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 1928 > Part 8
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(2) That the extensive campaign carried on during 1927 against diphtheria particularly among the school children, be resumed and extended to include a larger per cent of the preschool group."
The second of these recommendations has been carried out :- An increased per cent of the preschool group are being reached and immunization of the first three grades of the public schools is to be started next week.
Venereal Disease Control
"It is recommended :
(1) That further steps be taken by the Health Department to acquaint the local physicians of the facilities of the depart- ment for doing follow-up work of delinquent cases and encour- aging the prompt reporting of such cases.
(2) That physicians be urged to avail themselves of the preparations provided free by the Health Department for treat- ment of cases.
(3) That increased use be made of the clinic services now provided for venereal diseases."
As an additional recommendation I should like to suggest separate clinics for men and women. Until more money is ap- propriated this cannot be done.
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REPORT OF DEPARTMENT OF HEALTH
Tuberculosis Control
"It is recommended :
(1) That the nursing service give special attention to visits in behalf of post-sanatoria patients bringing about a better balance between post-sanatoria and other nursing care."
As a matter of fact the great majority of Quincy's sanatorium cases are at Norfolk County Hospital and this hospital, by their own system of follow-up, relieves the local department of much of the burden.
(2) That open air classrooms be provided for potentially tuberculosis children. The Tuberculosis Dispensary Physician in his annual report for 1928 emphasizes the importance of supple- menting the work accomplished in summer camps by such facil- ities."
Pre-Natal Service
"Maternity hygiene service in Quincy is provided almost en- tirely by the Visiting Nurse Association.
Quincy's experience with regard to maternal mortality (six deaths in 1926; 15 in 1927 and five in 1928) indicates that the present accomplishment is not as good as is possible. Recent demonstrations in this field point out clearly that maternal mor- tality rates between two and three for white mothers are quite possible, where adequate medical and nursing supervision is pro- vided. The decision to abandon the idea of a pre-natal clinic is believed to be sound but it seems desirable to recommend a
considerable extension of the pre-natal nursing service which at present reached less than 30 per cent of the total births. It is of course appreciated that a higher percentage of births have hospital delivery and many are under medical supervision out- side Quincy. This does not mean, however, that instructive nursing service carried on in conjunction with the physician should not be desirable.
It is recommended :
(1) That, in view of the fact that pre-natal clinic facilities are not provided in Quincy, the present nursing service be some- what extended to include a larger per cent of the total number of births.
Infant Welfare Service
"The clinic service, however, is said to be handicapped by lack of space.
In 1928, 1,032 infants under one year of age were registered with the nursing service of the Health Department. To these infants, 1,859 visits were made by the nurses of the department, while additional visits totalling 2,390 were made by the Quincy Visiting Nurses. The ratio of visits by nurses to infants regis- tered with the service was 4.1. Adequate nursing service for a city with an infant mortality rate for the past three years of 51 to 75 requires an average of at least 10 visits to each infant registered.
It is recommended :
(1) That consideration be given to the provision of proper quarters for infant welfare clinics.
(2) That more time be devoted to securing the attendance of a greater number of infants at the welfare clinics.
(3) That the nursing services now provided for this group be extended to render more intensive service.
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CITY OF QUINCY
(4) That the program for infant hygiene include immuniza- tion against diphtheria of all infants registered with the clinic and nursing service."
Quincy is sadly in need of at least one health centre which would furnish quarters for not only an infant welfare clinic but also for correlation and centralization of pre-natal work, tuberculosis prevention, dental hygiene, pre-school clinics; pos- ture and nutrition classes, habit clinics and diphtheria prevention clinics. This recommendation has been embodied in the annual report since 1923. At the present time on the second Thursday of each month it is possible to see the following activities carried on simultaneosuly at Woodward Institute: Infant Welfare, Pre- School, Habit, Diphtheria Prevention, Orthopedic and Nutrition Clinics. It is only through the kindness of the trustees of Woodward Institute that this is possible. Would that some public spirited citi- zen could present a health centre, or even the land for one, as a stimulus for others to contribute sufficient funds for a modest building. At the present time it is not feasible to handle a larger attendance at the welfare clinics. More intensive nurs- ing service is possible only by securing another full time nurse or by instituting a system of generalized nursing.
