CLiimATOliOGY AND Diseases of Souttern California BY F. D. BULLARD, lleprititedfrom the Southern California Practitioner. Climatology AND Diseases of Southern California.* BY FRANK D. BULLARD, A. M., M. D. Introduction.—The climate of a country has such an influ- ence upon the prevalence of disease and upon the character of the prevailing affections, that, in order to understand the disorders to which any region is prone, it is necessary to be acquainted with its meteorology. Accordingly, the writer of this article will first consider briefly what constitutes climate, and then apply these general principles to Southern Califor- nia; after which he will discuss the chief diseases, with a special reference to their season and virulency. Factors of Climate.—Climate may be defined as habitual weather. The factors which go to make up this accustomary condition are not a few. Temperature.—Temperature is doubtless the most impor- tant ingredient, as heat and cold of themselves are powerful agents, but it occupies the first place, not so much from a high or low therinometrical average as from evenness or va- riability. Rapidity and extent of variation, frequency of sud- den changes, nyctheineral and yearly range are all important considerations under temperature. Humidity.—The per cent of moisture in the atmosphere modifies to a great degree the effect of heat on the body, dry- ness rendering even an extreme heat tolerable. This mitigat- ing property is the result of the evaporating power of the air —a quality which is increased by heat, wind, aud light atmos- pheric weight, and diminished by moisture, low elevation, and increased air-pressure. Relative Humidity.—Absolute humidity, the amount of * Prire Essay of the California State Medical Society for the Session of 1890. 2 Climatology and Diseases of Southern California. moisture in the atmosphere, is exceeded in importance by rel- ative humidity, that is, the degree of satisfaction of the vapor - containing capacity. A very hot air will hold more water than a moderately cool one. It may contain considerable moisture and yet be thirsty for more—at the same time absolutely moist and relatively dry. Clouds and fogs regulate the humidity, temperature and consequent drying power of the atmosphere by gauging the amount of direct sunlight. Rain and Wind.—Rainfall, both as to amount and distribu- tion, stands hardly second to temperature in the determination of climate. The winds, their frequency, direction, velocity and composition from over laud or over sea, define in a great measure the character of the atmosphere. Latitude and Elevation.—Latitude, and more especially elevation, modify the weather; e. g., the height and direction of mountain chains, acting as a guard to fend off cold, con- densing the hot, moist air-streams into rain, controlling the passage of wind currents, causing some slopes to face the sun and turning others from its rays, have a varied and great effect upon climate. Miscellaneous Climatic Factors.—The proximity of land to lakes, desert or sea, the presence, direction and character of ocean currents, the slope of the country, the character of its soil—its porosity, vegetation, drainage and water supply, and lastly, the quality of the atmosphere itself—whether laden with dust and organic matter, or clear, bright and pure; all these are factors, which in no small degree determine the climate of a country. Coast.—In defining California of the South, the western slope of the Sierras below Point Concepcion is usually meant. The coast extending thence to Lower California is some three hundred and thirty miles long, but in making this distance it measures two hundred and fifteen miles east and about as far south—forming, with the southeast diagonal, a bow, which throws the northern coast with a southerly exposure, and trends the southern shore toward the west. Mountains.—Starting from the same point, a spur of the Coast Range turns east and meets the Sierras, forming a high wall between the northern and southern sections of the State; then the united ranges, hugging, at first, the shore in Santa Barbara and Ventura counties, diverge more and more from Climatology and Diseases of Southern California. 3 the coast, aud curving in San Bernardino county again point south, thus causing the land in the north to face the sun, and in the south to be turned west to the sea. The mountains do not, however, form an unbroken wall, but are let down in several low passes, which serve as channels both for trade and for the great air-rivers. The height of this chain is suffi- cient, nevertheless, to store, in the form of snow, water to irrigate the plains below, and to temper with its cool air the hot breath of the desert beyond. Islands.—Quite parallel with the mountains on the land there seems to be a double range at sea, whose tops dot the waters as the islands off our banks; these, as well as the changed coast line, ward off from the land the cooled Japan stream and allow a return warm current to bathe the shore— a fact evidenced by the harsher climate of the outer and more exposed tier. Effect of the Mountain Chains.—As these sea mountains turn aside ocean streams, so the land mountains have an im- portant bearing on the air currents. During the summer the northeast trade-winds blow off shore, which, coming from the land, are, of course, dry, and make the warm season; but in winter the southwest counter-trades, laden with moisture from the sea, blow on shore and bank the clouds against the rocky wall of the Sierras, causing our wet season. Rainfall and Winter Winds.