officer should know the existence and locality of each case, so that proper information for the protection of other members may be given the family, if needed, and the room thoroughly disinfected after death or removal.

THE RESPONSIBILITY OF PHYSICIANS.

There is no position in life that is of equal importance and responsibility as that of the physician. He has a duty to his patient, for life and health depend upon his skill, but he has also a broader duty to the community, for upon his neglect, as well as want of skill, oftentimes depend the lives of many whom perhaps he never saw.

This thought is brought out by recent investigations of epidemics in the State. Very many of these epidemics are the result of ignorance or worse on the part of some one who passes for a doctor, and sometimes, unfortunately, he has a legal right to class himself with that highminded profession. Oftentimes the first case of smallpox, diphtheria, scarlet fever, or other contagious disease falls into the hands of such a person. He may fail to recognize its true character or more often at the solicitation of the family deny the true diagnosis, and disregarding the law conceal it from the authorities, and death and distress follow.

The physician's responsibility by no means ends when he gives the best skill he has to his patient. If that patient is suffering from a communicable disease, and he fails to report it, he is responsible for all cases arising therefrom. He has committed a misdemeanor and is punishable under the State laws for his neglect or willful disobedience. The difficulty is to convict him, for he takes shelter in ignorance and publicly declares his inability to recognize the disease. The only protection a community has against such men, men who for some personal motive will endanger them all, is to give their patronage to some one more reputable.

We should all consider that if the doctor will cover up a communicable disease to please us, he will to please our neighbor, and that our children will be exposed by his act.

Almost every epidemic we have starts from a neglected case, too often not reported to the health officer. The law requiring the reporting of all cases of communicable disease extends to all parts of the State, outside of cities as well as in, and every one, whether doctor, nurse, or friend, commits a misdemeanor who has charge of such a case and does not report it.

PUBLIC HEALTH ASSOCIATION MEETINGS.

The Central California Health Officers' Association held their annual meeting at Hanford, March 11th.

Dr. R. W. Musgrove, Health Officer of Hanford, read a very interesting paper on "Septic Tank System of Sewage Destruction," with special reference to the one in operation in that city. He explained the bacterial action by which the organic matter in the sewage is destroyed, and the necessity that conditions be such that this bacterial life can exist. The author is strong in the belief that a city should have separate systems for house sewage and storm water. In cities with oiled streets and where oil is largely burned it gets into the sewers and destroys the bacterial action to a great degree. Manufacturing wastes, especially from wineries, should be kept out, for the same reason. The discussion was general and interesting.

At the business meeting the following officers were elected: President, Dr. R. W. Musgrove, of Hanford; Vice-President, Dr. S. W. R. Langdon, of Stockton; Secretary, Dr. Mary R. Butin; Treasurer, Dr. George L. Long, of Fresno.

The time and place of the next meeting will be determined by the executive committee.

All of the members present were delightfully entertained by Dr. Musgrove at his home, where was found in his charming wife one strong element of the doctor's success in his profession.

The attendance was not what the extent of the territory represented, the intelligence of the health officers, or the importance of the meeting warranted us to expect. Various causes contributed to this-bad condition of the roads, other business engagements, and possibly from a certain want of interest. That this should be so is greatly regretted, for the information, enthusiasm, and love of the work which are gained by those who attend these meetings redounds both to the honor and the profit of the participants.

There is something in the plea that health officers get very little pay for the amount of skill and work required, and that they can not afford to spend the money and time required to attend these meetings. The municipality or county should pay the expense, for they secure the benefit. This is done in some places, and should be in all. The pay of health officers is ridiculously small in most places. No other kind of professional work gets such little pecuniary recognition. They can, however, regulate this themselves, if they only will, and organization and union are the best means, for "in union there is strength."

We must get the respect of the people, and show to them our efficiency and power for good, and the first step to gain that respect is to respect ourselves. We must study the problems involved in guarding the public health, and be able to meet any question that may arise. Unity of action and methods, and a constant search for the best is necessary. Sanitary science is rapidly advancing, and he who thinks because he has served for years in his office, plodding along in the same old path, that he is doing the best possible work for the public is mistaken. Giving no better work than he did years ago, there is no sensible reason to the average man why he should receive better pay; but let the public see that the health officer understands the many means of protecting and safeguarding life and health, and is earnest and impartial in enforcing these means, and they will willingly pay the price for the better work.