The precentage of infants immunized against diphtheria is steadily increasing.
Pre-School Hygiene
"As in the case of infant hygiene, the nursing service is ren- dered by the Visiting Nurses and the Health Department, the former making 295 visits to the 200 pre-school children registered, while the latter made 619 visits to 598 pre-school children; a ratio of but 1.1 visit per child. Obviously such a small number of visits could not be expected to supply satisfactory service. Though the work in Quincy has increased to some extent, the recording of the service is not sufficiently complete and the ac- tivities are not as yet so well organized as to receive full credit.
It is recommended :
(1) That records of the infant and pre-school clinic service be separated so as to show the extent and volume of service ren- dered to infants under one year of age, and to those in the pre- school age group, as the type of service and emphasis should be distinctly different for these two groups.
(2) That the present clinic and nursing service be extended to insure more satisfactory and nursing supervision for the pre- school group. The program should include an active campaign for the immunization of all pre-school children in the City and a physical examination at least four months previous to enter- ing school."
The first of the above recommendations is to be carried out. Until the present nursing force is increased in number it will be impossible to extend the present clinic and nursing service.
Many more pre-school children are being immunized than heretofore.
Health of the School Child
This is under the care of the School Department.
Public Health Nursing
"The public health nursing activities still show a specializa- tion which has been proven by experience in other communities
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REPORT OF DEPARTMENT OF HEALTH
to be costly and to prevent the most satisfactory handling of the cases carried, both from the viewpoint of the patient and of the nursing service responsible for the care. Considering the spread out nature of the city, specialization means a considerable loss of time in travel, which is both costly and wearing upon the nursing staff.
It is therefore recommended :
(1) That the Health Department, the Board of Education and Quincy Visiting Nurses give thought to the development of a program of nursing service as outlined above."
The Health Department is prevented only by an insufficient budget in carrying out the above plan-each nurse to have her own district-all under the charge of a supervisor. If proven satisfactory then the other two agencies might be induced to co-operate.
Food and Milk Control
"The practise of scoring food establishments has not yet been adopted in Quincy.
Records are not available showing the number of dairy cows in the area that were tuberculin tested in 1928 though it is re- ported that all raw milk sold in the city is from tuberculin tested cows.
It is recommended :
(1) That special emphasis be placed during the coming year upon the laboratory service in connection with milk control since only by careful supervision of raw milk before pasteurization and laboratory checking of the effectiveness of pasteurization can a clean and safe supply be assured to the community. By pub- lishing the bacterial counts of the various distributors supplying milk for Quincy it may be possible to stimulate the production of a milk supply of higher quality than is now being furnished."
The first recommendation in the above paragraph is to be car- ried out. It does not seem advisable to publish bacterial counts except as average counts for three month periods. Until the public appreciate what bacterial counts really mean there might be considerable false emphasis placed on an. occasional high count. This department would like to see compulsory double capping of milk bottles.
Sanitation
"It is recommended:
(1) That steps be taken to further the extension of sewage facilities of the city to all dwellings within the city and to elim- inate as rapidly as possible the remaining privies which are a constant menace to the health of the community."
Because of the rapid development of the city this is going to be a very difficult recommendation to carry out.
Laboratory Service
"The services are deficient in the examination of specimens of tuberculosis syphilis, milk and water.
It is recommended :
(1) That the physicians be encouraged to use the laboratory facilities provided, especially for those items which are shown to be deficient in 1928.
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(2) That greater use be made of the laboratory service in the milk control work."
Water examinations are not necessary inasmuch as Quincy is in the carefully supervised Metropolitan system.
Popular Health Instruction
"It is recommended:
(1) That the present program be continued, with the possible addition of special pamphlets on heart disease, tuberculosis and venereal diseases."
Heart Disease and Cancer Control
"It is suggested that facts regarding the prevalence of cancer and heart disease in the community be collected and that local physicians and other interested groups be encouraged to study these data in order that a satisfactory program for their con- trol may be worked out."