—As these counter-trades fol- low the sun, it is noted that usually the rainfall is a few days later than iu Central California. The general rule on the Pa- cific slope is, the further south the less the precipitation. The contour of the mountains iu some sections eauses an excep- tion. The range when running an easterly course presents a square front to the on-coming south winds and acts as a bet- ter condenser; hence, in Los Angeles, there is nearly the same average, sixteen inches, as iu Sacramento. When, however, the mountain chain bends south iu San Bernardino county and runs askance to the moist wind current, the precipitation is somewhat less, and in San Diego, on account of combined lower latitude and parallelism of the mountains, the rainfall is diminished nearly one-half. As the trade-winds occur between October aud May, the rainy weather is limited to this season, with but occasional showers at other times. The annual av- erage varies greatly, even in a few miles, being greatest on 4 Climatology and Diseases of Southern California. the coast and on the foothills. December and February have the heaviest records, it being cloudy or rainy one-fourth of the time during those months. Summer Winds.—In the summer the daily to and fro laud and sea breeze moderates the otherwise high temperature to a considerable degree. Back of the ridge the great heated des- ert warms the air, which of course rises aud sucks in the cool sea-breeze daily from noon till sundown. The heated air makes its way to the ocean in the upper strata, dropping down at night to help the natural off-shore land-breeze perhaps, for often one feels amid the cool mountain evening winds the warm puffs of the hot trade but lately born on the desert. The Santa Ana.—Another wind, local in nature, and er- ratic in course, called the Santa Ana, from a pass of that name, blows strong, dry and hot from the north; though dis- agreeable at the time from the heat and driving sand, it nev- ertheless leaves a bright clear atmosphere. Temperature, Yearly Range.—The temperature of South- ern California is very equable; the more even the nearer the coast, presenting both a lower aud a higher reading in the interior—from an annual variation of twelve degrees (from 54° to 66°) between winter and summer in San Diego to a yearly change of twenty-three degrees (from 50p to 73°) at Riverside. But as the relative humidity is in inverse ratio to the distance from the sea, the San Bernardino winters, while sharper, are less chilly than in places near the coast, and the summers, though hotter, are less sultry, for the air, capable of drinking in a large amount of moisture, assists greatly the insensible perspiration. Daily Range.— This country is characterized by a large nycthemeral range, which also increases as the coast is left. In most localities this difference is greater in summer than in winter; in Los Angeles the daily change is one-fourth more in the dry season, in which city the difference between sunrise and noon in July is twice as great as that between an aver- age August and December day. Fogs.—In the summer, on the shore-line, to a short distance both on land and sea, fogs occur, but as here the sea air derives its coolness from a warmer current than the Japan stream, they lack the penetrating chill of the northern fogs. Sunshine. —The amount of sunshine enjoyed in this region Climatology and Diseases of Southern California. 5 is unequaled, perhaps, in the civilized world. There will hardly average fifty days in the year, but what the sun shines part of the day. Fully half of the time the heavens are en- tirely clear. Atmosphere.—The atmosphere, as one might suppose, is quite pure, free from the smoke and dust of manufacturing re- gions, usually clear, bright and diathermic; sometimes filled with fine dust from the baked and pulverized soil, or in the fall, by the smoke of mountain fires. Soil.—The soil is of I wo chief varieties—one porous, sandy, and by its capillarity ever drawing moisture from the under- lying water-beds; the other clayey, cracking under the hot rays of the sun into hard masses entirely non-retentive of moisture. Respiratory Affections.—As Southern California has a reputation as a sanitarium for respiratory affections, an inves- tigation of the justice of this claim will be first in order. Phthisis.—Phthisis, according to the Los Angeles County Hospital records, stands first in the number of cases, making one-seventh of the grand total, and by far the highest mor- tality, causing two fifths of all the deaths. This showing alone would indicate an enormous amount of consumption in Los Angeles, but on examining the health reports of the city, which include the deaths from the hospital as well, it was found that the death-rate from phthisis is a little less than one-fourth, or exactly 23 9-10 per cent. The reason for this difference is plain: many people suffering from tuberculosis come to this country for their health, and some of them, hav- ing spent all their money, are compelled to fall on the county for medical aid and sustenance; consequently, there being but one free institution, it receives an undue proportion of hope- less cases. The author of this paper, from a year’s residence as interne, knows that the consumptives who enter this hospi- tal are nearly all in the last stages; but very few of those dying having been inmates over six months. Then, again, it is to be expected that a hospital will show a higher relative percentage in the more serious troubles, for, as the accommo- dations, especially in such a growing section as this, are inad- equate, many applicants have in the past been rejected, simply to make room for those who were more seriously ill; and if two persons equally deserving wished to enter the already over- 6 Climatology and Diseases of Southern California. flowing hospital, preference was given to him who had been the longer in the State. This factor in a measure offsets the tend- ency to fill the phthisical wards with new-comers. Percentage of Phthisis to other diseases.