USA > Massachusetts > Norfolk County > Quincy > Inaugural address of the mayor, with the annual report of the officers of the city of Quincy for the year 1927 > Part 8
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2. It is also suggested that sufficient clinical services be pro- vided for those cases which would not ordinarily be under medical supervision during pregnancy.
3. As an extension or modification of clinical service it would seem desirable to encourage physicians to refer cases to the Vis- iting Nurses for pre-natal supervision, with the understanding that the results of periodic visits would be immediately reported to the physician. Such report should contain a statement of the general physical condition in which the mother is found, with pro- visions for the immediate reporting by telephone in case of un- favorable conditions."
As the Health Department was duplicating to a considerable extent the pre-natal work which was being done by the Quincy Visiting Nurses for the various insurance companies furnishing pre-natal service, it was decided about March 1st to abandon what- ever pre-natal work the Health Department was doing. A pre- natal clinic is extremely desirable, but as yet there has not been sufficient sentiment aroused in its favor. There were fifteen ma- ternal deaths during childbirth; seven of these might possibly have been prevented. There were fifty-six stillbirths and forty- four infant deaths under one month.
Infant Welfare Service
1. "It would seem desirable in this service that the nursing activities be somewhat extended. At present there is but 1.7 nursing visits to home per case registered at the clinic. This is hardly sufficient to insure the best carrying out of clinic instruc- tions.
2. Since the infant mortality rate of Quincy is not truly por- trayed by the relation of local deaths under one year to local births, it would seem desirable that a study of the effect of non- resident births and deaths be made this year, and for several years back, if possible, in order that more accurate data may be pre- sented concerning the effect of the nursing and clinical service at present provided.
3. There are at present several baby boarding homes in Quincy taking babies, mostly from other parts of the State. Since these infants are technically residents of Quincy and since their health is recorded on Quincy records, it would seem advisable to extend the present nursing inspection service of these homes so that a monthly visit may be made."
During the past year 1,552 visits were made as compared to 400 visits in 1926.
Pre-school Service
"It has been the policy to drop cases at two years of age. It is recommended that this practice be discontinued and that a com- plete pre-school service be substituted in its place, including toxin anti-toxin work, consideration of habits, pre-school physical ex- amination and nursing follow-up, with the aim of turning over to the school system children physically fit to learn and to a large degree free from physical defects."
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CITY OF QUINCY
There is now a pre-school clinic held once a month. The toxin anti-toxin work is being handled very efficiently. The State De- partment of Mental Hygiene is holding a weekly habit clinic at the Quincy Dispensary. In addition to this, since May, 1927, there has been a monthly Orthopaedic Clinic held at the same time as the Child Welfare Clinic at Woodward Institute. Emphasis is placed upon the prevention of orthopaedic deformities.
Health of the School Child
This is under the care of the School Department.
Municipal Sanitation
1. "The principal suggestion in connection with sanitary inspec- tion services is for extension of supervision of food-handling es- tablishments. Though it may not be possible to provide physical examination of all food handlers, provision should be made for examination of those cases suspected of having some communi- cable disease.
2. The per cent of milk supply pasteurized could well be in- creased; this would probably result in a decrease in the number of distributors. Recent epidemics in Massachusetts of typhoid fever from milk supplies show the danger of even a small per cent of un- pasteurized milk.
3. In order to obtain the highest quality of market milk, bac- teria counts should be made and the results reported, if possible, directly to the farmers as a basis of inspection of production.
4. While the city is but 70 per cent sewered, an additional 27 per cent of the population are served by cesspools. A study of the incidence of typhoid fever with the possibility of fly dissemina- tion and the danger of soil or water pollution from the 374 privies should be undertaken.
5. The 374 privies at private dwellings should either be elim- inated or put in sanitary condition.
6. The inspection of installation of new plumbing has in the majority of cities become the function of some other department than the Health Department, usually it is placed under the Build- ing Department, as it fits in so closely with the supervision of other building inspections, and permits this service to function more economically, whereas in the Health Department it is en- tirely unrelated to other services. For this reason the position of Plumbing Inspector is omitted from the recommended provi- sions for Quincy."
All milk handlers were examined by private physicians employed by the various milk distribution agencies. Eighty-nine per cent of the milk is now pasteurized as compared with seventy-seven per cent in 1926. Bacterial counts are now reported to the farm- ers. No study of the incidence of typhoid fever has been made because there were only four cases during the year. Forty-seven privies were eliminated during the year.
Laboratory Service
No recommendations were made by Dr. Walker.
