ACTIVITIES of the San Jose Health Department Prepared by H. C. BROWN, M. D. City Health Officer and his staffii San Jose, California January 1, 1941 DEPARTMENT OF HEALTH Foreword Year after year citizens and students, especially students, who are interested in the activities of the health department have requested informa- tion on this subject. They desire to know what is being done to safeguard the health of the people. They ask for written or printed matter that we may have on hand dealing with health department activities. The number seeking such information has increased considerably year by year. In order to meet this demand, the writer, believing that a worthwhile service could be furnished these citizens and students, requested the heads and members of the various divisions to present a written concise condensa- tion of their activities that could be incorporated in a general report em- bracing all activities of the health department. It is with this thought in mind that this outline of the activities of the San Jose Health Department is submitted to the general public and to students in our schools for their study, criticism, discussion, and education. H. C. BROWN, M.D., City Health Officer. DEPARTMENT OF HEALTH HEALTH OFFICER The head of the department of health shall be the health officer. He shall have all the powers and duties conferred on boards of health officers by the general laws of the state and such other powers and duties as may be conferred by ordinance. The health officer shall have the degree of doctor of medicine or shall have received a degree in public health from the Uni- versity of California or other institution of equal standing and have prac- ticed or have been engaged in public health work for at least five years. He is appointed by the City Manager. He is responsible for the administration and supervision of the activities of the department, which are as follows : Administration General administration, policy formulation, budget preparation and control, accounting and statistics. Health Division Preventive medicine, sanitation, food, milk, water, sewage, refuse dis- posal, nuisances, rodent control, mosquito control, housing requirements. Laboratory Communicable Disease Control Morbidity and vital statistics, nursing, immunization, vaccinatiqn. Diagnostic service to physicians, tuberculosis control. Hygiene Maternal, child, and mental. DIVISION OF VITAL STATISTICS (Miss) Emilie G. Cornac, Deputy Registrar of Vital Statistics and Secretary to the Health Department Birth and death certificates are of great importance as you will notice in the following paragraph that gives the purposes for their use: Birth Certificates: To prove date of birth For entrance to school For first work permit For automobile license For right to vote For right to marry For entering military service For settlement of pensions For proving parentage For social security benefits to blind, dependent children, aged For inheritance of property For settlement of insurance For legal dependency For establishing identity For tracing ancestry For proving place of birth to establish citizenship for immigration, emigration, and for passports Death Certificates: To furnish official statistics for health departments To establish causes of death to prevent disease To plan health programs For life insurance to establish premium rates For mortality statistics by place of death by residence For estimating population To prove the fact of death for life insurance claims For settlement of estates To prove facts about the deceased for circumstances of death, time, and date of death For age, sex, and color; for nativity; for names of husband or wife and parents All birth and death certificates are filed and carefully checked for omissions. If a death occurred from a communicable disease, the funeral director is requested to hold a private funeral. If death was due to an ac- cident of any kind, and the Coroner’s signature does not appear on the certi- ficate, he is immediately notified regarding the death, and if he deems it ad- visable he conducts an investigation. Since the new death certificate bears the Social Security number of the deceased, a proof of death is typewritten and sent to the Social Security Board. A telegram is sent to Washington, D. C, Bureau of the Census every Saturday morning, giving the number of deaths occurring from auto- mobile accidents in the city. At the end of the month, classification and compilation of all births and deaths is made by tabulating for age, sex, color, nativity, and for the cause of death, for our annual report. If the name of child has been omitted on a birth certificate, a supple- mental report of birth is mailed to the parents with the request that when the child is named they fill in name and return to the Health Department so that the name of child will appear on the record. Birth and death certi- ficates are indexed each month, and at the end of the year are bound and kept on file. A great deal of time is spent in searching records of births and in an- swering inquiries. If the birth is on file, certified copies are issued at $1.00 each. Certified copies are used in all important matters. However, a Noti- fication of Birth Registration is issued free of charge. If a birth is not on file, information is given as to the preferences given by the government au- thorities for the next best document, such as baptismal certificates, affidavit by parents, or physician, etc. As secretary to the health officer and the health department my activi- ties are as follows: Answer the telephone and give information regarding ordinances on food, milk, sanitation, communicable diseases and vital sta- tistics. Answer counter calls, make appointments for different members of the department, take sanitary complaints, and keep record