—Referring to the monthly summary of cases (Table I), it will be seen that of the inmates 43 1-2 per cent were Americans, exclusive of natives of this State, 52 1-10 per cent foreigners, and 4 1-10 per cent Californians, mostly Mexicans. Among those af- flicted with phthisis, the ratio of Americans falls off 2 per cent, that of foreigners raises a like amount, while that of Californians remains about the same. As, however, the pop- ulation of this section is so very largely from those born in other States and countries, it is not so much a question of nativity as length of residence whether a certain case is do- mestic or imported. Length of Residence a Criterion for Responsibility.— While all sons of the golden west presumably contracted the disease here, natives of other regions may or may not have done so—a question that can only be settled positively by in- dividual investigation, but can be answered approximately by learning how long the patients have been residents of this State. Proportion of Cases of Foreign and Domestic Origin. —The hospital records, as to length of residence prior to May, 1889, are meager, but from all sources of information, includ- ing the author’s private memoranda, it is practically correct to say that 47 per cent of those admitted for phthisis have been in the State less than one year, and, with the exception of dissipated men who died in a few months, all those suffer- ing with the disease gave a history, on their admission, of about two years’ sickness. Now, if, in addition to the 47 per cent, nine out of ten of the 20 per cent who have had a resi- dence between one and two years, be supposed to have come to California with the disease firmly settled upon them, two- thirds of all cases of consumption are of foreign origin. Of the other third, about one-eighth have dwelt here between two and three years, and the remaining one-fifth over three years, one-fourth only of the latter being native Californians. Re- ducing these per cents and fractions to figures, we have on a two-year basis, of the 568 cases, 378 imported and 190 of home production. Climatology and Diseases of Southern California. 7 Mortality.—17 per cent of those entering the hospital from all causes die, and 47 per cent of the consumptives. Of the survivors, some are sent East at the county’s expense, a few raise the necessary funds to go back to die at home, others are taken away by friends that they may spend their last days outside of a public hospital, some are bettered, while still oth- ers improved or grown worse leave for parts unknown. Since December, 1888, very many, on improvement, go to the county poor-farm and there get the benefit of a country out-door life. Since the separation of the alms-house from the hospital, a smaller number of deaths—only one-third—from phthisis has been reported; one-tenth have left in as bad or worse condi- tion than when admitted, while the remaining half have ap- parently received some benefit. Residence of the Decedents from Consumption.—The deaths, as to time, appear to be quite evenly divided, one-third of the decedents having had respectively a residence of under one year, between one and two years and over two years in the country. From this it appears that not only two-thirds of those suffering from phthisis, but two-thirds of those dying from that cause were of those who had lived here less than two years; figures which seem to substantiate the moderate claim that two out of every three phthisical patients in South- ern California contracted the disease elsewhere. As this disease is no respecter of persons, attacking the rich and the poor alike, and as the wealthy have the means to come here, it is reasonable to infer that the proportion of consumptives to other diseases is nearly as high outside of the hospital as within its walls, but the death-rate is very much less, because the rich are able to return East to their friends. Seasonal Mortality from Phthisis.—On recalling the sea- sonal divisions in this country into a wet period from Novem- ber to April inclusive, and a warm dry one the other six months, the monthly aggregates (Tables I and III) disclose the interesting fact that while the total number of cases of consumption in the winter months exceeds that of the sum- mer by only 4 per cent, the deaths are 14 per cent more nu- merous. Deaths, it is true, from all causes, occur more fre- quently in winter than in summer, November beginning the winter change, reading abruptly a half-increase, followed by a gradual slide till July scores the minimum; phthisis, how- 8 Climatology and Diseases of Southern California. ever, runs somewhat ahead of the winter rate for other dis- eases. The lower temperature, increased relative humidity and greater variability of the winter weather in opposition to the higher temperature, desiccating atmosphere and daily general similarity of the summer climate, must account for the variance between the death and the case records. No other factor than dissimilarity of weather exists; accordingly, if that season of the year in California, which most nearly approaches the spring climate of the Atlantic slope, is the most unfavor- ble for phthisis, both in number of cases and fatality, we must conclude that patients suffering from this disease would get along better here than they possibly could in the East; and we would also infer that California is as much a summer re- sort as a winter sanitarium. Comparison with City Death-rate.