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There is among many people, and even among some physicians, a more or less strong opposition to the idea of reporting cases. It was the same in New York at first, but now it has practically the unanimous support of the physicians and laity, and the death-rate from consumption is decreasing, due alone to the efforts of the health authorities following up with honest, effective work the cases reported to them.
There is no doubt that notification is the most important unit in the struggle with tuberculosis. There is much good in saving people already infected, but more in keeping others from being infected. The disease is communicable both directly from those infected to the well, and indirectly by means of things, and especially rooms. To check the spread of the disease the means of communication must be stopped, but how can a health officer do his duty in protecting the health of the community unless he knows where to work?
The object of notification is not to placard the room or house, nor to interfere with treatment, nor to make public the patient's condition, but to see in a quiet, non-public way that proper instructions are given the patient so that he may not be a danger to himself or others, and that after his removal from the rooms they can be disinfected. This would save many lives, and no hardship would be imposed on any one.
There is hardly a person but what has seen some one suffering from consumption spitting upon the floor of their room, or possibly upon the walls. This sputum, laden with the germs of the disease, dries and becomes dust. It settles on the walls, in the cracks, and everywhere, ready to infect the next person who unfortunately occupies the room. The disease is no doubt frequently spread by this means-a source of trouble that could easily be prevented by thorough cleaning and fumigation, but the know where is as necessary as the know how.
MOSQUITOES. The time of year is at hand when the mosquito, lean, hungry, and energetic, begins work. They will be few at first, but will multiply with great rapidity, and spread discomfort and disease; that is, if allowed to do so.
It is comparatively easy to destroy them entirely, and be relieved of one of the great discomforts of life. Every one should know and remember that the mosquito breeds only in water, never in grass and brush. They seek protection in these, but breed always in water. The wigglers seen in stagnant water are the mosquitoes in their early or larval form, and it is in that stage of life that it is easy to destroy them. If every one would see that no stagnant pools existed around their place; that no pail, tub, can, or any vessel is allowed to stand with water in it; that their cesspools and vaults are closely covered, or if exposed to the outside, that coal oil is frequently poured on the surface of the water; that watering-troughs are emptied once a week; that water tanks are tightly covered either with boards or a fine screen; in short, if all breeding places are protected or destroyed, there will be no mosquitoes. In places it is impracticable to drain all pools, but they can be easily covered with coal oil, which will effectually destroy the pests.
Many committees are taking up the question, and have arranged to destroy the mosquitoes which in the past have been such a menace to health and comfort. In this work the entomological department of the State University has rendered efficient aid. No town or city should be infested with this pest, and ordinances should be passed and enforced requiring that conditions should be such on each person's property that they could not breed. This is done in many places, much to the comfort and health of the community.
BAR TO SANITARY PROGRESS. “Prejudice, apathy, ignorance, selfishness, and vested interests still exist as bars to sanitary progress as in the days of old, and they clog the wheels alike of legislation and administration. We.possess the knowledge of how to reduce speedily the sum of infantile mortality, of enteric fever, of smallpox, of puerperal fever, of consumption and of the diseases due to alcoholism, and to a less degree the mortality of scarlet fever, diphtheria, measles, and whooping-cough, yet existing social conditions make progress slow and difficult. Dwellings are still ill-ventilated, dirty, and overcrowded, public and domestic water supplies are still polluted. Food is still adulterated, chimneys still vomit black smoke and chemical fumes, sanitary work is still badly executed, local authorities are still indifferent, employés still exact labor under conditions which are disastrous to the worker's health, and individuals are still careless or ignorant of the simple laws of health passed in the days of Moses. The solution of many public health problems depends upon the solution of problems which are social and political: the magnitude of the social and political problems to be solved cannot be exaggerated. Problems of public health, moreover, change with altered circumstances and new ones are constantly evolving. Many of the old ones are becoming more complex year by year, and some are so dependent upon a high ethical level among the general public for their complete solution, that only the millennium can be expected to see them solved. The public health worker can never hope for a complete realization of his schemes and ambition, and to his labors there can be no end. But his reward is the satisfaction of witnessing, almost daily, beneficent results from his work, and it is this that stimulates and gives him zest.”— Exchange.
