USA > Massachusetts > Worcester County > Fitchburg > Address of the mayor, together with the annual reports for the city of Fitchburg, Massachusetts for the year .. > Part 21
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Hernia inguinal,
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Incised wound, hand
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Incised wound, neck,
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Lacerated wound, face,
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Scalp wound,
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There were five deaths among the outside poor. Causes of death were-peritonitis, age 36; still born ; diphtheria, age 2; tuberculosis, age 56; and acute dilatation heart, age 57. One soldier died of acute dilatation of the heart during my ser- vice.
There were seven patients sent to the Burbank Hospital, one to the Worcester Insane Hospital and one to the State Hos- pital at Westfield.
CITY FARM.
There are now at the City Farm 34 inmates, and during my service I have been called upon to attend 28 of them. There were seven deaths during the year due to the following causes : Cirrhosis liver, age 58 ; cancer breast, age 70; valvular disease heart, (2) 70 and 73; arterio sclerosis, (2) ages 87 and 91; tuberculosis, age 79.
The general health of the inmates of the Almshouse has been remarkable good considering their ages, and I believe their habits regarding food and sleep, combined with the care they receive, is an important factor concerning their long life, and a great deal of credit should be given Mr. and Mrs. Cole- man for the interest they take in the care of these feeble old people.
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REPORT OF CITY PHYSICIAN
POLICE DEPARTMENT.
The amount of service rendered the sick and injured in this department is large. The service includes any emergency case, from a simple abrasion to a broken spine.
My recommendation of last year, asking that an emergency cell be equipped with a firm mattress and rubber covering, has been complied with and there is now a suitable room to meet most any emergency. In fact the Police station, with an auto- mobile ambulance in readiness, is answering many of the pur- poses of a Relief Hospital, and has rendered valuable assistance in accident and distress to many unfortunates.
In conclusion, I wish to extend my sincere thanks to the officials of all departments with which my work associates me, for their helpful co-operation.
Respectfully submitted,
GEORGE P. NORTON, City Physician.
TWENTY-SECOND ANNUAL REPORT
OF THE
BOARD OF HEALTH
OF THE
CITY OF FITCHBURG
MASSACHUSETTS
1911
+ A TOW!
, MAR. 8.1872.
FEB.3, 1764.
A CITY
FITCHBURG: H. M. DOWNS PRINTING CO. 1911
SALARIES.
Chairman,
$300 00
Clerk,
50 00
Bacteriologist,
600 00
Inspector of Plumbing,
1,000 00
Inspector of Milk,
350 00
Agent,
1,200 00
Inspector of Meats and Provisions,
600 00
Stenographer,
780 00
School Physician,
450 00
REPORT OF THE BOARD OF HEALTH
To His Honor, the Mayor, and the Gentlemen of the City Council : -
In accordance with the Revised Laws, the annual report of the Board of Health, containing a statement, tabulated and otherwise, of the sanitary condition of the city and the business of the Board for the year ending December 31st, 1911, is here- with submitted, including those of the Agents of the Board, Milk Inspector, Bacteriologist, Inspector of Meats and Pro- visions, and Inspector of Slaughtering, and School Physician.
-
The Board organized February 8, 1911; Dr. Frederick H. Thompson was elected chairman, Mr. James Barr and Dr. Dwight S. Woodworth being the other members. Miss Theresa A. Shea was elected clerk. Mr. Frederick R. Houghton was re-elected Agent of the Board. Mr. John F. Bresnahan was re- elected Inspector of Plumbing and Inspector of Milk. Miss Theresa A. Shea was re-elected stenographer and clerical assistant. Dr. Atherton P. Mason was re-elected Bacteriologist, and Dr. Henry D. Clark was re-elected Inspector of Meats and Provisions.
During the year twenty-four regular and nine special meetings were held. The work of the Board in its different departments has been carried on in accordance with the same general plan as last year, details of which will be found in the reports of the various heads of the different departments. It was the purpose of the Board to make a thorough, general investigation of the housing conditions of the city, but an epidemic of diphtheria started in January, which caused an indefinite postponement of this much-needed inspection of dwellings and tenement houses. We hope to take up the work the coming year. The only other noteworthy event of the year was the taking up by the Board of the work of school inspec- tion. This work properly belongs to the Health Department of
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REPORT OF BOARD OF HEALTH
the city and will be more fully considered in its appropriate place.
