It is these discussions entered into by all, and where each one feels free to express his belief, founded on experience, that make these associations particularly interesting and valuable. We all learn by experience, but the field is so large, a good deal must be from the experience of others. The influence of the association is bound to be great on the health conditions of the district. There will be strength of organization in fighting unsanitary conditions and disease, where formerly it was individual effort. It will bring the position of health officer more prominently before the public, and by showing its use and beneficial results lead to a more hearty coöperation and recognition. From the earnestness and ability displayed in the first meeting we predict a successful future for The Central California Health Officers' Association. Why not have similar associations in several other sections of the State? Southern California could have one to its great good. There are many health officers there who would profit much by such an association, and the whole section would reap the benefit. The same is true of the northern counties, and the coast counties could have a central meeting point at the bay. The State Board will be glad to take the initiative and aid in getting health officers together and organizing, provided there is any disposition on the part of those interested. SMALLPOX. In the February issue of the Bulletin we called particular attention to smallpox, and warned health officers to be on their guard against it. Despite that warning and the active work of many of the health officers the disease has spread until it is now reported from eighteen different cities and towns, in fourteen different counties, and there are no doubt cases in other counties that have not been reported. There is no disease more loathsome, few more fatal, and none more easily controlled. The comparative lightness of the disease during the past few years has apparently made people disregard and cease to fear it. They have entirely forgotten the tens of thousands who formerly died from it and the thousands who were left badly deformed, nor do they recognize the fact that the same severity of type may prevail again at any time. Indeed, it is already becoming more severe, and the death-rate is not insignificant. Vaccination has practically stamped the disease out of Germany, and, if properly done, would here. Health officers should insist on this and urge vaccination upon all. The health regulations of the State require that every one who has been exposed shall be vaccinated or quarantined for twenty-one days. This must be enforced. The school authorities should do their duty and enforce the vaccination law, and then the school children at least would be safe. There are a few so-called physicians in the State who seem to have a constitutional inability to diagnose smallpox, or, as it sometimes seems, possessed of an evil spirit which prompts them to deny its existence when they know the fact. This is largely responsible for the spread, and has caused much sickness, a few deaths, and the expenditure of many thousands of dollars by the communities for quarantine pur poses and other means of suppressing the epidemic caused by their denial. This class of men should be so thoroughly ostracized that they will need find other occupation, for they bring disgrace upon the profession and suffering and death to their patients. We recognize the difficulty of diagnosis in some cases, and that an honest difference of opinion may exist; however, it is not to this to which we refer, but to the many known cases where the attending physician will admit to the consultant or health officer the existence of the disease when he is forced by the evidence of the case to do so, yet deny it to the family and minimize the danger. Isolation of all cases must be carefully practiced. All bedding which can not be boiled must be destroyed. Rooms in which the patient is sick should be thoroughly screened, so that flies or other insects can not gain admittance or pass out, for they may be the means of communication. Patients are oftentimes let out before all sores are healed and scabs removed, thus practically wasting all the effort previously made to prevent the spread of the contagion. They should be kept in until entirely clean, and before they are allowed to go out, given an antiseptic bath. Disinfection is an important step in the prevention of its spread, for the contagion will cling for a variable length of time to articles used about the patient. The following from Welch and Schamberg is to the point: "All discharges, not excepting those from the nose and mouth, should be received into a vessel containing such disinfectant as chloride of lime, carbolic acid or bichlorate of mercury. Under no circumstances should the excreta be allowed to flow into the sewer or be cast away without first having undergone disinfection. In country districts where disinfection may not be readily obtained, the discharges should be buried deeply in the ground in a locality where there is no danger of contaminating the water supply. Every handkerchief, towel, and article of bedding and clothing used by the patient should be steeped for some time before leaving the room in a solution of two fluid cunces of chloride of zinc or four fluid ounces of carbolic acid to the gallon of water, and afterwards boiled by themselves for half an hour or longer in plain water; all small articles, such as bits of linen, sponge, absorbent cotton, and the like, should be burned immediately; all utensils used for eating and drinking should be purified by boiling water; and, in short, nothing should be allowed to leave the room without having first been subjected to some form of disinfection. After death or recovery, the sick room should receive attention. Everything of no great value, and everything that can not be properly disinfected, like the mattress, should be burned. Objects that can be subjected to wet heat without injury, should be boiled for half an hour. The room and such articles as can not be boiled must be subjected to thorough disinfection. Carpets should be raised from the floor, so that the gas can get under them. Neither the formaldehyde gas nor that from burning sulphur penetrates very deeply into dry material, so before fumigating it is well to spray the room and furnishings to be disinfected with some disinfecting solution. The forty per cent solution of formalin, which is generally used for disinfecting, diluted one or two times with water, is excellent for this purpose. The room must be carefully prepared by sealing all cracks and closing holes in the chimneys. If formalin is used, a pint to 1,000 cubic feet is not too much. If sulphur, five pounds to the same space, and in either case leave the room closed for eighteen hours. Sunlight and pure air are always in order, both through the time. of sickness and afterwards, and a plentiful supply should be furnished. They will kill the germs of disease; but the process