—While only one-sev- enth of the city’s mortality takes place at the County Hospi- tal, some years one-ninth, others one-half, on the average one- fourth of the fatal results from phthisis occur in this institu- tion. Pneumonia—One of the respiratory affections, pneumonia, that scourge of humanity beyond the mountains, is very rare, showing a decided preference for the counter-trade wind months. It must be remembered that these statistics com- prehend those who, in the East, would readily succumb to this disease—the poorly-housed, the badly-nourished and dis- sipated. Yet, in spite of this fact, this disease (which, accord- ing to life insurance statistics, accounts for 7.68 per cent of the deaths) here occasioned but 2.41 per cent of 664 fatal ter- minations, less than one-third the mean for the entire country. Exactly two-thirds of the attacks took place between Novem- ber and April, ten of the sixteen deaths occurring at the same time, giving a mortality about the average among such classes in other regions. Pneumonia and the Influenza.—In another investigation of pneumonia and the late influenza in Los Angeles, the wri- ter found that, after a climatic freak of the rainiest month ever known and during the wettest and coldest January for years, a combination of these two diseases caused eighteen deaths—a monthly average just equal to the ratio during one la grippe week in Brooklyn, a figure attained by this city or- dinarily only in half a year. Climatology and Diseases of Southern California. 9 Nationality of Pneumonia Decedents. — From personal observation of this institution for several years the writer thinks it is frequented more especially by the improvident foreigner and the dissipated American—the latter class out- numbering the former in two kinds of trouble: in the acutely severe, such as typhoid fever and pneumonia, by 50 per cent, and in those maladies resultant on dissipation—alcoholism and venereal diseases — by 25 per cent. From this state of affairs doubtless arises the fact that while two-sevenths of the Americans and one-third of the Californians attacked with pneumonia die, only one-seventh of the foreigners succumb. Epidemics.—By consulting the yearly table (No. II) one can see that the pneumonia cases are chiefly in two groups; twelve in 1881 and thirty-two in 1887 and 1888, one dying in the former and nine in the latter years. Pleurisy.—Pleurisy is quite uncommon, showing a double maxima, following the spring advent to dry and the fall change to wet weather; nearly half of the cases occurring during the height of pneumonia in 1888. Other Inflammatory Diseases of Air-passages.—Other inflammatory diseases of the air-passages show a marked pre- dilection for the damp weather—the five driest months read- ing less than one-fourth of the cases. Other investigators have chronicled the fact that hay-fever never originates in this section. The dry warm air, being both aseptic and des- iccating, tends to keep down all inflammations to which it has access. Three-fifths of the bronchial cases occur in the rainy months. Asthma, too, is more of a winter disease—the hot- test month showing the fewest cases—a natural sequence if respiratory inflammations are fewer in the dry seasons. Conclusions about Respiratory Affections.—These tables show in reference to this class of diseases, in brief, the follow- ing: phthisis, present as the most common and fatal disease, two-thirds imported, prevailing to an increasing extent and virulency among the Spanish-Americans; pneumonia most conspicuous by its rarity; bronchitis, asthma and pleurisy not frequent, and together with pneumonia to a large extent hyemal. Of all respiratory affections, including consumption, the death-rate amounts to one-fifth of the total for the city. Rheumatism.—Rheumatism stands a good second to phthi- sis and makes the unusual showing, that while two-thirds of 10 Climatology and Diseases of Southern California. the cases are during the on-shore wet winds, one-eighth more deaths occur in the dry season. Acute rheumatic arthritis oc- curred seven times with two deaths from heart complications —this number being one-eighth of the fatal results attribut- able to rheumatism. As acute rheumatic fevers, though very rare, come usually in the warm weather, more especially at the change from the wet spring to the dry summer, the excess of deaths from this disease in the hot season is accounted for; however, as the fatal outcome is so rare (even though the pro- portion of deaths to patients is still too high), a change of only two deaths from summer to winter would make the ratios even, so the discrepancy is not remarkable. Myalgia.—It is possible that under the loose designation rheumatism, myalgia is frequently meant—a disease especially Hable to be present in changeable weather, or whenever there is a great difference between the day and night atmospherical conditions. It has been brought to the author’s notice, and also felt by personal experience, that the pains of so-called rheumatism seem to be brought about by two classes of weather —the damp, changeable variety and the sudden transition from a cool night or period to an unusually hot day or spell. There- fore some patients complain more during the shifting climate of winter, others now and then in the summer at any marked alteration in the temperature, and still others seem to suffer continually when the nycthemeral range is greatest. Pains of Rheumatism vary with the Weather.