In September, Mr. Frederick R. Houghton resigned his position to accept a promotion to a higher one, that of Visiting Agent for the State Board of Insanity, a position he is well qualified to fill, owing to his natural abilities and long experi- ence as agent of this Board. We accepted his resignation with regret and desire to put on record our high appreciation of the long, intelligent, painstaking and successful service which he rendered this Board. There being no eligible Civil Service list from which to make an appointment, the Civil Service Commis- sion gave us authority to make a temporary appointment to fill the vacancy. Mr. Arthur Belliveau, who had been employed as Assistant Agent during the diphtheria epidemic, was ap- pointed Agent, and rendered faithful and efficient service until his successor, Mr. John D. Hassett, was appointed on January 2,1912.
DISEASES DANGEROUS TO THE PUBLIC HEALTH.
This Board has adjudged that the diseases known as actinomycosis, anterior poliomyelitis, Asiatic cholera, cerebro- spinal meningitis, diphtheria, glanders, leprosy, malignant pustule, measles, opthalmia neonatorum, scarlet fever, small- pox, tetanus, trachoma, trichinosis, tuberculosis, typhoid fever, typhus fever, varicella, whooping cough, and yellow fever, are infectious or contagious, and dangerous to the public health and safety within the meaning of the statutes. Physicians are required to report in writing, over their own signatures, immediately to the Board, every case of either of these diseases coming under their care, and postal cards conveniently printed and addressed, are supplied to them for this purpose, A notice by telephone, previous to the written notice, will be greatly appreciated. Superintendents of hospitals are required to report every case coming under their charge, and every physician must report cases coming under his care even though he may know they have already been reported by someone else. The law is plain. The Board wishes the hearty co-operation of all physicans in its effort to control contagious diseases, and will endeavor to make all rules for this control as plain and simple as possible,
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REPORT OF BOARD OF HEALTH
reserving the right of judgment to decide what are proper, in view of the fact that no set of rules can be adopted that all will agree to be just and necessary.
CEREBRO-SPINAL MENINGITIS.
Four cases of cerebro-spinal meningitis were reported from April 18 to April 22, 1911; all were Greeks who landed in New York, having sailed from ports in Greece where this dis- ease of a very fatal type was prevalent. Three died, and one recovered after an illness of four or five weeks. The first died in two days, the second in one day, the third in five days after the beginning of the illness. Not being able to get hospital accommodations at first for these cases, the last two were quarantined and cared for at the houses where they were taken sick.
ANTERIOR POLIOMYELITIS.
Only one case was reported during the year; this was not quarantined because it was not reported for several weeks after the beginning of the illness, and it was thought the danger of contagion had passed. There were ten cases reported in 1910, none in 1909 or 1908. Cards of warning are put up in cases of this disease and they are quarantined for three weeks. A diagnosis of this disease is difficult in its early stages. Sus- picious cases should be reported so that they may be investi- gated by experts if necessary.
SCARLET FEVER.
48 cases of this disease were reported during the year, with one death. There were 77 cases in 1910, with one death; 90 cases in 1909, with four deaths.
MEASLES.
There were 31 cases of this disease reported, with no deaths. In 1910 there were 153 cases and no deaths; in 1909, 814 cases and five deaths.
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REPORT OF BOARD OF HEALTH
WHOOPING COUGH AND CHICKEN POX.
There were 28 cases of whooping cough reported, with 11 deaths. Seventeen cases of chicken pox were reported, 110 deaths. Cases of these diseases are not quarantined, but since the mortality attending whooping cough is quite large, and since children 'having these diseases are excluded from the schools, it is important that these cases should be promptly re- ported in order that prompt notification may be sent. Physi- cians will do us a favor by promptly reporting these as well as. other cases of contagious or infectious diseases.
OPTHALMIA NEONATORUM.
There were four cases of this disease reported, with no deaths.
December 1, 1911, the State Board of Health for the fourth time in two years sent a circular regarding opthalmia neonat- orum to every registered physician in Massachusetts. This circular says, "there remains, however, much to be desired in the way of prompt notification of this disease and its proper management subsequent to notification." It also says, "in this connection the point is emphasized herewith that physi- cians, if they would properly protect themselves, must report their cases in the very earliest stages," and still further, "it would certainly seem that medical practitioners can have little cause for complaint if in the future their failure properly to notify this and other diseases, declared by the State Board of Health to be dangerous to the public health, is followed by prosecution." No flagrant violation of the law regarding opthalmia neonatorum has come to our notice in Fitchburg; if such should occur the offender will be promptly brought into court.