of all calls. Write letters and reports for the health officer. A bulletin is issued at the first of every month. Approximately 200 are mailed to schools, health workers, and physicians. An accrual report for all monies received is given to the City Auditor at the first of the month, and a list of laundries recommended for a permit is given to the City Council, together with a summary of the department’s activities. A list of vaccinations and immunizations given in the health department on its regular Wednesday afternoon clinics, and at the well baby conferences, is kept in alphabetical order. All barbershop, poultry dealers, auto camps, meat license fees, and vital statistics fees are turned into the City Treasury, and records kept. DIVISION OF COMMUNICABLE DISEASES (Miss) Margaret F. Nelson, Public Health Nurse (Mrs.) Elizabeth Campisi, Public Health Nurse (Mrs.) Josephine Wagner, Public Health Nurse The following are the activities of the communicable disease division: 1. Communicable Disease Control 2. Venereal Disease Control 3. Tuberculosis Control 4. Infant Welfare 5. School Nursing Public health nurses are employed to assist the health officer in main- taining a program which meets community needs in these five standard divisions of public health activity. Nurses work under the supervision of the health officer, and their duties are as follows: Communicable Disease Control It is the nurses’ duty to assist the health officer in tracing the source and preventing the spread of communicable disease. This is done by en- forcing state and local regulations governing the various diseases report- able by law. Major diseases are quarantined and a nurse visits the indi- vidual suffering from such a disease for the purpose of placing, supervising, and terminating quarantine. Minor diseases receive two nursing visits. A continuous program of education is carried on to secure a large percentage of immunized and vaccinated children. The health department maintains a weekly vaccination and immunization clinic for infants and pre-school children. Venereal Disease Control Health department nurses assist the health offcer in a social hygiene program by cooperating with physicians and the County Hospital Hygiene Clinic in securing treatment for the infested individual, finding sources and preventing further spread of infection. When a patient lapses treatment, the nurse visits such patient and tries to keep him reporting regularly for treatment. Tuberculosis Control A health department nurse attends the weekly clinic at the County Sanitorium where she takes histories, interprets doctors’ recommendations to the patient, and becomes acquainted with the patient and his condition. The nurse becomes further acquainted with the patient and his family sit- uation by making visits to the home. For the infectious cases at home the family is instructed in isolation technique to prevent spread of the infection to other members of the family. The entire family is tuberculin tested and reactors are X-rayed and examined in clinic. Cases of contacts are super- vised and given appointments for examination as often as the doctor ad- vises. By close follow-up tuberculosis is prevented or discovered in an early stage where the percentage of cures is high. Health department nurses as- sist the school department is case finding by annual tuberculin survey. Infant Welfare The health department conducts weekly well baby conferences. The nurses assist the pediatrician in his examination and instruct the mother in general hygiene and care of the infant. Pre-school children are admitted to the conferences for advice on habit training and for diphtheria immuni- zation and smallpox vaccination. Home visits are made by the nurse in an attempt to give further help to the mother in keeping healthy babies healthy. School Activities In December, 1938, with the addition of a new nurse in the health de- partment, health supervision in the parochial schools was taken over by the health department. Each school has the services of a nurse for two hours two days a week. The present routine includes investigation of absentees, weighing, measuring of children and communicable disease control. This year a program of physical inspection of all the school children is being carried out by a panel of volunteer physicians. Notices are mailed to parents to notify them of the defects found, and reports of defects corrected are kept by the nurses. Nurses are required to report in the health department three times a day to get new calls, and to take care of telephone messages. A daily re- port of activities is given to the health officer. The nurses do the record work in all communicable and infant welfare cases. New cases are recorded daily and school cases reported to the school department. Nurses are on duty in the health department at definite hours to take nose and throat cul- tures, read tuberculin tests, and inspect children after communicable disease and issue school permits. One clinic a week is held in the health department for Mantoux testing, vaccination and immunization. Another is held for reading and repeating the tests on pre-natal cases attending County Hospital Clinics. DIVISION OF FOODS M. B. Bell, Chief Food Inspector and William B. Champion, Food Inspector The Division of Food Inspection covers a large scope of diversified inspections and is not confined entirely to the inspection of foods, but in- cludes sanitary inspection of the premises, utensils, and other equipment where foods are prepared, served, or sold to the public. Types and number of food establishments under the supervision of this division are as follows; Bakeries 52 Food factories 58 Groceries, fruit markets and delicatessens 265 Restaurants 296 Soft drinks and confectioneries 72 Meat, fish, and poultry markets 133 