—It is a well known fact that rheumatic patients are good weather prophets, sometimes regular barometers, in the East, telling by their aches and pains if it is going to rain. Here they have the same feelings with the varying relative humidity of the atmosphere, but no rain comes. The Author’s Suggested Explanation.—As a falling barometer recording meteorological disturbances foretells a storm, as the hot, eager air drinks from the tissues the insen- sible perspiration to a much greater degree during the warm- est days of summer, and as at other times the fogs and rains weigh heavily upon the body, is it not possible that the dis- turbance of nerve-pressure from the wonted condition—to- gether, doubtless, with the sudden alteration in temperature— is one of the causes for the so-called rheumatic pains? The author does not dispute other and various reasons assigned Climatology and Diseases of /Southern California. 11 for them, but he has often noticed that, while apparently in the best of health, a sudden change, as stepping from a cool room into the blazing noon-day sun, or going from a house that had been warmed, quickly into the night fog, has caused instantly darting or continuous pains in various joints or muscles. But just as this climate is more even than that on the Atlantic slope, the writer personally has found he is by far more comfortable here, and though subject to rheumatic fevers, has been entirely free from them in six years’ residence on the coast. Neuralgia.—Turning to neuralgia for light on the above question, of the half-hundred cases reported, nearly one-third occurred in the transitional months of May and November. Along the coast, in the fog-line, both rheumatism and neural- gia are reported frequent. Erysipelas.—Erysipelas comes but rarely, and two-thirds of the instances are during the on-shore winds, lower temper- ature and greater moisture of winter, the period of greatest heat having no cases at all. It is only about half as frequent as the average for the United States and shows a very low mortality, having one death in eleven years. As meat, if ex- posed to the dry winds of summer, will not spoil but cure, it must needs be that such an air is quite free from germs, conse- quently if, as has sometimes been supposed, this disease is, in any way, dependent upon atmospherical conditions, we would naturally expect in California a small amount of erysipelas, especially in summer. Be that as it may, the clinical experi. ence, as shown by this record and inquiries among those prac- ticing here, makes this disease rare and decidedly a winter malady. Reasons why Renal Patients should do well here.— Theoretically the climatic conditions of Southern California are favorable to sufferers from kidney troubles. The skin is freely active, the greater part of the year, in supplying the copious insensible perspiration which the thirsty air demands. Then the equability and evenness of the weather prevent those sudden chills which every now and then in harsher cli- mates throw double eliminative work on these already wearied organs. Still another factor of great value in treating kidney or other troubles must not be overlooked; viz., the uniformly cool nights which render refreshing sleep possible. A proof 12 Climatology and Diseases of Southern California. to the author’s mind of the salubrity of the evenings is the fact that he, a sufferer from rheumatism, while covered with only a pair of heavy blankets, was able, most any clear night, winter or summer, to bivouac with comfort and perfect rest, without ache or paiu — a thing he has frequently done on camping excursions. Explanation of what the Author includes under Kid- ney Diseases.—Under the head of kidney diseases, for sim- plicity’s sake, the writer has classified, along with various forms of Bright’s disease, three cases of diabetes and fifteen patients against whom, in the earlier records, the word “dropsy” was written. Although it is by no means certain that all or any of these were suffering from renal lesions, if we grant for argument’s sake that they were, the percent from such diseases is still under that which insurance companies expect. The figures are compared with insurance statistics, because the age and sex are about the same among policy- holders and the persons mentioned in this report. Effect of Season.—On account, doubtless, of the inclem- ency of the winter weather, those afflicted with kidney troub- les seek the hospital in the rainy rather than the dry season in the proportion of six to five; and as changeableness is especially detrimental to such people, we find that fully one- fourth of the deaths occur in the two most uncertain months, November and March. View of the President of State Board of Health.—The president of the State Board of Health, in an investigation made in 1884-85, found that acute kidney troubles were rare, apparently forming a descending curve from the sea-shore— occasional on the coast to rare or wanting in the interior. Summer Diseases.—Passing from the winter to the sum- mer diseases, one finds malaria, fevers, diarrheal disorders and eye troubles on the list. These maladies, however, are not (as one might suppose on account of the long dry season in this region) excessively prevalent; indeed all, perhaps, but eye troubles are under the mean for the rest of the country. Typhoid Fever.