual? Well, fundamentally, it is part of the great change in our way of looking at things which was introduced by the bitterly fought but finally accepted doc trine of evolution. We had been in the habit of thinking of mankind as something apart from nature-an extra, tucked in, late in the game; a sort of after thought-not part of nature but in some way different from, superior to, not fitted for all with designs on him. His life was one long battle, one long series of escapes, from heat and cold, flood and drought, thunder, lightning, animal enemies and often human enemies. He was self-centered to an extreme. All things outside himself he must run from, conquer ог destroy; otherwise they would conquer or destroy him. But as man lost this attitude of the terrorstricken child, kicking and screaming, scratching his nurse's face, opposing everything whatever because of fear of being hurt, he gradually found his great nurse, Nature, who was his mother also, would help him, not hurt him, if only he would stop biting her long enough to find out what she wanted. So, very very slowly, with many a slip and stumble, and many a scar to show for early errors, mankind has reached the point where nature is no longer a thing to fear, no longer a thing to fight, no longer a thing to conquer even, as a rebellious slave; but rather a bountiful mother, to be studied, understood, cooperated with-blood of our blood, bone of our bone, literally as well as metaphorically-and harmful to us only when we fail to understand, or venture rashly into foolish feats. The force behind the lightning, the pain and fear of earlier generations, we do not fight or flee from; we use it kindly, gently, almost without thought, to cook for us, to move our coal and furniture, to tell our troubles to our friends. Fire, the terror of animal and savage, we use for countless purposesit has become the 'harmless, necessary cat' of modern life. Disease has been longer than any other of nature's forces misunderstood, fought against blindly, combatted without real study. Scarcely 70 years ago did the first real glimmerings of what disease really is strike into the human mind in any practical way. Scarcely 30 years ago did the first real uses of that new knowledge begin to show themselves in remodeling human life. 'Cooperating with disease' through understanding of it-a new idea indeedis the idea which has made the new public health as it has made modern medicine. At first sight this idea strikes us as a suggestion would strike our savage forefathers, that they 'cooperate' with fire or lightning or with Niagara. On second sight it strikes us as just as sensible as furnace heat, or telephones, or hydro; and so it is. We now use the forces of disease to cure, and even better, to prevent disease, as we use fire to put out fires with, as we use ice-cold Niagara to warm us. We do not struggle with the universe at large to save us from disease, as did our ancestors. We do not fear or dread anything from our skins out. Nothing outside us can hurt us until it gets into us; and often, not even then. Only from our skins in can anything harın us; and that is why we have turned from regarding the environment and doctoring it, to regarding ourselves and keeping ourselves diseaseless. We know to a great extent what the causes of most diseases are, physical, chemical, biological; and that they can not act upon us except by contact with us. We know also to a great extent how to prevent these causes of most diseases from harming us. Thus we may immunize ourselves against some of them, or obviate their coming to us, or best of all destroy them altogether. That is the New Public Health, up-todate, progressive, aggressive, scientific, public health and boiled down it means attention to the individual, rather than the surroundings; improving the person rather than the premises; caring for boys rather than for buildings; caring for girls rather than for garbage; caring for men and women rather than for manure and waste. Therefore we repeat, the New Public Health is chiefly individualistic rather than environmental."-H. W. Hill, M.D. 爨 嬖 Qualifications for Public Health Nurse Examination. Following is the text of a resolution pertaining to the necessary prerequisites for examination for certificate for public health nurse, as adopted by the California State Board of Health at its regular meeting held in San Francisco, October 6th. Resolved, that applicants for examination for certificate as public health nurse shall be: 1. Registered nurses under the laws of California, and 2. Shall have completed a public health nursing course of from four to eight months Board of Health, or in a school approved by the California State 3. Shall have completed at least a semester (four months) of post graduate work in social service, including theory and practical work, or 4. Shall present evidence of having engaged in general public health nursing for at least organization approved by the California State two years in connection with a public health Board of Health. 5. All applications for examination as public health nurse shall be filed in the office of the California State Board of Health and shall be passed on by a committee of the board. 