135
REPORT OF DEPARTMENT OF HEALTH
Popular Health Instruction
"There is need, however, for interpreting health activities and results to the public through a regular bulletin published monthly, which will combine the principal activities of the Health Depart- ment, the Board of Education and the nursing service. Films on important health subjects might well be used by theatres and before local clubs."
There is now a monthly bulletin with a mailing list of 350. During the year films on diphtheria prevention and the production of clean milk were shown both at a local fair and at baby clinics.
We do not include in this report the Budget and Personnel as recommended by Dr. Walker.
It is to be hoped that in the near future that Quincy might have more commodious quarters for the Health Department. A "Health Centre" would be the most logical way of coordinating all the various health activities of the city and could be used as well for the Health Department.
The Health Department Budget for 1926 was $56,219. In 1927 the Health Department spent $55,282. It will be seen that an increased amount of work and, therefore, of service has been per- formed at a decreased cost. It will be further noticed that while an increased amount has been expended for personal services, a decreased amount has been spent for expenses. Salaries for 1926 amounted to $22,709. In 1927 salaries were $23,597. "Higher indi- vidual rates, securing more capable employees, and greater atten- tion to effectiveness of organization and procedure, so that more work may be done better with fewer employees at higher pay, is the way to true economy and better service in the long run."
Besides the various recommendations made by Dr. Walker, I should like to place on record the following suggestions for the extension and improvement of Health Department activities:
1. A baby clinic at Houghs Neck.
2. A local tuberculosis preventorium to take care of those chil- dren that cannot be accepted at Norfolk County Health Camp.
3. Establishment of a nursing supervisor.
4. Establishment of a full-time food inspector.
5. Establishment of generalized nursing service wherein each nurse would handle all the public health problems in her own section of the city.
6. The immediate purchase of at least three new automobiles.
For all the cooperation and assistance that the Health Depart- ment has received I should like to thank the State Department of Health, the Quincy Visiting Nurses, the School Department, and His Honor the Mayor and the President and Members of the City Council. The loyalty and interest of the employees of the Health department have helped the progress of the work more than any other factor.
Respectfully submitted,
E. B. FITZGERALD, M. D., Health Commissioner.
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CITY OF QUINCY
MORTALITY STATISTICS Number of Deaths and Death Rates
During the year 1927 there were 559 deaths which occurred in Quincy. This number was an increase, of 23 over 1926 when there were 536 deaths. There was a very slight increase in the death rate. Based on the estimated population of 65,275 on July 1st (mid-year), the death rate for 1927 was 8.6 per 1,000 population as compared with 8.5 in 1926. Of the persons who died in Quincy during the year, 35 were non-residents but there were 99 residents of Quincy who died outside the city. There were, therefore, 623 Quincy residents who died during the year. The "resident death rate" was 9.5 per 1,000 population.
SEX. Of the 559 deaths in 1927, 291 or 52.1 per cent were males as compared with 54.4 per cent in 1926. The proportion of males in the population as shown by the United States Census of 1920 was 50.6 per cent. The estimates for 1927 were 33,029 males and 32,246 females. Based on these estimates the death rate per 1,000 for males was 8.8 as compared with 9.1 in 1926. The rate for females in 1927 was 8.4 as compared with 7.8 in 1926.
AGE. Of the 559 deaths in 1927, 65 or 11.6 per cent were of infants under one year of age as compared with 12 per cent in 1926. Among the deaths registered during 1927 there were 10 over 90 years of age, 6 of whom were males and 4 were females. The oldest was 94 years, 1 month, 27 days. The average age at death fell in the 60-64 year group, as it did in 1926.
NATIVITY. 341 or 61.5 per cent of the decedents whose nativ- ity was reported on the death certificate were native.
SEASONAL DISTRIBUTION OF DEATHS. The largest num- ber of deaths in any one month occurred in February, when there were 59, and the next largest in December when there were 58. The lowest number occurred in August when 29 were registered.
INFANT MORTALITY. The infant deaths in 1927 were 57 per 1,000 live births. The infant mortality rates since 1910 are shown below:
1910
103
1919
64
1911
102
1920
66
1912
82
1921
55
1913
108
1922
73
1914
75
1923
70
1915
76
1924
53
1916
72
1925
58
1917
71
1926
66
1918
90
1927
57
The highest proportion of deaths under one year of age occurs during the early period of infancy and especially is this true of the first week. In 1927 there occurred 29 deaths in the first week, constituting 44.6 per cent of all deaths under one year of age. In the first month there were 44 deaths or 67.7 per cent of all infant deaths. These percentages are higher than in 1926 when the deaths under one week constituted 40.6 per cent, and under one month 59.4 per cent of all infant deaths.