— According to the hospital records ty- phoid fever occasions 3.44 per cent of the deaths against the general average in America of 5.99 per cent; its mortality, however, is almost 18 per cent—very near the mean for that disease. By consulting the yearly table (No. II) it will be Climatology and Diseases of Southern California. 13 seen that there was an epidemic in 1881, with no death out of 29 cases. In 1887 another typhoid wave, followed by a still higher crest in 1888, and a lesser surge in 1889, scored 97 cases with a mortality of 1 in 3,1 in 5, and 1 in 6 respectively in the three years. Reference to the monthly summaries (Table I) shows the curve of typhoid fever reaches its high tide in the latter part of the hot season, with 27 cases in September, and its low ebb in February and March, with but 1 case. Two- thirds of the instances of the disease occurred in the dry season. Fever.—Fever, the indefinite term which accounts for 3 per cent of the sickness and 2 per cent of the deaths, has a mor- tality of 11 1-5 per cent and occurs in 55 per cent of the in- stances in the summer; it is a disease, which under the better diagnoses of the last three years, is well-nigh eliminated. On the books it was sometimes called bilious fever, quite likely of malarial origin, often perhaps a misnomer for typhoid or the typho-malarial fever of many authors. Malaria.—Malaria stands next to typhoid in number of cases, occurring in 5G per cent of instances in the summer, and giving a mortality of 4 per cent. If the "total number of cases be divided into two equal portions, keeping as far as possible the years intact, the first half, covering eight years, will contain half again as many cases as the last half, includ- ing three years. This fact indicates that malatia is dying out, on account, doubtless, of the increased acreage in orchards and vineyards, improved methods of irrigation, better drain- age and full utilization of the former wastO water. It is prac- tically unknown on the coast, found in limited sections in the interior, where heat, soil and stagnant water can become nur- series of the miasmatic poison. It is below the average for the country at large, and is decreasing in frequency. Intestinal Disorders.—The troubles affecting the digest- ive tract are not well represented in the hospital; they cause but five per cent of the deaths, which is only one-third as high as the rate for the entire city. Diarrheal disorders are quite marked as to season, two-thirds of the cases occurring in summer. The authorities all agree that in infants intesti- nal troubles are especially rare; cholera infantum never oc- curred among the children (about forty) who have been in- mates of this institution. 14 Climatology and Diseases of Southern California. Dyspepsia.—Derangement of the stomach is a very infre- quent cause for admission into this hospital. Dyspepsia, in a climate capable of bearing so great a variety of fruits, is not a common disease, and a sojourn here is apt to benefit cases of indigestion. Yet, at certain seasons, intestinal troubles are likely to be produced by the eating of unripe fruits. Liver Complaints.—Liver troubles show a high mortality, but a low percentage, and seem, in the earlier records, to fluc- tuate with the changes in malaria, but in the later years ap- pear less frequently and quite uniformly as to number of cases. According to the author’s observation chronic alcohol- ism is the most frequent cause of hepatic disease in this hos- pital. Diseases of the Eye.—Classified as eye troubles are syph- ilitic iritis and corneal ulcers, but the vast majority are cases of conjunctivitis. Beyond doubt the continuous sunshine of this section is hard on the eyes, for while there are one-ninth more patients from all causes in winter, in eye diseases, three- fifths of the cases occur in summer. The dry hot air, the fine sand driven by the occasional Santa Ana, and in this city the large amount of glaring pavements, are conditions particu- larly trying to the eyes. Other Diseases.—The other diseases mentioned in this re- port have no dependence apparently upon climate or season. Heart Troubles.—Diseases of the heart bear a small ratio to the total number of cases, but register a very high death- rate—next to consumption. Cancer.—It has been reported that cancer is particularly prevalent in Southern California. The facts for the county hospital are these: it forms only two-thirds of 1 per cent of the cases, but as it is a fatal disease and very difficult to treat in a private house, a large number of its victims remain in the wards until death — a fact which gives cancer a larger mortality (65 1-10 per cent) than any other disease, and a per- centage of 2 1-2 on the total number of deaths. Referring to the combined death-rate for the city and hospital, we find that this disease accounts for little over 1 per cent—a little more than half the average for the entire country. Alcoholism.— Chronic alcoholism shows an unduly high proportion, but as this is a moral rather than a climatic dis- ease, it has but little bearing on these figures. Climatology and Diseases of Southern California. 15 General Debility. — Under the head of general debility doubtless were classed many hospital malingerers, but as it had so high a mortality (over 12 per cent), and expressed the run-down condition so apt to be present in the indigent sick, the author retains it in the report. Ulcers.— Ulcers were mostly of the chronic form, with which, in hospitals, one becomes so familiar. Many of them were of syphilitic origin, others the results of varicose veins; a large proportion of them were the cards of admittance to their possessors. The one death attributed to this cause is, doubtless, properly due to syphilis. Miscellaneous.