6. Upon examination, credit of 5 per cent will be given to applicants who have completed a four months' course in public health nursing, and 10 per cent to applicants who have completed an eight months' course in public health nursing. The most important step toward the prevention of any chronic disease is the proper education of the people as a whole. It is not True, we do forehandedly estimate and prepare in various ways against the causes of disease which exist in our surroundings, but we do not fear, as did our ancestors, these causes of disease so long as they remain in our surround-sufficient for physicians alone to know the great danger of the unchecked progress for ings. They are not to us, as they were months or years of any chronic disease like to our ancestors, things unknown, tuberculosis, tumerous growths, or goiter. If intangible, able to strike from a distance everybody must know what to do and why to progress toward prevention is to be made, Looking Back Upon Dark Days. Sneezing More Dangerous Five years ago thousands upon thou- A San Francisco attorney has written sands of Californians were suffering to the State Board of Health concernfrom influenza, several thousands of ing the dangers connected with the whom died. The disease, as it appeared transfer of respiratory infections through in California, constituted but a small sneezing. Education of the general part of the pandemic that covered most public concerning this menace to health of the globe. In October and Novem- progresses slowly. Most intelligent perber of 1918 it was not uncommon to see sons, however, are well aware of the the entire populations of large and small impropriety and danger that lie in the cities wearing gauze masks which unprotected sneeze. The writer's intercovered the nose and mouth. Under-esting letter deals with the matter in takers were so overwhelmed with work pertinent fashion and is reprinted here. that in many parts of the state bodies He writes: of persons who died of influenza could not be promptly and properly cared for. Small towns in isolated districts were sending pitiful calls for assistance. It was not uncommon for every resident In the case of expectoration the of a small community to be stricken, sputum is placed on the floor and there with none left to care for the sick. is only the slightest danger that any Physicians and nurses were laboring active organisms it may contain will be night and day. Families whose members brought in contact with the sensitive were suffering from influenza were membranes of others while they are fortunate if they could secure the serv- still alive. ices of a nurse for but half an hour of each day. During the fall months of 1918 no less than 230,845 cases of influenza were reported in California and there were 13,340 deaths from the disease during those few weeks. Looking back upon those frightful days the autumn of 1918 seems almost like the recollection of a delirium. It is almost impossible, at this time, to conceive of such a calamity as occurred so recently. It can not be said that any definite advance has been made in the specific control of influenza, but the outbreak has given tremendous impetus to the study of the disease and to research into all respiratory infections. Thousands of workers in all parts of the world are laboring incessantly in an endeavor to solve the many problems associated with the control of such infections and this work is leading toward favorable results. "Why is it that warnings are SO urgently posted against expectorating and that nothing is said about coughing and particularly about sneezing? In the case of sneezing the sputum is sprayed into the air under crcumstances specially favoring its reception upon the sensitive membranes of persons who may be near by. This is particularly true under conditions as they exist in public places, and public conveyances. On the train and ferry on my way to my office from Berkeley the other morning I was sprayed by no less than seven different people no less than eight times. Of course I came down with a filthy cold and the worst of it was that it was communicated to my wife and baby daughter in spite of my precautions. Why does public opinion make so much of ordinary assaults which result in transitory bruises and make nothing of assaults by sneezing? In the last five years I have received over twenty colds, two influenzas and a double pneumonia by being sneezed on in public places. floors?" Can't something be done to emphasize Announcements from these investiga- the danger of sneezing on people as well tors, from time to time, indicate the as the danger of expectorating on progress that is being made. No one expects the discovery of a specific for influenza, but that our knowledge of respiratory infections will be greatly enlarged as a result of the research work now being undertaken, is definitely assured. Let us not forget that the entire child goes to school-body, soul and mind. Any system of education which ignores one or the other of these factors will be to the disadvantage of the child.-Rosenau. "The study of mankind is man." -Thomas Carlyle. The economic loss sustained through sickness and inefficiency is a direct drain on our country's resources. It therefore becomes our patriotic duty at this time to see that neither our own health nor that of our neighbor is impaired. Ignorance, superstition and disease go hand in hand and our skill should be vigorously directed against their spread. Diphtheria. MORBIDITY.* 202 cases of diphtheria have been reported, as follows: Los Angeles 57, San Francisco 35. Los Angeles County 26, Oakland 15, Pasadena 6, Ukiah 3, Madera 1, Santa Ana 1, Solano County 1, Long Beach 3, Fresno 2, Santa Barbara 1, Pacific Grove 1, Tulare County 2, Stanislaus County 1, Ontario 1, San Joaquin County 1, Brawley 1, Imperial County 1, South San Francisco 1, Riverside County 1, San Bernardino County 1, Stockton 3, Orange County 2, Sacramento 2, Sacramento County 3, San Fernando 3, Alhambra 1, Berkeley 6, Kings County 1, Fresno County 2. Richmond 2, Ventura County 1, Redwood City 6, Sonoma County 2, Bakersfield 3, Emeryville 2, Pittsburg 1. Measles. 