For detailed reports of the various activities see the reports following mine. In Dr. Walker's report I have only abstracted the criticism. There is much that is commended in the same report. I should like to emphasize most particularly the fol- lowing needs (some of these have been repeated for some years.)
(1) "It is to be hoped that in the near future that Quincy might have more commodious quarters for the Health Depart- ment. A 'Health Centre' would be the most logical way of co- ordinating all the various health activities of the city and could be used as well for the Health Department." (Report for 1927).
(2) Some of the staff are still underpaid for the highly technical services that they render in a most efficient manner.
(3) Establishment of the position of a nursing supervisor.
(4) Establishment of the position of a full time food in- spector.
(5) Establishment of a generalized nursing service wherein each nurse could handle all the public health problems in her own section of the city.
(6)
The immediate purchase of a new automobile.
"The National Board of Fire Underwriters has developed an appraisal form of rating the fire protection of cities. Poor standing means higher insurance rates. Improved standing means reduced rates. Such an appraisal form speaks in a language of dollars and cents that is unmistakeable. Are we not approach- ing a time when life and health and accident insurance com- panies will differentiate in their rates between cities with or- ganized business-like health service and those with ill-equipped or disorganized machinery for public health protection (Ap- praisal Form for City Health Work 1929 Edition). The per capita cost for the Quincy Health Department has been 77 cents (net cost). A complete program of public health work usually means a per capita cost of $1.00.
For all the co-operation and assistance that the Health Depart- ment has received I should like to thank the State Department of Health, the Quincy Visiting Nurses, His Honor the Mayor and the President and Members of the City Council.
The interest of the citizens of Quincy and the generous pub- licity of the newspapers have been most heartening. Finally
-
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REPORT OF DEPARTMENT OF HEALTH
this report and the appended reports show the progress that is possible when a loyal and interested department puts its shoulder to the wheel.
Respectfully submitted,
E. B. FITZGERALD, M. D. Health Commissioner.
MARCH 31, 1929
REPORT OF SUPERINTENDENT
JANUARY 1, 1929.
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, 1928.
The personnel of the department is as follows:
Commissioner of Health and Insp. of Milk Dr. E. 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 Rogers
Dispensary Physician
Dr. C. J. Lynch
Child Welfare Physician
Dr. Rachel L. Hardwick
Dr. E. E. Smith
Tuberculosis Nurse
Gert. T. Russell, R.N.
Tuberculosis Nurse
Mary E. Keeley, R.N.
Contagious Nurse
Cath. F. Coleman, R.N.
Child Welfare Nurse Nettie D. Fowler, R.N.
Child Welfare Nurse
Mary E. Marr, R.N.
Inspector of Animals and Slaughtering. . Dr. E. A. de Varennes
There has been one addition to the personnel of the depart- ment the past year, that of the appointment of Miss Mary E. Marr as assistant Child Welfare Nurse, made necessary with the con- stant growth of the clinics. She has proven very faithful and efficient.
Under date of June 1, 1928 this department made a hard and fast rule, to the effect that all complaints must be made in writing or in person at the office. This rule has worked to great advan- tage to the department, as we do not now receive any unnecessary complaints.
Appended you will find the reports of the various inspectors and nurses, also report of diseases and deaths reported for the year 1928.
See Auditor's report for statement of receipts and payments.
Respectfully submitted,
THOMAS G. SMITH, Superintendent.
Venereal Disease Physician
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CITY OF QUINCY
REPORT OF CHILD WELFARE PHYSICIAN
JANUARY 1, 1929.
EDMUND B. FITZGERALD, M.D., Commissioner of Health, City of Quincy, Massachusetts.
DEAR DOCTOR FITZGERALD :- It is my privilege to submit to you the report of the Child Welfare activities for the year ending December 31, 1928.
Statistics
There have been 354 clinics held this year.
330 clinics for the examination and regulation of feeding of children up to 3 years of age.
12 clinics for the examination and regulation of hygiene of children in the pre-school age group.
12 Orthopedic clinics.
The total registration is 1933. Infants and children up to age 3 years, 1492.
