your rabbit, it may become lousy and then its lice will give you Tularaemia, etc. Perhaps your rabbit may infect your white mouse, which, as of course you know, harbours the mite called Liponyssus Isabellinus-in which event Isabella's mite will get it in the neck and develop a sore and a bubo; for the disease starts with a shin abrasion and goes on to suppuration of adjacent lymphatic glands. In deed, this "new" disease might well be modified form of plague, or of any other sort of old-fashioned septicaemia. To find some new thing has always been a human desire, and we rebel against the saying of the preacher that there is no new thing under the sun. To discover a new star, to come to a new island, newly to unearth even an ancient tomb is joy to the discover; but before bursting into print the observer should have a care that he is not describing as new something which is in reality very ancient or something very well known to other scientists or earlier civilizations. Tularaemia Francis 1921 existed no doubt in 1291 among the rab bits and men of those days, although happily it was not then the medium of an advertisement. 爨 Three California Cities on Honor Roll. Health Administration Dr. Allen W. Freeman, professor of hygiene and public health in the Johns Hopkins School of Hygiene and Public Health, made an address recently upon the subject of "Health Administration in Rural Districts," before the health officers of New York State assembled in their annual conference. He urged the importance of appointing full-time county health officers. In his opinion the best way to bring this about lies in the adoption of an optional plan which will enable counties, if it may be desired, to receive grants from official and unofficial sources, which will permit the development of the full-time system. If we "The question of all questions in regard to the county health officer,” said Dr. Freeman, "is how to keep the office out of politics. Once the office becomes a question of political patronage, all hope of permanent constructive work is gone. The comparative success of our colleagues California may well be proud of the in England in keeping politics out of remarkable records in low infant mortal- public health depends on the rigidly ity rates made last year by Berkeley, specified conditions under which a license Long Beach and San Diego. According or diploma in public health may be proto the American Child Health Associa-cured. can devise a licensing tion of Washington, D. C., these Cali- system whereby an intending health offifornia cities have the lowest infant cer, before appointment, must pass a by an mortality rates of all cities in the United rigid examination impartial States Birth Registration Area having authority, we can lessen greatly the populations of from 50,000 to 100,000. pressure of politics. Nine times out of The published rates are ten when a health officer is displaced as follows: Berkeley 37, Long Beach 38, and San for political reasons it is because the Diego 47. appointing authority can not resist the The three cities of similar size, all out-pressure to appoint some one else to the side of California, which have the high-position. If appointment were limited to est infant mortality made rates of 129, those properly qualified, this pressure 129 and 122, respectively. so as to conserve health that life may be enjoyed to the highest possible would be much reduced or entirely absent. The traditional civil service requirement does not meet the need because the test is applied by a nontechnical agency and the examinations are not sufficiently severe. It has seemed to me that it might be possible for the U. S. Public Health Service, given the necessary authority by Congress, to institute a system of examining and licensing health officers issuing perhaps a national diploma in public health. In this way the qualifications specified by statute might be made to mean something more than they do at present." Dr. Freeman reported that, taking the United States as a whole, there are now 231 counties in 33 states which have officials serve 11.6 per cent of the rural whole-time health officers, and these populaion of the United States. The health administration has doubled since visiting nursing, if there is any distinc1920, when it was 109. On the basis of tion between the two. The private pracmany years experience and observation, titioners of the county will be mainly Dr. Freeman stated his belief that the concerned with the health supervision of whole-time county plan is the real their patients. They will probably be answer to the immediate problem of paid on an annual fee basis and will have health supervision of rural districts. approximately one thousand patients "Its service is tangible and valuable, its each. Everyone will be under constant cost is not excessive and it commends supervision. There will be no need of itself to the judgment of those who sup-much of what we ordinarily call health port it and live under its service." work. It will be the routine, normal Even with ideal health administration, activity of the whole medical service. however, Dr. Freeman asserted that the The medical director of the county will complete health service of the future can be in charge of the whole organization, be rendered only when there is complete under a board of trustees. The whole integration of the private practice of will be supported in part from state and medicine with the practice of public local funds, but largely from the payhealth. "This must be brought about ments of patients. The savings in medithrough an organization of all the cal and surgical fees which would result various sorts of doctors necessary to from having a single consulting physikeep the individual well, or to restore cian and a single surgeon, kept constantly him to health when he becomes sick in busy with an even flow of material, spite of our efforts, on the one hand; instead of having several practicing over and, on the other hand, we must have a large area and spending most of their an organization to maintain the contact time going to and fro as at present, between the individual citizen and this "would be great." medical organization. These functions, it seems to me, represent the true fields of activity of the physician and the health officer of the future." Diphtheria. MORBIDITY.