— The miscellaneous diseases include 29 cases of measles, 20 of skin diseases, 12 of poisoning, 7 each of aneurism and chorea, 6 each of coxalgia and peritonitis, and 5 of cerebral meningitis, the other third being scattering instances of various complaints. The higher rate of mortal- ity attained by this subdivision is due to the fact that all the deaths, from unknown causes, of which there were about 20, were assigned to this class. Comparison of the City’s and Hospital’s Mortality.— The death reports (Tables III and IV), in comparison with the city’s record, show two great differences, a proper allowance for which must be made for a just appreciation of their rela- tion to the diseases of Southern California; the hospital rate is 10 per cent too high in respiratory affections and 10 per cent too low iu diseases of the digestive system; a minor diverg- ence also exists in the disorders of the genito-urinary tract and the eruptive fevers, the hospital showing an increase of some 3 per cent in the former and a deficiency of the same amount iu the latter class of troubles. The reasons are plain; the long continuation of cases of phthisis and nephritis com- pel the poor to ask for public aid, the rich are more apt to suffer from troubles of the digestive system, and the eruptive fevers, save measles, have not been admitted to this institu- tion. Diphtheria also appears in the city’s report as account- ing for 2 1-2 per cent of the deaths. Conclusion.—In conclusion the author observes that a com- parison of these and other statistics shows that the same dis- eases are prevalent in a greater or less degree, the world over, that some regions are better adapted for treating certain troubles than others, and that no one climate contains quali- 16 Climatology and Diseases of Southern California. ties which are the best for all diseases; so it is with Southern California. The cool reaction every night from the heat of the day gives refreshing sleep and invigorates the body worn by wasting diseases, but this great daily change may give rise to rheumatic and neuralgiac pains. The air, so bright, so dry, so clear, allowing the life-giving rays of the sun to shine through day after day, is delightful for the sick man to breathe, but its constant brightness may be too dazzling for his eyes. He who is marked by some dread disease may come too late to these genial shores to find in its days of spring coolness and summer heat too great a change for a weakened body to endure; while, on the other hand, he, whom the changeful climate of the East has warned by cough or wasting flesh to flee in time, may here escape the blight entirely and live in health to ripe old age. Explanation of the Tables.—These tables were compiled for this article by the author from hitherto uncollated data; the classi- fication is general rather than specific, on account of the character of the records consulted. Table I gives the dieases, the number of instances per month, the percentage which each disease bears to the total and the relative standing of Americans, Foreigners and Native Californians. Table II is quite similar, but furnishes a yearly summary of cases, and records the annual relative fre- quency of nationalities alone. Tables III and IY are respectively monthly and yearly summaries of deaths. In Table III the figures after mortality, in the hoizontal line from left ta right, give the ratio of total deaths to the entire number of patients for each month, while the numbers in the vertical column under mor- tality mark the proportion that the deaths from any disease bear to the whole number of instances of the same The horizontal percentage distributes the deaths between the months, on the scale of one hundred, and the vertical percentage gives the percent of the fatal results from any cause on the total number of deaths. Thus, phthisis is fatal in 47 cases out of a hundred; but causes only 40 per cent of the deaths. The mortality for January is 15.34 per cent, while only 9.34 per cent of the deaths occur in that month. Climatology and Diseases of Southern California. 17 TABLE I.—Monthly Summary of Cases DISEASES. January. February. March. April. May. June. July. 3 be 3 < September. October. November. December. Total. Percent. American. 1 Percent. B u V 0 Ex* Percent. Californian. Percent. Phthisis 46 33 44 52 •9 37 5° 55 57 46 568 14.58 2. §2 2.03 229 45 32 35 4°32 312 54-93 56.3S 59-49 40.58 5'-52 68.75 4-75 £ = ■*/ rt.S Asthma 6 7 9 7 4 4 4 6 4 7 8 9 79 69 33 32 40.90 4°-5' 5°-73 45-4° 25.00 4i *7 22 3 2.72 'E. v 2*e Pneumonia 9 7 4 5 4 4 4 1 7 6 8 6 8.69 Inflammatory Diseases of the Air-passages.... 3 2 4 4 5 7 5 2 I 3 1 5 3 5 2 •°5 .84 2 3°3 6.25 C x 43 3 59 5 28 8 40 6 31 12 45 21 53 22 43 Q 5>9 124 13.82 3.18 221 SQ 42.58 47-59 284 64 54-72 51.61 14 I oc Malaria 7 n 24 10 X ■ 52 5° 3°-77 33 63-4?' 44.00 5 7-69 50.00 4*-77 50.00 3 5-77 12.00 s 1 5 3 5 2 2 5 o.2 5 4 2 2 .67 2.41 2.03 •36 11 43 44 7 44.0° 42.31 45-75 53-7° 50.00 ■5 47 33 07 £4 7 2 3l 25 94 79 M 4-25 2-53 7 1 ? 7 51 5 4 Morphinomania.. I 3 3 3 7 1 2 5 1) X Typhoid Fever 6 | 7 5 2 6 f ! 5 6 4 18 16 27 13 3-44 2-99 .67 86 53 12 44 60 12 2.99 2.59 7.70 3 > 0 u Fever Erysipelas. I I 3 4 s 13 I 3 1 7 4 i7 2 12 2 9 2 26 45-69 46.15 5**73 46.15 3 2 7 2 9 4 4 4 6 3 2 8 _ 7 2 3 49 45 73 25 23 7s 45 1.26 lisi .64 •59 25 21 29 9 17 s6 27 51.02 46.67 39-72 36.00 73-9' 33-33 60.00 23 23 4° 13 46.94 s'." 