202 cases of measles have been reported, as follows: San Francisco 112, Monterey County 13, Eureka 12, Los Angeles County 5, Riverside 6, Alameda 6, Oakland 3, Burlingame 2, Salinas 2, Sausalito 4, Santa Maria 1, Sacramento 1, Los Angeles 3, San Luis Obispo County 3, Lassen County 1, Ontario 1, Richmond 1, Hollister 4, Berkeley 3, Kings County 1, San Mateo 8, Sonoma County 2, Santa Rosa 5, Lompoc 1, Pittsburg 2. Scarlet Fever. 132 cases of scarlet fever have been reported, as follows: San Francisco 18, Los Angeles 22, Oakland 13, Riverside 6, Stanislaus County 7, Los Angeles County 6, Pomona 6, San Luis Obispo County 1, Merced County 1, Fresno 2, Santa Barbara 1, Long Beach 1, Santa Ana 1, Tulare County 1, Orange County 1, San Joaquin County 2, Stockton 1, Mono County 1, Livermore 3, San Fernando 3, Whittier 2, San Gabriel 1, Roseville 1, Alameda 2, Berkeley 2, National City 1, Kings County 2, Fresno County 8, Richmond 1, Redwood City 6, Kern County 4, Sonoma County 1, Santa Rosa 1, Colusa 2, Santa Cruz 1. Whooping Cough. 22 cases Los of whooping cough have been reported, as follows: Glendora 5, Eureka 1, San Francisco 2, Pasadena 2, Los Angeles County 1, Angeles 3, Riverside 3, Orange County 4, Berkeley 1. Smallpox. 51 cases of smallpox have been reported, as follows: Los Angeles 44, Los Angeles County 4, Long Beach 2, Pomona 1. Typhoid Fever. 24 cases of typhoid fever have been reported, as follows: San Bernardino County 5, Oakland 1, Napa 1, Long Beach 1, San Joaquin County 4, San Francisco 1, Orange County 1, Los Angeles County 1. Yolo County 1, Sacramento County 1, Sacramento 2, Huntington Park 1, Los Angeles 2, Burbank National City 1. Cerebrospinal Meningitis. 1, San Francisco reported 1 case of epidemic cerebrospinal meningitis. Epidemic Encephalitis. Los Angeles reported one case of epidemic encephalitis. Poliomyelitis. 20 cases of poliomyelitis have been reported, as follows: San Joaquin County 1, Napa 1, Lassen County 1, Redlands 1, Long Beach 1, Woodland 1, Los Angeles 4, Orange County 1, Los Angeles County 3, Sacramento 1, Stockton 1, Lodi 1, Riverside County 1, Berkeley 1, Santa Paula 1. *Reports received on October 29th and 30th for week ending October 27th. COMMUNICABLE DISEASE REPORTS. Entered as second-class matter February 21, 1922, at the post office at Sacramento, California, under the Act of August 24, 1912. Acceptance for mailing at special rate of postage provided for in Section 1103, Act of October 3, 1917. Vol. II, No. 39 NOVEMBER 10, 1923 IMMUNIZATION AGAINST DIPHTHERIA. GUY P. JONES By WILFRED H. KELLOGG, M.D., Director, State Hygienic Laboratory. The steady increase in the prevalence of diphtheria in California, together with the fact that the mortality from this disease continues high in spite of our possession of a specific treatment in antitoxin, prompts the following brief consideration of the subject. With the introduction of antitoxin about twenty-five years ago there was a remarkable fall in the percentage of cases that resulted fatally. This drop was from an average case fatality rate of forty per cent to about ten per cent, which percentage, since that time, has not been reduced. The reasons for this failure of antitoxin to completely suppress the death rate from diphtheria are several and to a considerable extent unavoidable. They in clude such things as delay in recognition of the condition by both parents and physicians, delay in calling the physician in cases of throat trouble and sometimes inadequate dosage of antitoxin. Diphtheria, therefore, continues to be one of the terrors of childhood and it is responsible for from twenty to thirty thousand deaths of children each year in the United States. The usual control measures available to the health officer have been the quarantine of cases of diphtheria and the search for and isolation of healthy carriers of the diph theria bacillus. Owing to the existence of many cases of true diphtheria that are so mild as to escape identification as such and to the great difficulty of finding and controlling carriers, diphtheria continues to be practically as common and widespread as ever. The most effective control measure for any communicable disease would be a method of immunizing individuals against it; such as vaccination against smallpox, which has resulted in reducing this disease from the dreaded plagues of the middle ages and from the universal destroyer of even a century ago to a state of comparative abeyance, a condition that accounts for the large number of persons who honestly believe that smallpox is not a disease to be dreaded. There are very few diseases in which we have such a specific preventive, only three in fact, and these are smallpox, typhoid fever and diphtheria. The preventive measure for the latter disease is the most recent and the most spectacular advance that has been made in preventive medicine. It is not a vaccination, as in the case of smallpox, but a subcutaneous administration of a very small quantity of diphtheria toxin made from cultures of the organism and practically neutralized by antitoxin so that it gives little or no reaction and does not produce a sore on the arm as does the inoculation of vaccine virus. This |