IT IS NOT UNWORTHY.
Wm. J. Lampton, in “Success."
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,
O. STANSBURY, M.D.
STATE HYGIENIC LABORATORY. ARCHIBALD R. WARD, D.V.M., Director...
University of California, Berkeley
NOTICE TO CORONERS.
Definite Statements of Causes of Death.- The attention of coroners is directed to the requirement of section 6 of the law for the registration of deaths that: “Causes of death which may be the result of either disease or violence shall be carefully defined; and, if from violence, its nature shall be stated, and whether accidental, suicidal, or homicidal.” Deaths from violence should always state the character, as accidental, suicidal, or homicidal, in addition to the means of death. “Accidental drowning,'
," "Gunshot wound (suicide)," and "Poisoned by arsenic (murder),” are examples of complete returns.
In all cases of accidental injuries causing death, the nature of the accident should be definitely stated, as, “Accidental gunshot wounds,” “Injuries by machinery,” “Injuries in mines and quarries,” “Railroad or street car accidents or injuries," "Injuries by horses or other animals," “Automobile accidents,” etc.
Furthermore, when under section 7 of the death registration law coroners investigate deaths occurring without medical attendance and not resulting from violence, they must to properly comply with the law investigate each case sufficiently to determine some specific disease as the cause of death. The return “natural causes » is worthless for statistical purposes, nor is the term “heart failure" any better, since the heart always "fails" before death from any cause. In investigating any death not from violence, coroners must invariably certify to some specific disease as the cause of death, as tuberculosis, pneumonia, heart disease, Bright's disease, apoplexy, etc.
The fact that California has the honor of being included by the Federal Census Bureau among the 16 registration states makes it very important that causes of death be stated definitely on all our certificates. The coöperation of coroners is therefore sought to the end that in all cases investigated by them the cause of death will be given with proper definiteness.
MODIFICATIONS OF REGISTRATION LAW. Chapters 92 and 236 of the Statutes of 1907 make certain modifications of the law for the registration of vital statistics first enacted in 1905. The changes meet the difficulties encountered in the operation of the law during the past two years and serve to make the law as it now stands less rigid in operation than before and also more uniform in minor details.
Temporary Removal of Body.—The rigidity of the law is lessened especially by amendments to sections 4 and 10 of the law for the registration of deaths. Section 4 now provides that for the purpose of being prepared for burial or shipment a body may be removed without formal permission from the registration district where the death occurred, to another registration district in the same county, or to a contiguous registration district in a different county. Thus, without a formal permit, a body may be removed temporarily from a residence in the rural portion of a county or in a separately incorporated suburb to an undertaker's establishment in a city where proper facilities are available for preparing the body for burial or shipment. Of course, before making the final burial or shipment, the undertaker must, as in the past, first secure a permit for the interment or removal of the body from the registrar of the registration district where the death occurred.
Permit for Burial in Contiguous District.-Section 10 of the death registration law, as amended, authorizes the registrar of the district where a death occurs to issue a burial permit, which is legal authority for an interment not only in the district where the death occurred but also in a contiguous registration district in the same or an adjoining county. Thus, the registrar of deaths in a city where no burials take place may now issue a burial permit authorizing an interment (or cremation) at a cemetery in a contiguous registration district, as in a neighboring city, in the rural portion of the same county, or even in a different but adjoining county. The formality of issuing a removal permit and of attaching to it a complete copy of the certificate of death is now required only in case the interment is to be made in some registration district not contiguous to that in which the death occurred, as, for instance, where a body is to be shipped by any transportation company or common carrier for interment at a distant point in California or at some place in another State.