When cases of this disease are reported to the local Board it will furnish a consulting specialist and a competent nurse to ensure prompt and proper treatment at their homes, provided they cannot be sent to the local hospital or the Massachusetts Eye and Ear Infirmary, and are in indigent circumstances. We believe it would be well for physicians, on the occasion of their final visits to maternity cases, to say to the mother and to
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REPORT OF BOARD OF HEALTH
the nurse, "if the baby has sore eyes, no matter how mild, you had better send for me at once."
For the propylactic treatment of this disease a one per cent solution of nitrate of silver in convenient form, with directions for its use, will be furnished, free of expense, to every physi- cian applying for it; a routine treatment with this remedy is advised in all suspicious cases, preferably in every case of the newly born. '
SMALLPOX.
No cases of smallpox have occurred during the past year. The isolation hospital for smallpox has been renovated lately and is ready for the reception of patients.
TYPHOID FEVER.
Forty-three cases were reported, with three deaths. Thirty cases were treated at the Burbank Hospital, with no deaths. In 1910 there were 113 cases with 10 deaths; in 1909, 27 cases with three deaths. Nine of this year's cases occurred on the route of one milkman, between the dates of June 12th and 19th. The total number of cases reported during this week were 15. He was stopped peddling milk from June 19th to August 29th, until conditions at his bottling shed were made satisfactory to this Board. Widal tests were taken from his family and all the families at farms from which he obtained his milk. All were negative. While the source of contagion was not positively determined, it was believed that the water used in cleansing the milk cans came from a stream polluted by typhoid discharges from a farm 250 feet up the stream ; a case of typhoid fever having occurred at this farm one year and a half previously. In one family of ten persons there were eight cases with no deaths. The primary infection in these cases may have come from the milk sold by the milkman above meil- tioned, but at least six of them came from contact infection, owing to lack of care and poor sanitary conditions. While there were more cases this year than in the year 1909 there seemed to be no common source of contagion except as above mentioned.
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REPORT OF BOARD OF HEALTH
DIPHTHERIA.
During the early part of the year diphtheria became epi- demic in this city, most marked in the thickly settled part of Ward 2 and the easterly part of Ward 3, requiring active meas- ures and a large expenditure of money to quell it. The State Board of Health kindly advised us as to the proper measures to be employed, and their directions were followed during the epidemic. Cultures were taken from very many of the school children, and in some cases from entire schools, with a view of locating carrier cases. An isolation hospital was opened at the Burbank Hospital in the building which was at first used for a general hospital. This proved a great help in combating the disease. Carrier cases, as well as clinical cases, were quaran- tined for a time. During the year there have been found 205 clinical and 668 carrier cases of diphtheria, with 15 deaths. There are now 15 clinical and 2 carrier cases. There . are nine houses under quarantine for clinical cases and one house is quarantined for a carrier case. While this number is not large we cannot be assured that it may not largely increase at any time unless we have at our disposal better means than we now have of dealing with contagious diseases. A review of the statistics of diphtheria in Fitchburg for the past 11 years shows that in 1900 there were 97 cases; 1901, 52 cases ; 1902, 53 cases ; 1903, 17 cases ; 1904, 16 cases ; 1905, 48 cases ; 1906, 46 cases ; 1907, 44 cases ; 1908, 46 cases ; 1909, 83 cases ; 1910, 186 cases ; 1911, 205 cases. In 1903 and 1904 there occurred the smallest number in 11 years, namely 17 and 16 respectively. This number increased to 48 in 1905, and remained practically stationary until 1909, when it became almost twice as many, namely 83 cases, and in 1910 and 1911 four times as many, or an average of 195, and almost twelve times as many as in 1904. There has been no account made of carrier cases until the past year when we found 668 carriers, that is, persons who have the germs in their noses or throats, but are not ill. During the epidemic all carrier cases were quarantined for a short time. Since that time carriers when found have been quarantined, until lately, when we have quarantined only carriers that are found among school children, releasing them as soon as one or in some cases two negative cultures have been obtained. We
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REPORT OF BOARD OF HEALTH
believe that in persistent carrier cases the virulence of the germs should be tested by inoculating guinea pigs, in order to avoid quarantining them (the carriers) longer than is necessary. Clinical cases are quarantined until two negative cultures on successive days have been obtained, the last culture to be taken by the Board of Health.