CAUSES OF DEATHS:
PNEUMONIA caused 42 deaths in 1927 or 64 per 100,000 pop- ulation. It was responsible for 49 deaths or 77 per 100,000 pop- ulation in 1926.
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REPORT OF DEPARTMENT OF HEALTH
HEART DISEASE. The deaths from heart diseases in 1927 numbered 147 or 26.5 per cent of all deaths or 222 per 100,000 population as compared with 124 deaths or 23.3 per cent of all deaths or 194 per 100,000 population in 1926.
TUBERCULOSIS in its various forms claimed 37 victims in 1927, of whom 35 died from tuberculosis of the respiratory system. Deaths from tuberculosis constituted 6.6 per cent of all deaths in 1927. The rate per 100,000 population in 1927 was 56.5 as com- pared with a rate of 44.5 in 1926. In addition 11 Quincy residents died of tuberculosis in sanatoria, making the total number of deaths from this disease 48. Subtracting from the number 2 non- residents who died in Quincy, the corrected rate per 100,000 pop- ulation was 70.5. Of the 26 deaths in Quincy from tuberculosis among males, 13 or 50 per cent of the decedents were former gran- ite workers.
CEREBRAL HEMORRHAGE and apoplexy caused 38 deaths or 6.8 per cent of all deaths or a death rate of 58 per 100,000 population. In 1926 there were 41 deaths from this cause, cor- responding to almost 8 per cent of deaths from all causes or a death rate of 65 per 100,000 population.
CANCER caused 65 deaths in 1927, corresponding to a death rate of 100 per 100,000 population as compared with 56 deaths with a rate of 89 per 100,000 population in 1926.
BRIGHT'S DISEASE and nephritis were the cause of 33 deaths in 1927, corresponding to a rate of 50 per 106,000 population as compared with 44 deaths and a rate of 70 per 100,000 population in 1926.
DISEASES OF EARLY INFANCY and congenital malforma- tions caused 36 deaths in 1927, a rate of 55 per 100,000 population compared with 32 deaths and a rate of 51 in 1926.
EXTERNAL CAUSES. The number of deaths from external causes was 41, with a rate of 63 per 100,000 population as com- pared with 40 deaths and a rate of 63 in 1926. Automobile acci- dents were the cause of 8 of these deaths as compared with 9 in 1926.
138
CITY OF QUINCY
REPORT OF SUPERINTENDENT
JANUARY 1, 1928.
Dr. Edmund B. FitzGerald, Health Commissioner.
DEAR SIR :- I hereby submit the annual report of the Depart- ment of Health for the year ending December 31, 1927.
The personnel of the department is as follows:
Commissioner of Health and Insp. of Milk .. Dr. Edm. B. FitzGerald Superintendent Thomas G. Smith
Clerk
Verna M. Kelley
Sanitary Inspector
A. A. Robertson
Assistant Milk Inspector
James O'Dowd
Plumbing Inspector
J. J. Keniley
Inspector of Meats and Provisions
Howard O. Rogers
Dispensary Physician
Dr C. J. Lynch
Child Welfare Physician.
Dr. Rachel E. Hardwick
Venereal Disease Physician.
Dr. E. E. Smith
Bacteriologist
Dr. E. E. Smith
Tuberculosis Nurse Gertrude T. Russell, R.N.
Contagious Nurse Cath. F. Coleman, R.N.
Child Welfare Nurse. Nettie D. Fowler, R.N.
Child Welfare Nurse. Mary E. Keeley, R.N.
Inspector of Animals and Slaughtering Dr. E. A. de Varennes
Under date of January 1, 1927, the Visiting Nurse Association took over the pre-natal work, which was performed by Miss Keeley during the year 1926. Miss Keeley was transferred to the Child Welfare work to assist Mrs. Fowler.
Dr. Hardwick was appointed Child Welfare Physician to take the position made vacant by the appointment of Dr. FitzGerald as Health Commissioner.
Appended you will find the report of the various inspectors and nurses, also report of diseases and deaths reported for the year 1927.
See Auditor's report of receipts and payments.
Respectfully submitted,
THOMAS G. SMITH, Superintendent.
139
REPORT OF DEPARTMENT OF HEALTH
REPORT OF CHILD WELFARE PHYSICIAN
EDMUND B. FITZGERALD, M.D., Health Commissioner.
DEAR DOCTOR :- The report of the Child Welfare activities for the year ending December 31, 1927, is herewith submitted.