is not rapid, and should be used to supplement the other, not to replace it. If these suggestions are carried out, all cases promptly reported, complete isolation of the sick and attendants, vaccination of those exposed, thorough cleaning of the convalescent patient, destruction of all discharges, bits of food, clothes, etc., used about the patient, screening of the room, and disinfection of house and contents, the present epidemic can be quickly subdued. TYPHOID IN ROCKLIN. At the request of the Board of Health of Rocklin, the Secretary of the State Board of Health visited that place on June 1st, for the purpose of determining the cause of the typhoid fever epidemic which existed there, and if found, have it abated. Rocklin is a small town of 1,000 inhabitants, the principal industrial industries being the railroad shops and granite quarries. The location is healthful and the water supply is from the mountains, the water being conducted in an open ditch to within about five miles of town, when it enters a closed pipe from a very small reservoir. Some of the railroad men bring water from the mountains on the engine for the use of their families. The first case appeared in December, 1905, and was soon followed by another in the same family. The second case might easily have been of secondary infection. There were no further cases until April, 1906, when a number of cases occurred in rapid succession, until on June 1st there had been nineteen cases. Loomis, a town of two or three hundred inhabitants, farther up the road and having the same water supply, had four cases of typhoid, which were no doubt traceable to the same cause, and are considered as part of the same epidemic. The cases were all typhoid, and there is no dispute as to diagnosis. Two deaths occurred out of the twenty-three cases. The cases were scattered in all parts of the town, and in only three houses was there more than one case in a house. In one there were three, and in two houses two cases each, leaving fifteen different points of infection, and in no case were the houses in close proximity, making it probable that the disease spread from one to the other. There was no common supply of milk, many keeping their own cows, so that milk as a cause was quickly eliminated, as was the vegetable supply, for a like reason. It seemed reasonable to suppose that the water supply was at fault, and this was strengthened by the fact that the families of railroad men who brought water from the mountains were not affected, and that Loomis, using the same water supply, had several cases of typhoid. It seemed so probable that the water was at fault that an investigation of it was undertaken by a member from the State and one from the local Board of Health. A sample from the reservoir had already been sent to the State hygienic laboratory for analysis, but the report had not been received. The reservoir was visited first. It was but a few yards across, and located close beside the wagon road and probably but one hundred or two hundred feet from the main line of railroad. It was entirely unprotected, even by a fence, which would keep boys or animals from bathing in it. This, of itself, might be the cause; but we determined to look further. The open ditch which brings the water to the reservoir runs through a farming district and is subject to the wash from many fields, orchards, and, no doubt, corrals. The capstone was reached, however, when at Penryn we found a China and Jap town situated in a small hollow, with gently sloping sides, but with quite a steep descent. The houses were built on either side and directly across the hollow which received all the drainage from them. Across the lower end of this hollow ran the water ditch into which discharged quite a stream of water, the drainage from the hollow. It seemed useless to hunt further for a cause, for while other sources of pollution might be found, here was enough to condemn the supply. The result of the examination of the water at the laboratory, received soon after the inspection, confirmed our belief that the water was polluted, colon bacilli being plentifully found. Owing to the reticent nature of the Orientals and their fear of being disturbed in their mode of life, it is very difficult to get from them any history of previous sickness. This makes it impossible to trace the disease to a former case, but as the Japanese are quite subject to typhoid, in this State, at least, it is more than probable that some one of them was sick with it in that camp, or came there while convalescing. To summarize: (a) We have two adjoining towns, having the same water supply, afflicted with a sudden epidemic of typhoid, where one in fifty of the inhabitants was sick, and a death-rate of ten per cent. (b) But four of the cases could possibly have been secondary. (c) Milk and other food supplies, as a cause, were eliminated. (d) All the cases used the town water supply. (e) A bacteriological examination of the water showed colon bacilli, and plenty of pollution was found by examining the ditch. There had been an attempt to keep the ditch free from pollution by building a flume over it for the drainage of the hollow to pass through. This, however, was ineffective, and the company was notified to at once take steps to conduct the water over the drainage. This they promptly did, and that source of danger has been shut out. The mud in the reservoir may be still infected, and when stirred up by any means may yet cause trouble. CALIFORNIA STATE BOARD OF HEALTH. Vol. 2. MONTHLY BULLETIN. Entered as second-class matter August 15, 1905, at the post office at SACRAMENTO, JUNE, 1906. No. 1. STATE BOARD OF HEALTH. N. K. FOSTER, M.D., State Registrar..Sacramento | GEORGE D. LESLIE, Statistician..... Sacramento STATE HYGIENIC LABORATORY. University of California, Berkeley ARCHIBALD R. WARD, D.V.M., Director. VITAL STATISTICS FOR JUNE. Summary.-For June there were reported 1,807 living births, 2,439 deaths, exclusive of stillbirths, and 2,342 marriages, as compared with 1,712 births, 2,375 deaths, and 1,739 marriages registered in May. The annual rates, based on an estimated State population of 1,882,483, are as follows: Births, 11.5 for June against 10.9 for May; deaths, 15.5 for June against 15.1 for May; and marriages, 14.9 for June against 11.1 for May. The increases in the rates for June over those for May reflect the growing completeness in the registration of vital statistics in California, though the rise in the marriage rate is due also to the fact that June is a favorite month for weddings. As usual, tuberculosis was the leading cause of death, followed by diseases of the circulatory and nervous systems, and by pneumonia and broncho-pneumonia. The most fatal epidemic diseases in June were typhoid fever, measles, whooping-cough, diphtheria, croup, and influenza. The mortality from typhoid fever was the same in June as in May, while the deaths from measles were less than before, and those from whooping-cough were greater in June than in the preceding month. |