ï~~ 16 REPORT OF TIH[E STATE BOARD OF HEALTH. Williamls Ophuls' work on arteriosclerosis and cardio-vascular dish ease shows through the results of 500 consecutive complete necropses aÂ~ close relationship to the ini fetios (liseases. Ie states: " The injury to the arteries usually occurs early in life and the anatomic lesions seem to develop very slowly and progressiveTy even after the original infection has become extinct." PROBLEMS PECULIAR TO STATE. California, because of its unique geographical position, has many public health problems which are essentially peculiar to the state and which require continual alertness upon the part of the local, state and federal authorities. Among these are the tremendous flow of tubereulous persons into the state: chronic plague in rodents; typhus fever, ever present on our southern border; and the potential danger in other highly dangerous diseases from Oriental sources. With all of these dangers continually before us there still remains this most important problem of all-the prevention of an excessive communicable disease prevalence and the far-reaching and ravaging end-results of these diseases. The public wants to know not only why so many physical defects are found in young adults, hut it also wants to know what is the cause of these conditions and why they are not corrected. The physician is nearest to this )1oblenl, and it is through him that a solution must come. In the words of Boyd, in the introduction of his "Practical Preventive Medicine," this situation is very clearly set forth-"The medical profecssion can play an important role in the field of preventive medicine and public health. At present physicians are neglecting their opportunity. If this neglect continues, the opportunity will lessen and the field will be taken fron the physicians. Many agencies, both official and unofficial, are actively engaged in the furthering of child health and welfare, and are stressing the impor tance of physical perfection, although it is known and appreciated that building strong bodies has in all probability great influence in the reduction of the number of deaths and prevention of harmful sequelm of these diseases, it must not be forgotten that. influenza, apparently, took gruesome deli ght in selectilg its victous from amn11111g the most robust. Health 1eparItmiielnts can 1(int with p11id to th1cir aeeonp)lishments in the prevention an( control of co11111umueable diseases through the removal of environmental cansative factors. The victory over typhoid and the winning fight being waged against mlalaia are matters of common knowledge to every s(hool boy. These results have been acconi plished by health authorities purely through the control of environ mental conditions, in the accomplislullet of which the services of the medical profession have not been required. PUBLIC WANTS TO KNOW. The general public now wants to know how all communicable diseases are controlled. It wants to know why the diphtheria death rate con tinues high in spite of antitoxin. It wants to know why measles and scarlet fever are of such commnon occurrence. It wants to know why so many children die of whooping cough. The demand for such infor mation is continuous. The medical profession must give closer coop orntion in tihe control of these and all other contact diseases. It must;,. 1 r',t.!; {i i y f t s 1( f''"" '.;CI' "E. ih.:..Y. i s. rj,;,'::, 4:: r: t-- (!',, kit' d" L:: u ' t. J'?. G-:, REPORT OF SECRETARY.17 give careful attention. to the regulations for their control. Without such cooperation, public health authorities are helpless in reducing the prevalence of these communicable diseases that have so much to do with diseases of adult life. Unless the medical profession unites wholeheartedly in the performance of this civic duty, results that may be exceedingly disastrous not only to the prestige of the profession but also destructive to the health and welfare of the Nation's children and its future citizens are sure to follow. With the full support and unreserved interest of the profession it is possible to obtain results that will reflect not only to the honor of medicine, but which will also go far in maintaining our children's health and in making of them strong, sturdy, healthy citizens. II. INFLUENZA.!' f'.:. r r h.< The last of the important waves of influenza was noted in California during 1920, with a slight recurring rise in 1921. The numbers of cases and deaths from this disease for the past four years are as follows: Year Cases Deaths 191S -----------------------------------30,845 13,340 1919 ---------------------------------852,082 4J4-6 1920 -------------------------------6,153 2,715 1921 --------------------------------2505 339,fi, 4., t''; ":: SMALLPOX. The increased prevalence of smallpox is due, largely, to the fact that a considerable portion of the population of California has not been vaccinated against this disease. It is probable, also, that many cases of a more severe type of the disease have been imported from Mexico, causing a higher mortality for this disease during 1921. The control of smallpox in California has been particularly difficult, because of the cumbersome and awkward vaccination act of 1911, which was repealed in the legislature of 1921. In the ten years of its operation, this law brought only discord and lack of harmony. Most of its measures were never enforced by school and health officials. Its provision for the exclusion of all unvaccinated persons in attendance upon the schools whenever smallpox existed within the district led to situations difficult to control. Under the act of 1921, the control of this disease is placed under the regulation of the State Board of Healthlocal school and health authorities being -forbidden to pass any regulations or orders for its control. The numbers of cases and deaths from smallpox reported during the past four years are as follows: Year Cases 1918 ---------------------------------- 1,016 1919 ------------------------------2,002 1920 _ _ _ __------------------------------4,497 1921 ___-------------------------------5,579 Deaths 3 5 21 DIPHTHERIA. The increase in diphtheria morbidity and mortality is not confined to California, alone. The other states have shown the same increases, and la nvhi n ronnrn+zA -1nin +m -+ 1 +L, a - - ' 0