The detailed statistical data of the clinics will be found in the report of the Child Welfare Nurse. Her report will include the number of clinics held during the year, the average attendance, the number of new cases enrolled, and the total clinic registration.
Certain facts implied by these figurees seem worthy of special note:
a. The number of newly registered children for the year 1927 shows a continued interest in the character of service which the clinic offers.
b. Infants are being enrolled at the clinics at much younger age than formerly. This is a very important step in the progress of our Child Welfare work, since it has enabled us to reestablish the mother's breast milk supply in many cases where the object of clinic attendance was to seek advice about artificial feeding be- cause a hungry baby was dissatisfied.
c. Of the four clinics having the largest attendance only three now have the service of a physician in regular attendance.
The new clinics have been added to our program this year. The clinic for pre-school age children (ages 3 to 6 years) and the Ortho- paedic clinic, each meeting once a month.
There have been eight of these clinics, and although the at- tendance has been small for statistical material, the number has been all that the present staff could handle.
The results of the examinations have indicated an urgent need for mothers to watch the child's health and habits during the years from the nursery to the schoolroom.
The importance of the orthopaedic examinations is made clear from the findings recorded in a separate report.
During the latter part of the year, certain regulations in the administration of the clinics have been worked out successfully. The problem of conference with the examining physician has been arranged so that each mother receives a number in order of her arrival at the clinic session. In sequence these babies are seen by the physician in charge. The number of children to be seen on each afternoon is able to be fairly accurately estimated and numerals above this estimate are told early in the clinic period that they are unlikely to be seen that afternoon. If a mother chooses to wait until the end of the clinic she is always seen. Chil- dren whom the physician has asked to return on a certain date are seen on the date arranged. All new babies are examined on the first day of registration unless they prefer to postpone the con- ference.
As a part of the educational plan for the Children's Welfare, an endeavor was made to have brief talks given at the clinics, while the mothers were waiting for conference with the physician. The first experiment was made with a five-minute talk on "What Is Good Milk, Certified, Grade A, and Household Milk ?" The speaker was one who appreciated his audience and knew his subject. He had the added attraction of two reels of interesting moving pic- tures to illustrate his talk. In spite of an almost ideal perform- ance it was quite obvious to those in charge of the clinic that our present housing facilities were not suited to such a program. On
140
CITY OF QUINCY
this account the plan for continuing the talks on other subjects was abandoned for the year.
With our present organization the teaching program is covered by: (a) the physician's instructions to the individual mothers at the time of the conference; (b) through the printed literature which the clinic provides as health instruction; (c) the detailed instruction given by the Child Welfare Nurse during her follow-up visits to the homes of all newly registered babies and others need- ing extra tutoring.
Special thought is given to cooperating with the activities of the other clinics provided by the city for the welfare of children- the Diphtheria Prevention Clinic, the Habit Clinic, and the Under- nourished Children's Clinic.
During the summer months instructions were given about sun baths for babies and children. The clinics whose proximity to the beaches afforded the children the privileges of Quincy's natural resources were very successful in carrying out the plan.
For the improvement of Child Welfare work, the following rec- ommendations are made:
1. A physician in attendance at the clinics of each ward.
2. Additional nursing service so that there may be at least two full time nurses to extend the educational program through more follow-up teaching and the arrangement of demonstrations and exhibits of health material for clinic instruction.
3. Reiteration of the recommendation made one year ago,- "Establishment of a Health Center for the correlation and cen- tralization of pre-natal work, infant welfare clinics, tuberculosis prevention, dental hygiene, pre-school clinics, posture and nutri- tion classes, habit clinics and diphtheria prevention" (from City Report 1926-Dr. E. B. FitzGerald).
4. The cooperation of a Children's Ward at the Quincy City Hospital to which could be referred children needing hospital care under the direction of a pediatrician but unable to afford this privilege as a private patient. Difficult feeding cases frequently present this problem.
In closing, may I express my appreciation for your generous helpfulness and understanding of the problems involved in this work. I wish also to thank for their cooperation, Mrs. Fowler and Miss Keeley. the Child Welfare nurses to whom is due much credit for the success of the clinics; Dr. Katzeff and the physicians from the Graduate School of Harvard Medical School, who have volun- teered several months of service; the Boston Dispensary Hospital for Children; the personnel of the Health Department, the Fore River Club, the West Quincy and Atlantic Councils of the K. of C., the Presbyterian Church of South Quincy, the Trustees of Wood- ward Institute and the Quincy and Wollaston Women's Clubs.