Pre-school group ages 3 to 6 years, 130. Orthopedic clinic registration, 164.
693 new registrations have been added this year. This is an in- crease of 71 over the figure of last year.
The orthopedic clinic registration has increased 100% since last year.
The total attendance figure is 7,002. A more detailed analy- sis of the statistics will be found in the reports of the Child Welfare Nurse and that of the examining physician at the Or- thopedic clinics.
Enrollment and Attendance
For the past two years there has been in operation a plan designed to give the maximum amount of individual service to the mothers and promote the most intelligent use of the clinics by the mothers.
Needlessly frequent visits have been eliminated by having the doctor advise the mother the date on which she should return.
The following schedule guides the return date :-
Infants up to 4 months of age seen weekly for weigh- ing regulation of feeding.
Infants 4 months to 7 months of age are seen every 2 weeks.
Infants and children over 7 months of age are seen once a month.
It has been a gratification to find that mothers have co-operated with this plan and used very good judgment in deciding for them- selves whenever it was necessary to bring the children at a date not set by the schedule. The few babies who do not attend the clinic on the expected date are visited in their homes by a nurse.
It is obvious that while this plan automatically reduces the total yearly clinic-attendance figures it represents a saving of the time of doctors, nurses, and mothers and gives a greater sat- isfaction to all, because it tends to keep the daily attendance within a number compatible with individual attention. This plan has not influenced the total registration figure or the number
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REPORT OF DEPARTMENT OF HEALTH
of newly registered children as compared with figures of pre- vious years.
Attendance
Registration
Year
New Enrollments
7,800
1,561
1926
497
7,047
1,752
1927
622
7,002
1,933
1928
693
Clinic at Hough's Neck
In May, 1928, a new clinic was opened at Hough's Neck. This is an added convenience for the mothers who previously attended the clinic at Quincy and it is hoped, will extend the clinic service to some families who could not arrange the transportation to the Quincy Center clinic. The new clinic has lightened the at- tendance at Quincy Center to more satisfactory proportions.
Nutrition Work
Since October, 1928, the Educational Director of the New England Dairy and Food Council, Miss Marjorie L. Foster and her assistant Miss Mona McWilliams have given volunteer serv- ice in one clinic each month. At the Pre-school clinic Miss Foster has given talks to mothers in groups, while Miss McWilliams has entertained the children with health stories and picture books. The dietitian's talks have been illustrated by demonstrations which she prepared each month.
Topics for discussion include :-
The Tooth-building diet in the first 6 years of life.
Average servings of food for normal children-Illus-
trated in terms of household measures.
Christmas Candies for Children-Made from nutritious foods.
The choice of foods according to the Season's Market. Economic buying for the Family Market Basket.
At each clinic the dietitian has an opportunity to help, individ- ually, the mothers whose children have presented a specific dietary problem. Such conferences are held at the recommenda- tion of the examining physician and the nurses have been carry- ing on the follow-up work in the homes.
Visitors
Seventy-five visitors have been welcomed to the Child Wel- fare clinics this year. Physicians, directors of public health activities, and students who will return to their homes for active participation in various kinds of health service have been in- terested to observe the health work in the Quincy clinics. The visitors have represented India, Japan, China, France, Italy as well as fifteen States other than Massachusetts.
Recommendations
Before making recommendations for 1929 it is interesting to review the progress of those submitted last year.
(a) A physician in attendance at the clinics of each ward has been arranged.
(b) Additions to the nursing service have been made which brings the staff up to the recommendations of last year, "at least two full-time nurses."
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CITY OF QUINCY
(c) For the last two years there has appeared in the recommendations of this department a plan for proper housing of health activities. Necessity for this has become increasingly apparent as the work of the various clinics has been strengthened and developed.
At present the housing of the clinics is most conspicuously in- adequate in the matter of proper rooms for weighing the babies. This is now done in the general waiting room where correct heating is difficult to arrange.
The educational work is severely handicapped by the lack of display space for exhibits and safe storage for demonstration materials.
A building which would meet the combined needs of the city's health activities for children should include :
Clinic rooms suitably arranged, heated, and ventilated. Indoor and outdoor parking space for baby carriages. Class room space and equipment for group teaching. A library of health material for distribution.