The eighth semi-annual session of the California Public Health Association was held at Monterey, April 15th. The President, Dr. William Simpson, of San José, called the meeting to order and delivered the following excellent address:

Cicero said: "Nothing brings men nearer to the gods than the giving of health to their fellow creatures.

Prior to the middle of the nineteenth century the practice of medicine was largely tentative, always indefinite and often heroic. This period was followed by an interim of skepticism, minimism, and expectancy, and this again has been followed by what now may be truly termed the period of scientific medicine, for drugs have been tested and labeled until their efficacy and place in the practice of medicine are fixed, expectancy has its own corner and knows and keeps its place, the skeptic leaves the practice of medicine for other fields, and the minimist, who believes there is so little in his work that it is hardly worth doing, simply hangs on the outer edge and is the horrible example that stimulates his conferees to better work.

For centuries the practice of medicine was simply a game of "follow my leader," and the dogmatic assertion of the leader of the period was as final in medicine as a papal bull in theology. From this the pendulum has perhaps swung to the other extreme, until any person who has kissed the blarney stone or read some forgotten story of the days of Mesmer or Cagliostro may propound a new system of medicine or theology with the assurance of finding followers a-plenty.

For these conditions the medical profession are alone to blame, in that they, in the beginning, and even to this day, too much neglect the psychological side of the profession, emphasizing so strenuously the physiological side that it leaves room for the faddist to successfully foist upon humanity the rankest fallacy. From this contemplation it is a pleasure to turn to a society like the Public Health Association, which has no theories to advance, no selfish ends to gain, can not be suspicioned of self-seeking or self-interest, but preaches and practices the gospel of cleanliness, of self-help, of prevention-which seeks no honor for itself, no emoluments for its officers or members, but simply and solely the greatest good of the greatest number.

The interest in this organization, instead of being limited to the faithful few who have from its organization been devoted to its interests, should include every educator, every head of every public institution, every trustee or worker in or manager of every private institution, no matter what its character, in the State; for there is not one of these which does not have questions of sanitation constantly thrusting themselves on their attention, and to help in the answering of these is the province of this organization, and to this end we ask and believe we are entitled to recognition of our work by the State in the publication of our papers.

Those who have followed the meetings of this organization know that much valuable material has been lost for lack of funds to print our proceedings. Pope's couplet

"Reason's whole pleasure, all the joys of sense,

Lie in three words: health, peace and competence,"

are as true to-day as when written, and we who are the conservers of the first are contributors to the other two; for without health peace is impossible and competence worthless.

That the calamity which followed so speedily our last annual session caused no serious epidemic we are all sure is due to the sanitary precepts enforced by our secretary and by the Board of Health of San Francisco under the able leadership of our vicepresident and with the assistance of one of our charter members, Dr. Rupert Blue, of the United States Public Health Service.

In behalf of the California Public Health Association, I, as president, welcome you to our eighth meeting and thank you for the interest expressed by your presence.

Prof. Henry Johnson, of Stanford University, delivered from notes illustrated by drawings a very interesting and instructive lecture on 'Geology of Underground Waters and Mineral Springs." His lecture related especially to the formation of the Santa Clara Valley, and showed very clearly the source of the artesian water supply to be in the surrounding mountains, where the strata which underlie the valley come to the surface with a very steep dip, thus allowing the water which falls thereon, to rapidly flow into the underground reservoir. There was no discussion of the possibility of this water becoming polluted, and in this case being on high hills that are sparsely settled the danger is small, but under less favorable circumstances this might result, and all artesian supplies should be mapped out and studied by some one thoroughly capable of making a scientific report.