* 136 cases of diphtheria have been reported as follows: Berkeley 5, Oakland 12, Los Angeles County 8, Los Angeles 43, Fresno 7, San Francisco 27, Hawthorne 1, Pomona 1, Stockton 1, San Joaquin County 2, Montebello Redding 1. Measles. Dr. Freeman, however, condemned "state medicine" as the term is often understood, namely, "a vast political machine in which all physicians are employed by the state and in which the 1, Sacramento 2, Long Beach 2, Santa Paula individual citizen receives his medical, Covina 1, Redlands 2, Glenn County 1, service as it is given him, without choice Burbank 1, Ventura County 1, San Bernardino of physcian or of method." The solu- County 1, Sonora 1, Eureka 1, Piedmont 1, tion according to Dr. Freeman must be Modesto 1, San Mateo 2, Bakersfield 1, Santa found somewhere "between the present Barbara County 2, Fort Bragg 3, Santa Clara haphazard, hit or miss individualistic County 1, San Bernardino 1, Sunnyvale 1, system with its inadequacy, its inefficiency and its waste on the one hand and the so-called state medicine on the other." It is the task of the health official in Dr. Freeman's belief to find the middle path and the right solution, and certain tendencies already indicate the general direction this solution will take. "It seems probable that for rural areas at least medical health service of the future will center about the county hospital. Such a hospital, with a wholetime staff on a salary basis, with its attached out clinics will be the chief source of medical service. To it will come all the seriously sick of the county, all maternity cases, all obscure chronic complaints, for diagnosis by every available means and for treatment, the best that can be had. Out from the hospital will go the visiting nurses, covering the whole county, doing what we know as public health nursing as well as ordinary 550 cases of measles have been reported, as follows: Los Angeles County 13, Los Angeles 74, San Luis Obispo County 17, Berkeley 5, Santa Cruz County 6, Tehama County 5, Tuolumne County 7, Eureka 20, Humboldt County 8, Stanislaus County 14, Santa Clara County 10, Oakland 10, Gilroy 15, Palo Alto 9, Pasadena 6, Sacramento 16, Orange County 8, Lodi 7, Stockton 5, Sonoma County 35, Alameda 15, Roseville 5, Modesto 6, Monterey County 9, Venice 6, San Francisco 115, Contra Costa County 4, Benicia 1, Lompoc 5, Vacaville 1, Tuolumne County 2, Redwood City 2, Solano County 2, Piedmont 4, Sacramento County 3, Santa Barbara County 3, Sunnyvale 4, Tracy 2, Colfax 5, Santa Maria 2, Santa Paula 1. Watsonville 4, Colusa 1, San Mateo 2, San Leandro 4, Long Beach 1, San Bernardino County 2, Susanville 1, Fillmore 1, Hollister 1, Fresno 4, Mendocino County 2, Fresno County 2, Colton 1, Yosemite 2, Santa Barbara 1, San Bernardino 2, Napa County 4, Madera 4, Calistoga 4, San Joaquin County 2, Monrovia 1, Pomona 3, Burlingame 1, Modesto 4, Huntington Park 2, Burbank 2, Fullerton 1, County 1, Alameda County 1, Chino 1, Santa Santa Monica 2, Visalia 2. Scarlet Fever. 82 cases of scarlet fever have been reported, as follows: Los Angeles 30, Los Angeles County 2, Oakland 7, Fresno County 7, Chula Vista 1, Sacramento County 1, Modesto 1, Colton 2, Palo Alto 1, Lodi 1, Stockton 3, Newman 1, Pomona 2, Fresno 1, San Bernardino County 2, Sonoma County 2, Fort Bragg 1, Sacramento 1, San Leandro 1, Pasadena 1, Orange County 1, San Rafael 1, San Francisco 4, Riverside 1, Redlands 1, Glenn County 3, San Bernardino 2, Burbank 1. Whooping Cough. 73 cases of whooping cough have been reported, as follows: Lodi 10, Los Angeles 10 Berkeley 6, Eureka 5, Chula Vista 2, Solano County 2, Piedmont 2, Dinuba 3, Stanislaus County 1, Oakland 1, Fort Bragg 3, Santa Barbara County 1, Humboldt County 2, Sonoma County 3, Fresno 4, Hollister 1, Escondido 1, Huntington Park 1, Colfax 1, Monterey County 1, Pasadena 2, Los Angeles County 1, Benicia 2, Santa Rosa 2, San Fran cisco 6. Smallpox. Barbara 1, San Joaquin County 4, Los Angeles 3, Tulare County 1. Typhoid Fever. 10 cases of typhoid fever have been reported, as follows: Colusa 1, Fresno County 1, Los Angeles 2, Pomona 1, Sonoma County 1, Los Angeles County 1, Pasadena 1, Martinez 1, California 1. Cerebrospinal Meningitis. Four cases of cerebrospinal meningitis have been repoted, as follows: Fresno 1, Sacramento 1, Orange County 1, Los Angeles 1. Poliomyelitis. Two cases of poliomyelitis have been reported, as follows: Los Angeles County 1, Chino 1. Epidemic Encephalitis. Two cases of epidemic encephalitis have been reported, as follows: Sebastopol 1, National City 1. Leprosy. Los Angeles reported one case of leprosy. 