There is great difficulty in separating the sick from the well in some families. In such cases we try to immunize the whole family. While our efforts to control diphtheria are meeting with a fair degree of success, and the mortality from the disease has fortunately been low, we are still in danger, and are convinced that owing to the difficulties of isolating the sick and keeping strict quarantine, as well as for economical reasons, an isolation hospital is an urgent necessity.
Moreover the law says we shall build and maintain one, and we are warranted in saying that if we do not build it volun- tarily the State Board will very soon compel us to, as it has North Adams and other cities.
The total amount paid out for diphtheria during the past . year is, as near as can be estimated, $6,802.13, of which only $1,312.30 was paid out of the Board of Health appropriation ; $3,090.10 of bills were grouped together under the heading Diphtheria Epidemic and paid with money transferred from the incidental account.
$2400.00 was paid from the Burbank Hospital appropriation for the care and treatment of 33 patients sent to the isolation hospital, which was opened in the old Burbank Hospital building during the diphtheria epidemic. The number of deaths at the isolation hospital was five. The largest number in the hospital at any one time was twelve. The average cost per patient per week was $29.12. There were four intub- ation cases with two deaths. One patient wore a tube for several weeks, and then had a tracheotomy done, and is still wearing a tracheotomy tube (seven months after the operation). A detailed account of expenditures for diphtheria paid out of the Board of Health appropriation will be found under the head of expenditures at the latter part of this report
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REPORT OF BOARD OF HEALTH
TUBERCULOSIS.
There were 81 cases reported, with 31 deaths. A mortality of 38.2 per cent. In 1910 there were 97 cases and 27 deaths; mortality, 27.8 per cent. In 1909 there were 83 cases with 23 deaths ; mortality, 27.7 per cent. In 1908 there were 67 cases and 34 deaths ; a mortality of 50.7 per cent. In 1907 there were 49 cases and 45 deaths ; mortality of over 90 per cent.
It is impossible from these few figures to draw any positive conclusion as to mortality because no doubt there are still many cases that are not reported, but so far as it goes it shows that the mortality is diminishing. There have been 56 patients aided during the year. Of this number there were 4 at Tewks- bury, 20 at Westfield, 1 at North Reading, 10 at Rutland, 3 on farms, 15 at homes, and 2 in other cities. One patient was aided at Burbank Hospital for tuberculosis of knee. The cost of aid extended to these patients was $4,147.62 ; 45 cases were aided in 1901 at an expense of $3,612 46 ; 20 cases were aided in 1909 at an expense of $3,497.04 ; 5 cases were aided in 1908 at an ex- pense of $172.40. These figures show an increasing amount for the aid of tuberculous patients each year. The Society for the Control and - Cure of Tuberculosis this year as in the past has rendered valuable assistance in visiting and giving advice to tuberculous patients under our care. They have also furnished milk, medicines, groceries and clothing for tuberculosis patients to the amount of $155.69. The services of their tuberculosis nurse are always at our disposal for the asking. Miss Margaret E. Cartwright has fully sustained the enviable reputation for energy and efficiency of work established by her predecessor, Miss Annie B. Rose.
The greatest difficulty we have experienced in caring for tuberculous cases at State institutions is that we have no power compelling patients to remain any longer than they please. They soon become homesick and return to their homes and we are obliged to care for them here at an increased expense. Such cases would be best accommodated in a hospital in our own city near their own homes and friends. The policy of the State is to have each municipality take care of those tuberculosis patients that are public charges by means of two agencies, a tuberculosis dispensary and a tuberculosis hospital; the latter
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to be grouped with buildings for an isolation hospital for other contagious diseases besides smallpox. In this tuberculosis hospital can be treated cases in all stages of the disease. The dispensary is the agency for the examination of suspected cases, for the treatment and supervision of cases who do not need hospital care or who have been discharged from hospitals as cured or arrested cases. It is also as a sort of an intelligence office for these latter cases to the end that they may be furnished with suitable work under conditions that will not favor a return of the disease ; in short, a sort of clearing house for tuberculous cases.
ISOLATION HOSPITAL FOR CONTAGIOUS DISEASES INCLUDING TUBERCULOSIS.