Poultry killing plants 3 Sausage and processing factories 3 Wholesale meat jobbers 4 Commission and wholesale produce houses 26 There is a total of 912 food establishments; the number of inspections made last year was 8,266. Ordinances and Regulations Application for a permit to conduct a food place of any kind must be made in writing to the health department before operating. Inspection of the premises is then made and if found to comply with the sanitary require- ments, a permit to operate such business is issued by the health officer. Sanitary Requirements of Premises. Interior of building must be of a smooth finish. Walls and ceilings where cooking, baking, or processing is done must be finished with a washable surface; floors must be water tight and smooth. Ventilation. Adequate ventilation must be provided. Entrance doors with screen door or rapid action blade fan. All other openings to have stationary screens. Toilets and Dressing Rooms. Toilets for both sexes, double vesti- billed, and vented to outer air; both toilets to have wash basins with run- ning water supplied with soap and paper towels. Sanitary Requirements. Equipment. Sink must be all metal and have two compartments; separate sink for glass washing is required; automatic controlled water heaters for hot water supply connected to both compart- ments of sink; hoods over all cooking equipment vented to outer air; ade- quate refrigeration, 40 to 50 degrees F. temperature; glass cases or con- tainers to protect food supplies ; and any such other equipment that may be necessary to conduct the business that a permit is applied for. Method of Inspection Special attention is given to the washing of eating utensils in public eating places. Bacterial counts are made in the City Laboratory from cul- tures taken from these utensils. By this means it is determined if they have been properly washed and sterilized. Foods must be protected from flies, dust, or any other foreign or injurious matter. Foods are inspected for their fitness for human consumption, and any foods found to be contami- nated by disease, spoilage, adulteration, or from any other source that would cause it to be unfit for food are condemned and destroyed. HOUSING SANITATION Hotels and apartments are supervised by inspectors of this division. There are 949 hotels and apartments under supervision at the present time. The State Housing Act and ordinances of the City of San Jose define the re- quirements for obtaining a permit to operate a hotel or apartment house. The inspector visits the premises to ascertain if all the requirements have been met as to the cubic feet of air space, square feet of floor space, window area, and ventilation of each type of room. If the requirements have been met, a permit is issued. DIVISION OF MILK AND DAIRIES E. P. Bernard, Milk Inspector This division of the Health Department is divided into three distinct groups; namely, the producer dairy farms, the producer distributor farms, and the city milk plants. Sixty-four producer and producer distributor farms comprise the San Jose Milk Shed that supplies the City of San Jose with approximately 10,000 gallons of market milk daily. State Laws re- quire that all dairy cattle shall be tested for bovine tuberculosis every year. During 1939 there were 5400 herd of dairy cattle in the San Jose Milk Shed tested for tuberculosis and only 27 head reacted to the test. Four grades of milk are sold in the City of San Jose. They are as follows: Certified Raw Milk Certified raw milk is market milk that conforms to the regulations, methods, and standards for the production and distribution adopted by the American Association of Medical Milk Commission. Certified milk shall contain not more than 10,000 bacteria per milliliter. Grade A Pasteurized Milk Grade A Pasteurized Milk is market milk that is uniformly heated to a temperature of 142 degrees and held at such temperature for at least thirty minutes, then cooled to a temperature of fifty degrees Fahrenheit. The purpose of pasteurization is to protect the public by eliminating organ- isms that are harmful to human beings. Grade A Pasteurized milk shall contain not more than 15,000 bacteria per milliliter. Guaranteed Raw Milk Guaranteed Raw Milk is market milk produced in dairies that score not less than 90 per cent. Guaranteed raw milk shall contain not more than 10,000 bacteria per milliliter. Grade A Raw Milk Grade A Raw milk is market milk produced in dairies that score not less than 80 per cent. Grade A Raw milk shall contain not more than 15,000 bacteria per milliliter. DAIRY FARM INSPECTION All dairy farms are inspected at frequent intervals and an inspection is made of milking barn, milk house, corrals, storm sheds and milk hand- ling. General supervision is also given to methods used in milking and handling of milk, water supply, water troughs, feed, control of flies, health of cows, and general appearance of premises. MILK PLANT INSPECTION There are 19 milk plants under San Jose’s milk inspection service, where milk is received for processing and distributing. In milk plants an inspection is made of the receiving room, the milk handling room, the wash room, the storage room, and the vehicles of distribution. Special attention is given to bottles, cans, milk cases, personal appearance of employees for clean hands and wearing apparel. A water sample is taken in plants that have their own well. All operators of pasteurizer equipment must hold a pasteurizer’s license. Before issuing such license the applicant is given an examination by the Health Department in order that the Health Officer may be satisfied that the applicant’s knowledge as to the technique and the laws pertaining to the pasteurization of market milk and cream is satisfactory. DIVISION OF SANITATION Lester W. Keaton, Sanitary Inspector The