Space for permanent exhibits of health material.
There is already ample proof that many mothers welcome the instruction which has been offered in nutrition and classes in nursery training would give them the modern methods in child care to make more effective the work of the Pre-school clinics and the Habit clinic.
The development of Quincy in community centers makes it possible to organize the health work to meet the needs of each neighborhood-but the lack of proper housing is sure to hinder the progress in this direction.
If all the child health activities for one of the city's com- munity centers could be ideally housed for a year it is possible that the demonstration would stimulate the interest and en- courage a future financial support from citizens who believe in the value of health education for the purpose of keeping little children well.
Further Recommendations
1. The reinforcement of the present child welfare staff with the services of a worker or workers trained in dietetics, physical education, hygiene, and the pedagogy of health education. Such a worker would construct health material for display on clinic afternoons and would go to the homes for teaching and follow-up in posture and muscle training and nutritional problems.
2. That one clinic each month, in each ward of the city, be designated as a pre-school clinic and children of the age group 3 to 6 years be encouraged to attend on that date.
This plan would offer, with more convenience to parents, the privilege which is now extended on the second Thursday of each month at Woodward Institute. The suggestion is made with the thought that more children would be given the advantage of an examination.
3. That a booklet entitled "The Mothers' Book" be compiled for distribution to the clinic parents. Members of the Department of Health could collaborate to produce this booklet which should cover important facts concerning the hygiene of infant and child- life written in simple type to answer the inquiries made fre- quently at clinics.
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REPORT OF DEPARTMENT OF HEALTH
4. That the Thomas Crane Public Library be asked to arrange in each of its Branch Libraries, a shelf of books especially planned for the clinic mothers. To assure publicity for this it would be helpful to have prepared for distribution in the clinic a brief description of the current literature concerning the health of little children.
The Child Welfare work owes its progress of the past two years to the encouragement and material help which you, as Commissioner of Health, have given to the clinics.
Mrs. Fowler and Miss Marr-Child Welfare Nurses, have been able helpers to the doctors at the clinics and have strengthened the link between the mother in the household and the clinic teaching.
An expression of thanks and appreciation is extended to the New England Dairy and Food Council whose staff members, Miss Marjorie L. Foster, Educational Director, and her assistant, Miss Mona McWilliams, have volunteered their help in conducting, at the Quincy Center clinic, an Educational program of food values in health.
The Wollaston Women's Club is to be thanked for the very useful additions which it has made to the clinic equipment at Wollaston and for the help which its personal representatives has given on clinic days. The good will of the Club is much appreciated.
For their co-operation, appreciation is expressed to the per- sonnel of the Health Office, other members of the Staff, the Fore River Club, the Presbyterian Church of South Quincy, the West Quincy and Atlantic Councils of the Knights of Columbus, and the Trustees of Woodward Institute.
Respectfully submitted,
RACHEL L. HARDWICK, M.D. Child Welfare Physician.
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CITY OF QUINCY
REPORT OF CHILD WELFARE NURSES
DECEMBER 31, 1928.
DR. EDMUND B. FITZGERALD, Health Commissioner.
DEAR DOCTOR :- We herewith submit our annual report for the Child Welfare activities for the year ending December 31, 1928.
There were 330 baby clinics held during the year. These clinics had an attendance of 7,293, with an average attendance at each clinic of 21. There were 4,039 complete or partial ex- amination. There were 693 new enrollments, making a total of 2,130 babies registered during 1928. One hundred ninety-seven of these moved from the city.
There were 12 pre-school clinics held by Dr. Hardwick at which there were 107 visits and 107 examinations. With 19 new en- rollments this year there is now a total of 130.
On the same days, as the pre-school clinic there is also a Preventive Orthopedic clinic held by Dr. Miriam Katzeff. She made a total of 164 examinations on 91 new cases and 73 cases followed up from 1927. At this latter clinic Miss Marjorie Foster, Educational Director of the New England Food and Dairy Council and her assistant volunteered in giving very help- ful instruction and information to the mothers.
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