proper elimination of the wastes of the body and assimilation of nutrition to take its place, no person can be in health; and these functions will not go on in an efficient manner under the influence of improperly preserved or prepared food. The National Pure Food Law, which was passed at the last session of Congress, is recognized as a great step in advance, but without proper State laws to supplement it the full benefit will not be realized. The national law is operative only when it concerns interstate trade and gives us no protection from impure home productions. To cover this, the State Board of Health has had a Pure Food Bill prepared to be presented to the coming Legislature, which will be in perfect harmony with the national law. Such harmony, is absolutely necessary, for otherwise there will be a constant conflict, and an honest dealer would be to a great disadvantage. Give us a State Pure Food Law, but by all means have it harmonious with the national law. HEALTH AND CLEAN STREETS. If there is one lesson which the medical knowledge of the last quarter century has made plain, it is the value of cleanliness. The possibilities of aseptic surgery, the successful treatment of consumption, the conquering of yellow fever and malaria and cholera and the bubonic plague, are all results of what, broadly speaking, may be called the discovery that health is cleanliness. For one form of cleanliness is the purging of the places in which pestilential insects breed. One of the latest indications that the public is beginning to appreciate the importance of this knowledge is the growing dissatisfaction with dirty streets and littered yards wherever they exist, and a growing tendency to clean them. Denver is making capital-and honest capital it is-from the excellence of the street-cleaning department, and the hearty coöperation which its citizens give it. American visitors to Paris, and to many other European cities, notably those of Germany and Switzerland, are impressed by the care and thoroughness with which the streets are cleaned. Some Americans, indeed, have had the impression "borne in upon them" by policemen who have seen them drop torn paper in the streets, and compelled them to gather up the pieces again. That, after all, is the nub of the matter. It is not alone that municipal street-cleaning departments are often inefficient; littered streets are frequently due to lack of public interest and cooperation. Only carelessness or ignorance would permit the pedestrian to throw the empty paper bag or the banana peel into the nearest gutter, or allow the housemaid to sweep into the street the dust and litter she gathers from the front rooms and the hall and steps. Yet both of these things can be seen hundreds of times a day in every large city. What is most needed is greater care on the part of the individual. He should have civic pride enough to refrain from throwing newspapers or other rubbish into the streets or leaving it where it will be blown about. When he sweeps his sidewalk, he must remove or destroy the dirt, not merely brush it out of his own way. In other words, he should carry some of his indoor manners with him when he goes outdoors.-Youth's Companion. CALIFORNIA STATE BOARD OF HEALTH. Vol. 2. MONTHLY BULLETIN. Entered as second-class matter August 15, 1905, at the post office at SACRAMENTO, DECEMBER, 1906. STATE BOARD OF HEALTH. No. 7. 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 DECEMBER. Summary.-For December there were reported 1,694 living births; 2,683 deaths, exclusive of stillbirths; and 1,997 marriages. For an estimated State population of 1,882,846 in 1906, the December returns give the following annual rates: Births, 10.8; deaths, 17.1; and marriages, 12.7, per 1,000 inhabitants. Tuberculosis and pneumonia were the leading causes of death in the month, with heart disease next in order. Typhoid fever, as usual, was the most fatal epidemic disease in the State, though the proportion of all deaths due to this disease was less for December than for November and October. Causes of Death.-The following table gives the number of deaths due to certain principal causes in December, as well as the proportion from each cause per 1,000 total deaths for both December and November: There were 409 deaths, or 15.2 per cent of all reported for the month, from tuberculosis of the lungs and other organs, and the same number from pneumonia and other diseases of the respiratory system. The proportions for tuberculosis and pneumonia were higher for December than for November. Next in order are diseases of the circulatory system, heart disease, etc., causing 362 deaths, or 13.5 per cent. Typhoid fever caused 95 deaths, or only 3.5 per cent of the total for December, against 4.5 per cent for November, and 4.4 per cent for October. For December there were also reported 35 deaths from diphtheria and croup, 12 from measles, 11 from whooping-cough, 5 each from malarial fever and scarlet fever, and 16 from various other epidemic diseases. REPORTING TUBERCULOSIS. Tuberculosis caused the death of 4,183 persons, or 15.5 per cent of all the deaths in the State during the twelve months from July 1, 1905, to July 1, 1906. To be sure, many of them contracted the disease eĺsewhere, and came here to die-an act they could have performed with equal credit and more comfort at home-but over 28 per cent were natives of the State and as many more had lived here over ten years, so had in all probability contracted the disease here. Many who had lived here less than ten years came in perfect health, and it is safe to say that 65 per cent of all those dying from tuberculosis in California contracted that dread disease in the State. One thousand five hundred in round numbers came here to get the advantages of our climate, the best climate no doubt out of doors, but when confined within four tight walls and filled with the products of gas or coal-oil combustion and the emanations of diseased bodies, no better than what they left. In this good climate, 2,500-think of the number-died in one year from tuberculosis contracted in the State. There is no doubt many of these contracted the disease from cases coming here without the means for proper care. These infected strangers, living in dark and ill-ventilated rooms, eating at cheap restaurants and expectorating everywhere, will infect more natives than ten times the number who reside in good homes