We believe that an isolation hospital for contagious diseases should be built at once to accommodate 25 scarlet fever and diphtheria patients, and a tuberculosis hospital for at least 25 patients. These should be sufficiently near together to be heated and administered from the same central plant. This is the plan that Worcester is trying to get an appropriation for, and one that has been in operation in Somerville for some time. It is the plan advocated by the State Board of Health and the State Tuberculosis Commission. The city owns land connected with the Poor Farm, situated between the County Jail and the Poor Farm, that is admirably adapted to this purpose; it is highly situated and slopes gradually toward the south and east, and is conveniently accessible by means of the Fitchburg & Leominster Street Railway. This plant could be adminis- tered by a competent woman superintendent, assisted by grad- uate nurses, or senior nurses from various training schools for nurses in Massachusetts who wish the experience of nursing contagious diseases. The expense of such a group of buildings would be about $50,000. Such institutions are by law under charge of the Board of Health and should be separated from general city hospitals. To obtain the gratuity of $5 per week, which the State offers to every city or town which establishes and maintains a tuberculosis hospital, for each patient who is unable to pay for his support, or whose kindred bound by law to maintain him are unable to pay for the same, it is necessary to erect and maintain such an isolation hospital as I have
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described, apart from any general hospital or private tubercu- losis hospital, according to the opinion of the Attorney General, given Dec. 4, 1911. The plans for such a hospital must also be approved by the State Board of Health.
A city and adjoining towns may, with the consent of the State Board of Health, establish such hospitals in common, and the tuberculous patients of all such towns that are public charges may receive the gratuity of $5 from the state provided tuberculosis germs are found in their sputa. This opinion was given to us by the Secretary of the Tuberculosis Commission. This decision allows us to establish and maintain an isolation hospital in common with Leominster and adjoining towns, if we desire. We have given you a detailed account of the cost of caring for tuberculous patients and of the large amount paid the past year for caring for diphtheria patients, and our opinion of the inadequacy of the means at our disposal for the control of the present situation, for the purpose of emphasizing the need of an isolation hospital for contagious diseases, including tuberculosis.
We wish in this connection to call your attention to the admirable report of our Bacteriologist, Dr. Atherton P. Mason, who unqualifiedly asserts that he believes such a hospital is necessary to control the epidemic of diphtheria which he be- lieves is still prevailing.
SANITARY STATIONS.
Chapter 596, of the Acts of 1911, provides that in cities of over 10,000 inhabitants there shall be provided one or more sanitary stations for both sexes, which shall be established and maintained by the city or town in which they are located. The number and location of such sanitary stations shall be deter- mined by the local Board of Health. The Board has considered this matter and believes that the station under City Hall is well located and properly kept. It also believes that another station should be established underground in the little park opposite the railroad station, and the City Government will be required to built and equip one in this place unless we can be convinced that some other location is more desirable. If changes to tlie approach to the railroad station are to be made, as outlined in
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articles that have appeared lately in the public press, this san- itary station could be located so as to conform to the general plan for such change's and be established when they are carried out.
OFFAL, ASHES, HOUSE DIRT AND RUBBISH.
The regulations of the Board of Health require the owner, agent or lessee of every building within the limits of the city to provide a suitable receptacle for ashes and rubbish and not to allow ashes or rubbish to be thrown in or about the yard or premises. They also require that every house shall be provided with a suitable, water tight, covered receptacle in which to keep garbage and swill. The collection of the garbage and swill is under the jurisdiction of the Board of Health and a five-year contract for such collection, covering the whole city was made with Russell K. Proctor, November 21, 1911, for the sum of $3,300 per year. This collection is made by him twice a week and is generally well done. No others are permitted to collect swill without permission from the Board of Health. Only one person has this permission. It is the policy of the Board not to grant licenses to private parties, as they are hard to control.
It is the duty of the Street Commission to collect ashes, house dirt and rubbish. The collection of ashes is well done every two weeks; a more frequent collection during the cold weather would be better. The collection of house dirt and rub- bish is very unsatisfactory as it is made only twice a year. If collections were made every two months it would be an induce- ment for householders to provide proper receptacles and keep their premises free from rubbish and dirt. We urge your honorable body to pass an order requiring a collection of house dirt and rubbish to be made every two months. The Board of Health gets the blame which should be placed on the Street Commission where it belongs. We have no power to interfere until a nuisance exists. We have had rubbish signs printed in four different languages and shall try to prevent dumping of rubbish in improper places, as far as possible. The public dump is properly kept under the direction of Mrs. Noah Jack- son, and parties are urged to make use of the same. The Board pleads guilty to a part of the blame laid at its door for the dirty
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