54.80 52.00 21.74 58.97 38.33 2.04 2.22 5.4s X c •* 2 o€ Diseases of Liver Diseases of Kidney.. I 5 3 4 1 3 11 6 8 5 3 2 5 7 5 7 9 1 4 *5 S 5 7 3 3 4-3$ 7.70 i-§7 4 3 3 4 6 9 5 '3 4 5 46 '7 Diseases of Eye J 6 2 7 2 3 5 1 1.15 1 Diseases of Women.. 3 jJ 28.57 7-15 ii-43 3.62 9.20 6.20 3-9* 6 6 7 2 16 20 8 40 35 26 221 •63 97 537 8 83 «4 47 220 23 >3 130 64 44 296 65 71 50.00 5S.82 39.27 45.36 55-12 64.S4 58.67 41.56 T3 4) <■ *5 Cancer Ulcer 2 29 2 10 22 1 24 6 2 17 9 4 23 ■5 24 7 7 52 1 20 16 4 11 12 2 11 >3 13 44 .67 $ 2.49 >3.78 50.00 37-55 Si-53 8 >5 «« 18 6 0 45 6 40 45 46 47 5° 40 47 4' 40.96 £ 14 5 t j- g 7 10 16 14 23 '5 15 12 15° 154 3.8.5 3-95 61 7i 40.6* 46.IO .67 12.34 Miscellaneous 28 12 16 II >3 § 10 64 19 Total | 404I 2741 3‘9f 3>o| 275/ 303I 3211 329I 3851 3971 324l3897li°°. if94l43-5°l2°3'l52.io 17214.40 18 Climatology and Diseases of Southern California. TABLE II.—Yearly Summary of Cases. DISEASES. 1S79 1S80 1S81 1SS2 1SS3 1SS4 1SS5 1880 1SS7 1S8S 1S89 Total j. Phthisis 33 21 33 43 40 42 63 40 63 91 99 568 o c Bronchitis l6 3 6 2 6 l6 48 13 I IO r.2 Asthma 3 8 2 6 13 7 4 6 8 12 IO 79 'n % Pneumonia 3 12 4 2 3 6 12 20 7 69 Pleurisy 2 2 2 I 3 15 s 33 Inflam. Dis. Air-pas’gs S 1 2 1 s 5 13 32 C c/j Rheumatism ss 20 18 27 39 27 63 26 63 109 72 5'9 OQ Malaria 1 7 3 is I I i5 iS 15 3' 7 124 Neuralgia 3 2 I ( 3 3 2 i 5 3 7 11 52 3 c Insanity 2 I 3 4 4 5 3 6 7 15 50 Epilepsy.. .. 4 2 4 2 4 7 3 26 u o Paralysis 26 5 9 14 3 IO 2 2 I I 12 94 Alcoholism... I I I s I 3 4 12 29 22 79 < Morphinomania . . I 3 I 9 14 Fever . 8 9 14 14 12 17 25 s 8 I 3 116 < fa Erysipelas 4 3 3 3 I I 2 5 4 26 Diseases of Heart .... 7 3 7 2 8 I 7 6 5 3 49 Cfi Diseases of Liver. 4 6 10 3 I 7 7 7 45 -; o Si 73 Diseases of Kidney. s 3 4 6 7 3 2 9 l6 14 4 73 n Diseases of Stomach. I 2 I 4 2 5 9 25 fa .2 Diseases of Rectum . 2 I 5 I S 5 4 23 Q Diarrhea 3 6 S 3 7 9 IO 12 2? 3 7S Diseases of Eye 2 6 I 2 6 4 3 2 9 10 45 Diseases of Women. 4 I 2 I 6 14 Confinements. 2 s 3 2 4 6 3 IO 35 'O Cancer 5 2 I I IO 7 26 £ Ulcer 12 2 >5 7 9 13 22 23 32 4s 38 221 73 Syphilis 10 6 2 4 I l6 IS 42 43 24 163 i2 Gonorrhea I 4 4 I 2 •7 9 3' 28 97 c Injuries 24 II 12 18 36 33 59 56 77 III IOO 537 fa Seniljty I I 7 3 5 6 8 ■ 5 I 37 General Debility 3 4 5 6 8 25 11 22 56 10 150 Miscellaneous s 6 4 5 6 8 13 27 49 3' i54 Total 222 134 203 211 250 198 369 303 527 852 62S 3897 Percentage on Total. 5 7° 3-44 5-2J 5-4' 6.42 5.08 9-47 7.78 13-52 21.86 l6. II IOO. American Born 91 49 116 84 "3 89 170 131 229 362 361 1694 Percentage on Year... 40.99 36-57 57-14 39.81 45.20 44-95 46.07 43-2.4 43-46 42.49 4I-S6 43-50 Foreign Born ”5 72 SO 123 i3S 106 189 160 260 401 329 2031 Percentage on Year.. 51.So 53-73 39-4' 58.29 54.00 53-54 51.22 bo 49-34 54-ii 52-39 51.10 Californians l6 13 7 4 2 3 *IO 12 38 29 38 172 Percentage on Year... 7.21 9.70 3-45 1.90 .So i-5' 2.71 3-96 7.20 3-4° 6.05 4.40 Climatology and Diseases of Southern California. 19 TABLE III Monthly Summary of Deaths. Unclassified. Local Affec- tions. Acute Fevrs Nervous Affect’ns. Gen Dis. Total of Respiratory Percentage Respi- ratory Affect’s S 0 tA Ov 4 00 05 bo 4 8 -4 *00 tv O' ■4 tv ps pi On NO dv « 8 Gn Ov 4 •j\ i 0 55 w > C/5 M C/5 Total Percentage Americans Percentage Foreigners Percentage Californians. Percentage is^'s-glp r- a: ,rT rt • -t ii p “ 5• • S g O’ : ; • • o oft’ : ' : ~ c2! ■< : *: : ! i 1 :::::: i B 00000 p 73 73 7) 7 "1 ft tt ft ft *1 p p p 3* 7) 71 73 7) (T ft CD CD CD P 73 73 73 7) I 0 0 O 0 M% l-h ht» t-f* ■ «?*ro : S a<’£ • 3 3 2 3. : sr. • W^IH -t < T3 73 rt 3- ir i £ : % . . n • • ◄ • • (i ►i Sfc?P^! § |s w 3? : 0 g 5 P • • • A • * . m E-n fi c • c. i S -> 04 N- 04 N- .k*& w u> 'o January. Ul U) \p M li M Os *OnOv *4 •- OOGn MtA\o o o tv ~ tVOvOV - tv —• Gn tv tv is a tv «-• Gn February. (A 4 Ov ~ Gn nO t 81 \0 tV tV tV 04 Gn <- tv tw nO March. vO 'o O O S* 8 S'S a&S 4*- tV tV4 ~ tv Jji tv tv tv April. 00 S' & M *- tV Ov On « c*v 4 vj>M - O'4*- CCvO 4 ~ 4*. ~ ~ « tV tv Ov 00 SSs tv ~ H- ~ Ov May. h tn Ui 0-4 tv *4 O Gn 4 GO S' vC Gn 4 -■ tv 7l H 04 - tv On 'a 8 IV N *- O' June. tv -S p Os Gn (A N O m 04 o « O o tv tv o Ov ~ tv « •- tV « Ov tv 4 ■1 tv (A S «4 On tv — Gn nO - O July. 4 4 u\ *5 ’»"S' t «- tv N- Ov Gn _Ov tv o - tv -a O' O « Ov 8* a - 5 'i Total. 8 O J4 04 04 « IkJ -4 Qp M O dv -• On *- O JiC' - Oslsx QsU\ tv Gn — 04 ■jp*t r « \b -4 Gn 0*4 4 , #- ov b> bo o O -4 O Gn tv tv M - "o t '$.k is Percent. * VO O O 004 - o - - (AO. O 4 4 tv 04 « Ov Ov Gn tv O tv tv -S Americans p Sv'P 'c 04 n 'po •4 *Ov Os * 04 P *00 OOv tv Ov tv '88^8* Ov Gn O O' 3 8 — Gn Ov 4 O OGn •‘■aS Gn Ov P r *8 tv - Ov 'P _8’ I' - ■4 *• 00O tv 00 Ov OGn 04 Ov O tv Out 00 <0*4 04 4 M C/>1 Gn o-as^ ‘ k-k £8 Ov 4 Ov Gn O tv 00 7XA Gn « 0 Ov *8 s»fe*a. Percent. 4* •4 00 - - 4 ~ •* tv » tv La S tV -4 Californ’ns •4 a *+ (A Gm 4 Q tV IV Q 4 P •‘I Ov O Gn Gn Gn C/3VO s. kk'o *4 ps Ov O On tv Gn tv O On dv O *4 Percent. 4 — Gn Ov Ov tv OvOv Gn (AM ~ 0*4 *4 V> 4 Ov M O Ov Ov tV - Gn 004 ** ** I Ov Ov - Of. 4 M Ov 4 00 «86j!&'88 8> 4 OJ j»3 tv 4 Ov GO'© -4 vo "6 n8*8 Mortality. 20 Climatology and Diseases of Southern California. TABLE IV.—Yearly Summary of Deaths. DISEASES. 1S79 1880 1881 1SS2 iss3 1SS4 iSSs 1886 1S87 iSSS 1889 Total Phthisis 24 9 IO 21 11 12 32 24 45 So 29 267 Bronchitis I I I 6 I IO C/J Asthma £ 2 2 4 I 11 ss< Pneumonia I I 2 4 5 3 16 C 75 Rheumatism 2 I 2 I 2 4 I 3 16 Ofi Malaria I I 2 I I 6 a c [.Nervous Diseases I I I I 2 I 7 Insanity I I 2 f- o Paralysis 5 3 3 I I 6 3 5 4 3' Alcoholism I 2 2 I 6 Morphinomania. I I 2 a « Typhoid Fever 2 II s 4 25 P > Fever I 3 2 I 3 3 13 Erysipelas I I c/J Diseases of Heart. 2 2 I I 2 2 3 9 22 Diseases of Liver. 2 2 4 4 12 u rt O