Respectfully submitted,
RACHEL L. HARDWICK,
Child Welfare Physician.
141
REPORT OF DEPARTMENT OF HEALTH
REPORT OF CHILD WELFARE NURSE
JANUARY 1, 1928.
DR. E. B. FITZGERALD, Health Commissioner.
DEAR DOCTOR :- I herewith submit my eighth annual report of my work as Child Welfare Nurse for the year ending December 31, 1927.
The assistance of an additional nurse, Miss Mary Keeley, aided the child welfare work to a great extent. As it was possible to do a great deal more follow-up work we were able to learn more about home conditions and were better able to give proper assist- ance to the mother and to the child. Miss Keeley has assisted at clinics when necessary and has had charge of the Quincy Point Clinic which is held at the Fore River Club House.
There were 2,217 home visits made to babies. Nine boarding homes for babies were inspected. There were 147 babies referred to their family physician and seven babies referred to local physi- cians for special treatments. Two were referred to the Quincy City Hospital for X-ray of the thymus. Fifteen were referred to the Children's Hospital for the following reasons: dislocated hip, fractured nose, osteomyelitis, acrodynia, attendance at the muscle training, heart and orthopedic clinics. One was referred for the fitting of an abdominal supporter; four babies were referred to the Boston Dispensary; three to free beds as feeding cases and one to skin department. Three were referred to the Habit Clinic at the Quincy Dispensary. Four were referred to the Tuberculosis Clinic for Von Pirquet tests. I also assisted at the Diphtheria Prevention Clinics held on the same day as the Child Welfare Clinics.
Beginning May 10, 1927, a Pre-school Clinic was held once a" month at the Woodward Institute cn the same day as the Baby Clinic. Seventy children between the ages of 3 and 6 years at- tended at this clinic. Dr. Miriam Katzeff, a specialist in ortho- pedics, made 89 examinations in addition to those made by Dr. Rachel Hardwick. Four cases of birth injuries, 31 weak feet need- ing shoe correction, one infection of the shoulder, one dislocated hip, 15 postural defects and seven late and inactive rickets. Sixty of the eighty-nine children are being supervised at the present time.
During 1927 there were 65 deaths among babies under the age of one year. Nine of these were registered at the clinics but were not under direct supervision at the time of death.
The causes of deaths were as follows:
Bronchial pneumonia 2
Infectious diarrhea
2
Imbecility
1
Erysipelas
1
Malnutrition
1*
Suffocation
1
Pertussis
1
*Six weeks old-attended clinic once.
There were 622 new enrollments during the year, making a total of 1,752 registered babies.
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CITY OF QUINCY
There were 247 clinics held during the year with a total attend- ance of 7,047, making an average attendance of 28.
Percentage Increase or
Attendance
Ward 1
Woodward Institute
1,685
Decrease 6% decrease
Ward 2 Fore River Club
722
14.3% decrease
Ward 3
Presbyterian Church 1,307
19% increase
Ward 4 K. of C. Hall, West Quincy 678
8.1% decrease
Ward 5
Library Building, Wollaston 1,469
37% decrease
Ward 6
K. of C. Hall, Atlantic 1,186
13% increase
7,047
10.6% decrease
The total attendance at clinics since 1920 is as follows:
1920
539
1921
2,504
1922
2,757
1923
3,686
1924
5,023
1925
7,550
1926
7,800
1927
7,047
At this time I wish to thank Dr. Edmund FitzGerald, the Health Commissioner; the Public Welfare Department; Quincy and Wol- laston Women's Clubs; the Visiting Nurses of the Quincy Women's Club; the Quincy Hospital and the physicians of Quincy for the many courtesies extended the Child Welfare Division of the Health Department. To Dr. Rachel Hardwick, Dr. Miriam Katzeff and other physicians who so kindly gave their time and untiring as- sistance in the clinic work, and for their many courtesies to me, I express my deep appreciation.
Respectfully submitted,
NETTIE DENTON FOWLER, R.N., Child Welfare Nurse.
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REPORT OF DEPARTMENT OF HEALTH
REPORT OF ORTHOPAEDIC PHYSICIAN
JANUARY 2, 1928.
DR. EDMUND B. FITZGERALD, Health Commissioner.
DEAR DOCTOR :- The report of the work in the Orthopaedic Clinics during 1927 is as follows:
The first clinic for the orthopaedic examination of infants and children was held on May 18, 1927. Subsequent clinics have been held on the second Thursday of each month, meeting with the Child Welfare Clinics at Woodward Institute.
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