where care is exercised. It is not the number of sick coming to us that is of the most importance, but how and where they live after getting here. If we are to do anything to stop this terrible mortality we must know where to work, and this can be done only by having cases reported. The following is of interest as pertaining to this question: Compulsory Registration and Fumigation in Pulmonary Tuberculosis, the Two most Important of all Preventive Measures. By GEORGE H. KRESS, M.D., Los Angeles, Cal. Visiting Physician to the Barlow Sanatorium for Poor Consumptives of Los Angeles; Attending Physician to Helping Station of the Southern California Anti-Tuberculosis League. Compulsory registration and fumigation, when applied to pulmonary or lung tuberculosis (a disease also widely known by the name of consumption or the great white plague), have reference to the compulsory notification of the city, county, or state health officers, by the attending physicians, of the name and residence of every patient suffering from this widespread disease which comes into the hands of those physicians for treatment, to the end that, on the one hand, the infection of healthy citizens might be prevented, and that, on the other, the patient might be protected from re-infecting himself. In the system of compulsory registration and fumigation of pulmonary tuberculosis no placard or sign is placed on the house, as is the case in diphtheria or scarlet fever. In these latter diseases the chances of infection by simple contact are much greater than in tuberculosis, tuberculosis being a disease that requires for infection, as a rule, very close and somewhat prolonged contact with an infected person, room, furnishings or clothing, the danger in this chronic disease lying more in the fact that the millions and billions of germs which each consumptive expectorates in a short time so infect the room or furnishings that it is almost impossible for subsequent occupants not to inspire dose after dose of the germs, and if such persons be below par physically the chances of their becoming infected with tuberculosis are very great. Coming back to the system of compulsory registration, if our lay citizens could only understand that the system of compulsory registration of tuberculous patients (life-saving measures of a scope so great that only those who have studied the tuberculosis problem are in a position to appreciate their value) means not the least hardship, embarrassment, or inconvenience to family or patients; and further, that it means not the smallest iota of publicity, and that, so far as the outer world and neighbors are concerned, the patient stands in the same relation as to-day, except that the opportunity or privilege of infecting his relatives, friends, and fellows, and of re-infecting himself, is denied him, there would be none of this opposition to one of the most beneficent measures in the prevention of the world's great scourge, which we some times see manifest itself when this system of compulsory registration and fumigation is advocated. In speaking of the deaths from pulmonary tuberculosis, due to criminal negligence of proper regulations on our part, we have been tempted to characterize them as murders, for, in the ethical sense, is it not murder when human life is taken by means that we know could easily be prevented? Is it ethically any less a crime to infect an individual and cause his death by slow degrees from disease, and perhaps have him in time infect and cause the death of others near and dear to him (setting in motion an almost endless chain), than to kill him outright with bullet, knife, or other weapon, recognized as such in law? Is a human life not always a human life, and if it be sacred and worthy of protection from one class of weapon and preventable death, should it not also be sacred from all other types of weapon and preventable death? And the germ or bacillus of tuberculosis is nothing else than a weapon of death, a weapon of death in such constant use that it undoubtedly causes many times more mortality (one out of every ten persons dies of the disease) and certainly a vast deal more of mental pain and physical suffering than all the murderers in the usual sense, on whom the law seeks to expiate such crimes. It is a fundamental obligation on the part of a State to take steps to protect its citizens from preventable death. If the sputum containing millions and billions of germs of tuberculosis which is spread broadcast in California by our fellow citizens from the East, who come here in search of health-if this germ-containing sputum could be rendered innocuous before it has an opportunity to infect healthy citizens, hundreds of lives would be saved to this commonwealth. The Golden State, because of its climate, draws consumptives to its confines by the hundreds. These consumptives infect rooms and bed clothing and make these places dangerous to subsequent occupants. The poorer the consumptive (almost fifty per cent of our consumptives who come hither from the East are virtually penniless), the meaner and more crowded his boarding-house, and the greater the chance of having his sputum be the cause of infecting his fellows. When we know that the periodical fumigation of rooms which have harbored consumptives would prevent the larger proportion of these deaths and misery, and when these measures can be instituted without the least hardship or embarrasment to anybody, is it not almost a crime to refrain from bringing such measures into existence? What, now, do the terms compulsory registration and fumigation comprehend? In a few words, they are methods intended to destroy the bacillus of tuberculosis, i, e., the germ, without the presence of which in his body no person can have tuberculosis, and in destroying these dangerous germs the lives of many citizens would be saved. If infection can not take place without the germ, then if you kill all the germs there can be none, or at least only a minimum amount of tuberculosis. Now that is what compulsory registration and fumigation aim to do. The system known by that name aims to give to our health officers the name and residence of every consumptive, so that every such person may be instructed to destroy his sputum (for it is in the sputum or expectoration that the germ reaches the outer world), and it is to be remembered that the twenty-four-hour sputum of a single consumptive |