Dr. Chas. F. Clark, of Woodland, read a paper on Effect of School Life on Children's Health," which was both interesting and instructive. The writer believes that the steady raising of standards in the schools, and the consequent tax upon the vital energy of the students, are responsible for much of the nervous trouble which they certainly have. In support of this he refers to school statistics taken by competent examiners. Headache from whatever cause increases day by day and grade by grade as the student advances in his course. Investigations made in St. Petersburg and London prove the gradual increase of nervous troubles as the time in school advances. In Cleveland seventy-five per cent of the girls and thirty per cent of the boys who left school during the year did so from ill health. In Waltham a class of seventeen was

decreased by nine from ill health during the graduating year. The writer believes that the school is not the cause of this ill health; "heredity, home environment, and an endless number of conditions foreign to school" are factors, but that the continued mental effort superimposed on these factors is what breaks the health. Medical supervision of schools in a broad sense is demanded, a supervision that can guide the weakened mentalities and those physically frail to the best that can possibly be attained.

The discussion of the paper was very ably and interestingly opened by Prof. Job Wood, of the State Department of Public Instruction, who, while enthusiastic for the good work our public schools are doing, sees plainly the hardship they impose on the weaker scholars, and the mental and physical breakdowns which result.

The discussion was quite general, and the following resolution offered and adopted:

Resolved, That the California Public Health Association, recognizing the many cases of eye, ear, and throat troubles, as well as many other ills among the children in both public and private schools, earnestly urges that boards of education and superintendents of private schools shall appoint medical inspectors for the purpose of ascertaining and correcting these evils as they may be found to exist.

Dr. A. E. Osborne, of Santa Clara, read a paper on "The SocioEconomic Status of the Feeble-Minded." The paper was scholarly and full of good thoughts, but the lateness of the hour prevented discussion." An effort will be made to have the papers published so that the State may benefit by the labor spent upon them.

The Association adjourned to meet in its Fall session at Woodland, Yolo County.

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Dr. E. E. Stone, President of the Northern District Medical Society, has arranged for a section of "Public Health" at the next meeting, with one or more papers pertaining to that subject. All health officers will be welcome, and should avail themselves of this opportunity to discuss questions of vital interest to the public and themselves.

WILL THE LAW BE ENFORCED?

During the month of February there died in California 384 persons from tuberculosis, and 282 from pneumonia, both of them communicable and consequently preventable diseases. Six hundred and sixtysix out of twenty-three hundred and ten, or almost 29 per cent of all deaths, died in this one month from these two causes. What an awful sacrifice of life to ignorance and carelessness! A larger share of these were in the prime of life, and useful, productive members of society, and the economic loss to the State was immense, to say nothing of the sorrow and broken home circles.

The last Legislature, fully appreciating this loss, passed a law with the aim to check this wholesale murder, for murder it morally is for one person to kill another, whether it is done with a quick method like a shot or a slow one of infection with disease.

This law is as follows: "It shall be a misdemeanor for any person to discharge mucus from the nose or mouth, or spit upon any sidewalk of any public street or highway, or upon any part of any public building or railroad train, street car, stage, ferryboat, steamer, boat or other vessel or vehicle used for the transportation of the public."

Another law requires physicians and others to report all communi cable diseases, among which are enumerated pulmonary tuberculosis and pneumonia. Had these laws been in effect and carefully observed, many of the 666 who died of these two diseases the month the law was enacted, would now be alive and productive citizens. That sputum contains the disease germs, that these germs live for a certain time after the sputum has dried and become dust, that they are carried to homes on shoes and clothing, that as dust they get on our food and into our drink, are all demonstrable propositions, and that many of those dying received their infection from this source there can be no doubt.

The laws are now in force and should be enforced, and it is the duty of every police officer, sheriff, or constable to arrest any one caught violating the expectoration law. A few arrests of prominent spitters in every city or town would put a stop to the filthy and dangerous habit by making sentiment strong enough to outlaw any one who practiced it. Will these officers do their duty? We fear not, unless the sentiment is created first. And for this work there is no power so great as the newspaper and magazine. These publications in California have always been found willing and anxious to enlighten and help the people. Will they not now take up the question and publish the law so that none may be ignorant of its existence and show to their readers by editorials the dangers which exist in public spitting? Why can not our civic improvement organizations, our women's clubs, our different labor unions and our fraternal societies all lend a helping hand, for all are exposed to the same dangers. If they would spend ten minutes at each meeting in listening to a plain exposition of the dangers of this habit, more good would be received than by any other way it could be spent.