Time for Reports - Local Records—Numbering Certificates—Supplying Blanks.—Uniformity in details is secured by the amendment of sections 3 and 9 of the death registration law, so that certificates of deaths or reports of no deaths must now be transmitted to the State Registrar on or before the fifth day of each month, the fifth day being the date heretofore set for the transmittal of certificates of births and marriages. By the amendment of section 3078 of the Political Code the local record of births and marriages, as of deaths in the past, is required to be kept upon a form identical with the original certificate. Similarly, the local registrar must begin new numbers each calendar year for birth and marriage certificates, as for death certificates, and must also sign his name as registrar in attest of the date of filing in his office in all cases. Section 9 of the death registration law, as amended, specifically requires the board of supervisors of the county to supply local registrars with blank forms of death certificates, as well as of blank birth and marriage certificates as specifically required before.
Fund for Fees—Subregistrars' Compensation - By the amendment of section 14 of the death registration law it is definitely provided that a county recorder's fees for registering deaths in the unincorporated portion of a county shall be paid out of the funds of the county, just as the fees for registering births and marriages are expressly payable out of the county funds. Provision is also made for the compensation of subregistrars, who are now entitled to be paid the sum of not exceeding fifteen cents for each death certificate properly and completely registered and filed with the local registrar before the fifth day of the month. All amounts payable to subregistrars shall be paid to them by the local registrars appointing them, from the amounts received by the local registrars from the funds of the county.
Affidavits of Correction.-Section 3083 of the Political Code and section 13 of the death registration law, as amended, simplify the procedure of correcting errors in certificates of births, marriages, or deaths by providing that the change necessary to make the record correct may be made upon authority of the affidavit under oath of the person asserting the fact of an error, to be supported by the affidavit of one other credible person having knowledge of the facts.
VITAL STATISTICS FOR FEBRUARY. Summary.- For February there were reported 1,779 living births; 2,310 deaths, exclusive of stillbirths, and 1,607 marriages. For an estimated State population of 2,001,193 in 1907, these figures give annual rates per 1,000 inhabitants, as follows: Births, 11.6; deaths, 15.0, and marriages, 10.5. The corresponding rates for January were, respectively, 10.4, 14.6, and 10.3.
The number of marriages was highest for San Francisco, 362, and next for Los Angeles county, 352. The counties next in order were: Alameda, 197; Santa Clara, 58; Sacramento, 54; and Orange, 50.
The birth total was greatest for San Francisco, 377, and next for Los Angeles city, 359. The freeholders' charter cities with the next highest totals were: Oakland, 129; Sacramento, 45; Fresno, 35; Pasadena, 32; San José, 28; Berkeley, 27; and Stockton, 21.
The death list was greatest for San Francisco, 553, followed by Los Angeles city, 356, and Oakland, 145. The cities next in order were: San Diego, 57; Sacramento, 52; Stockton, 40; Berkeley, 39; Alameda, 31; Pasadena, 28; San Bernardino, 25; San José, 21; and Fresno, 20.
It may be noted that the births reported exceeded the deaths in the cities of Los Angeles, Pasadena, San José, and Fresno. If physicians were as sure to register births as undertakers have to be to register deaths, or even if physicians in all parts of California attended to the registration of births as well as they do in some cities, the State total of births would doubtless equal or exceed the aggregate number of deaths.
The deaths reported for February were distributed by geographic divisions, as follows: Northern California-coast counties, 105; interior counties, 135; total, 240. Central California-San Francisco, 553; other bay counties, 344; coast counties, 137; interior counties, 317; total, 1,351. Southern California-Los Angeles, 508; other counties, 211; total, 719. State total, 2,310. .
Causes of Death.—There were 386 deaths, or 16.6 per cent of all reported for February, from tuberculosis of the lungs and other organs, and 376, or 16.3 per cent, from pneumonia and other diseases of the