21 cases of smallpox have been reported, as 1923 Entered as second-class matter February 21, 1922, at the post office at Sacramento, California, under the auditors. Dr. Hermann M. Biggs, State Health The conference on child hygiene conCommissioner of New York, one of the ducted by the Bureau of Child Hygiene foremost public health administrators, of the California State Board of Health died in New York City on June 28th. in San Francisco is in progress at this writing. Miss Marie Phelan, ConsultThe influence of Dr. Biggs, in the ing Public Nurse, of the Children's determination of public health standards Bureau, Washington, D.C., is contributand in the establishment of procedures ing a valuable course for the public now in general use throughout the coun-health nurses in attendance. She is try, is recognized. Dr. Biggs was always lecturing each day of the conference a leader in the advance of public health and her work is appreciated by her and his death is a loss to all public health Among other speakers are workers. He was appointed Commission- Dr. Alfred Baker Spalding of the faculty er of Health of New York State in 1914 of Stanford University Medical School, and served in that capacity continuously "Prenatal Care"; Miss. Marguerite Wales, to the time of his death. From 1901 to R.N., of the Stanford University Clinics, 1914 he was general medical officer of Social Service and Public Health Nursthe New York City Department of ing"; Miss Dorothy Ledyard, R.N., Health. He held many other important Assistant Director, Nursing Division of posts during his life. It was he who the American Red Cross in San Franintroduced diphtheria antitoxin into this country and he was largely responsible for making bacteriological methods of practical use in the control of communicable diseases. New Edition of General A new edition of General Health Laws of California has been received from the State Printing Office and is ready for distribution to all individuals who may desire a copy. There are relatively few changes in the laws as published in the older edition, now exhausted. cisco, Dr. Langley Porter, San Francisco, "Infant Feeding"; Dr. E. V. McCollum of Johns Hopkins University, "NutriFrancisco, "Infant Care"; Dr. William tion"; Dr. Florence Holsclaw of San Palmer Lucas, Professor of Pediatrics, University of California Medical School, "The Runabout Child"; Mrs. Freda M. Whyte of the Bureau of Child Hygiene, "Midwife Survey of California"; Dr. Richard A. Bolt, Secretary of the Washington, D.C., "What the Child American Child Hygiene Association, Health Association can do for the Public Health Nurse"; Dr. Alvin Powell, Director of the Alameda County Health Center; "Organization of the Community for Prenatal and Infant Welfare"; Miss Anastasia Miller, R.N., Sacramento Red Public Health Nurses Organized Campaign Against In an address at the annual meeting of the National Tuberculosis Association, held in Santa Barbara on June 20th, Dr. Louis I. Dublin of New York City gave credit, in a large measure, to official and non-official agencies, for the lowering of the tuberculosis death rate. He said: The second institute for public health nurses conducted by the Summer Session of the University of California in cooperation with the California State Board of Health will open in Los Angeles on Monday, July 23, at the southern branch of the University on Vermont Avenue. A large number of nurses have registered for attendance at the institute and many who have not yet made formal application for admission are expected to attend. Certificates of attendance will be given, however, only to those who file application for admission with the State Board of Health, Sacramento. The program varies from that of last year's institute in that no freld work is included this year. The sessions will use but half of the day, leaving the rest of the day free for visiting clinics, health departments, hospitals, health and other institutions in Los Angeles and vicinity, if desired. centers "The decline in the tuberculosis death rate of the last two decades is in large measure to be credited to the organized campaign against tuberculosis which has been carried on by the official and nonofficial agencies during this period. Not all, but a large part, of the credit for the Miss Marie Phelan, Consulting Pubdeclining tuberculosis death rate can be lic Health Nurse of the Children's assigned to the anti-tuberculosis move- Bureau, Washington, D. C., will conment. No one knows all the facts on tribute important lectures at the instithe causes of the reduced prevalence of tute. Child Hygiene and communicable the disease. It would be unreasonable disease control, tuberculosis, nursing and to deny that there are persons so con- other subjects will be given considerastituted that even under favorable living tion and an opportunity for questions and hygienic conditions they may become and discussion will be provided. seriously sick with tuberculosis and The complete program follows: PROGRAM PUBLIC HEALTH NURSES INSTITUTE would not respond to any treatment now heritance; persons who unknowingly or State JULY 23 and Sheppard-Towner Act. DR. ELLEN STADTMULLER, "With the continued rise in the level 2 P. M. Prenatal Care. of general intelligence and economic well-being, the amount of control over tuberculosis will be increased. What MISS MARIE PHELAN, Consulting Public Health Nurse, Children's Bureau, Washington, D. C. may happen in the future is indicated by 3 P. M. Measles and Whooping Cough. DR. G. J. TELFER, District Health Officer, California State JULY 24 the phenomenal drop in the tuberculosis 1 P. M. Prenatal Care. Hygiene and Compli MISS MARIE PHELAN, Consulting Public Health Nurse, Children's Bureau, Washington, D. C. DR. H. F. TRUE, Director Health Work, City Schools |