activities of this division are many and varied and cover a large field. Among the more important ones are: Water Supply. Collection of water samples from cross connections of private wells with the city supply is frequently made. This is done to test for possible pollution of the well from harmful bacteria that would cause sickness and also to prevent a pollution of the public supply if the two waters should mix. Frequent samples are brought into the Health Department laboratory from the public supply. This is a double check on the water in order to provide all possible protection from water borne diseases. Swimming Pools. Weekly samples are taken from all pools, pools are inspected, and reports given the operators in order that the water may be maintained in a safe condition. Nuisance Complaints. Approximately 1100 complaints a year are made about garbage, chickens, animals, rats, buildings unfit for human habita- tion, mosquitoes, and many other miscellaneous complaints. The complaints are investgated, and special precaution taken not to divulge the name or address of the person making the complaint, and the offender is instructed as to how to abate the nuisance. Garbage Complaints. Garbage complaints are very numerous. The garbage ordinance provides no burning or burying of garbage be allowed, and all garbage to be kept in a regulation garbage can and disposed of by the garbage collector licensed by the city. There is only one garbage col- lection company in San Jose, and they have a fifteen year contract expir- ing in 1947 to remove all garbage. The rates and regulation of the com- pany are provided for by law and contract. In case of disputes such as overcharging or inefficient service the Health Department makes the final decision. Rat Complaints. Free rat poison is given with instructions as to how to put out the bait. When necessary a survey of the premises is made and recommendations given. Condemnation of Houses. Whenever a house becomes unfit for human habitation, a placard is placed on the house and notice given the owner or agent listing the necessary repairs. A house may be condemned as unfit for various reasons; principally for being old and dilapidated; poor or in- sanitary plumbing; roof leaky; floors unsafe, foundation bad; plaster cracked and broken ; in fact, any one or more things that would be unsafe or unhealthy. Barber shops are inspected about three or four times a year, and method of sterilization and general condition of shops checked. All laundry employees are inspected once a month for freedom of con- tagious disease. Dog Bites. Whenever a dog has bitten a person a complete history of the circumstances surrounding the bite is taken, and the dog usually sent to the Pound for rabies observation or quarantine. If at the end of two weeks the dog shows no indication of rabies, the owner is allowed to re- deem his dog. Persons bitten are interviewed and if wounds are serious, they are instructed to see their physician. THE MUNICIPAL PUBLIC HEALTH LABORATORY Luther U. Sovy, A.B., Bacteriologist A municipal laboratory serves three major purposes. First, It serves as an aid in establishing the diagnosis of certain com- municable diseases. Second. The laboratory provides for a certain degree of control of milk and other food products, for which there exists a local or state standard. Third. It assists in providing for control bacteriologically and chemi- cally of miscellaneous items for which no standards exist. Diagnostic Procedures The bulk of work in the laboratory control of communicable diseases consists of the examination of throat cultures for diphtheria organisms and streptococci; bacteriological and serological examination of specimens of infectious material from suspected cases or carriers of typhoid fever and dysentery (bacteriological and amoebic) ; examination of smears and sero- logical tests for the diagnosis of venereal diseases; smear examination, and animal inoculation for the diagnosis of tuberculosis; smear examina- tion for Vincent’s Angina (Trench Mouth); Agglutination tests for Malta Fever (Undulant Fever); Cough plate examinations for Whooping Cough, and the examination of animals suspected of having rabies or hydrophobia. Control of Milk and Other Food Products The State Law requires that Grade A Raw or Pasteurized Milk shall not have in excess of 15,000 bacteria per cubic centimeter of milk. There are also certain standards for the public drinking water supplies that must be met. The use of preservatives such as benzoates, sulfites, or other chemicals used in preserving meats, meat products, and certain other foods are prohibited. Only by laboratory analysis is it possible to maintain these standards. Laboratory Control of Miscellaneous Items for Which No Standards Exist Bacteriological examinations are done on restaurant utensils such as spoons, forks, glasses, and cups at regular intervals. Bacteria counts on wash and rinse water from restaurants, as well as testing for sterilizing agents such as chlorine is frequently done. Chemical examination for spray residues on fruits; bacteriological examination of watercress or other plants and vegetables usually consumed in the raw state is occasionally done. When suspected poisoned foods are brought to the laboratory by owners of pets or by humans made ill by foods, the most common poisons looked for in these instances are arsenic, cyanide, and strychnine. Besides the examination of suspected substances, stomach contents, or certain organs of the animal poisoned may have to be analyzed. These are the major chemical and bacteriological procedures usually carried out in public health laboratories. However, there are many tests of minor importance that are done less frequently, but all have some value in maintaining our present high standards in public health.