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 9
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The attendance at the various clinics is as follows:
At- tendance
Percentage Increase or Decrease
Ward 1. Woodward Institute
1173
30% decrease
Ward 2. Hough's Neck
458
Started May 11
Ward 2. Fore River Club
876
21% increase
Ward 3. Presbyterian Church
1087
17% decrease
Ward 4. K. of C. Hall, W. Quincy
831
22% increase
Ward 5. Library Building, Wollaston
1494
1.6% increase
Ward 6. K. of C. Hall, Atlantic
1152
2.8% decrease
7293
3.4% increase
There has been a physician in attendance at Hough's Neck since the clinic was started; in Ward 3 since May 23rd; in Ward 4 since March 19th and once a month in Ward 6. The marked decrease in the clinic at Woodward may be due to the opening of the Hough's Neck clinic. It is hard to explain the 17% decrease at the South Quincy clinic.
There were 2,454 visits made to children up to the age of 6 as compared to 1,552 visits in 1927. 93 visits were made to 8 board- ing homes.
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
1928
7,293
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REPORT OF DEPARTMENT OF HEALTH
Children referred to local physicians 67
Children referred to Habit Clinic . 4
Children referred to Boston Dispensary for treatment. 3
Children referred to Quincy City Hospital for X-ray 2
Children referred to Quincy City Hospital for T & A (fees paid by Kiwanis Club) 2
Children referred to Childrens Hospital
6
Children referred to Quincy Dispensary for tuberculin test. 4
From January 1st to March 1st Miss Mary Keeley assisted at the clinics and had charge of the Quincy Point clinic. At that time Miss Mary Marr was apointed Child Welfare Nurse and took charge of the West Quincy, South Quincy and Hough's Neck clinics. During September, October, November and December Miss Marr made a daily visit to St. Joseph's parochial school. During March and April Miss Marr assisted in the work of the health examination by the State in the public schools ("10-year program"). From January to April 18th Mrs. Fowler assisted in the examination above mentioned.
There have been seven deaths among the 2,130 registered babies due to the following causes:
Erysipelas 1
Pneumonia 4
Tuberculosis 1
Acute gastro-enteritis 1
Of these deaths perhaps those from tuberculosis and gastro en- teritis might be considered as preventable.
Respectfully submitted,
NETTIE DENTON FOWLER, R.N., MARY E. MARR, R.N.,
Child Welfare Nurses.
140
CITY OF QUINCY
REPORT OF ORTHOPEDIC PHYSICIAN
JANUARY 1, 1929.
EDMUND B. FITZGERALD, M.D., Commissioner of Health, City of Quincy, Massachusetts.
DEAR DOCTOR FITZGERALD :- It is my pleasure to present the fol- lowing report of the orthopedic clinics maintained by the City of Quincy as part of its Child Welfare program for the year 1928.
There have been twelve clinics, one on the second Thursday of each month.
One hundred and sixty-four children have been examined as con- trasted with the 1927 report of eighty children.
New cases examined in 1928
91
Follow up on examinations made in 1927 73
The results of the examinations may be classified as follows :
Pronated feet and poor posture
43
Knock knees 16
Bow legs (early) 9
Rickets with correctable deformities 9
Abnormal gait 2
Club foot
1
Torticollis with slight Erb's palsy 1
Tuberculosis hip
1
Apophysitis
1
Highly arched feet with tight tendon Achilles 2
Children without orthopedic defects
6
91
It is interesting to note that these figures show approximately the same prevalence of correctable orthopedic conditions as was found in the infant and pre-school age group of last year.
It is probably fair to assume that this is the average incidence of orthopedic conditions among so-called well children. Proof of this however, is not yet available because Quincy still bears the distinction of pioneer work in this field. When other cities include preventive orthopedic as a part of their constructive health pro- gram, more data will be available for comparative study.
A large degree of the satisfaction in the follow up of the children who have been attending the clinic for the past two years, lies in the fact that deformities have been prevented. Although weak- nesses detected at the time of examination allowed the condition to be classified as one of the recognized clinical orthopedic entities, the early age at which the child was first seen placed these condi- tions in the class of correctable disorders.
For the results of the year's work, definite tribute should be paid to the Child Welfare Nurses who have been keen to recognize and arrange for the registration of the children needing this service and to the mothers who have faithfully co-operated with the clinic instructions.
To make the orthopedic clinic still more valuable for another year, I recommend that there be a worker trained in physical edu- cation who could be available for the follow up of these children in their homes.
The exercises shown the mothers at the clinic session should be checked up in the home to make certain that the facilities in the
141
REPORT OF DEPARTMENT OF HEALTH
house are being used to the child's best advantage. In posture training this means, suitable time and place for the exercises ad- vised, proper chairs for seating at table and at play, and proper sleeping arrangements.
Respecfully submitted,
M. G. KATZEFF, M.D.
REPORT OF QUINCY HABIT CLINIC
DR. EDMUND B. FITZGERALD, Health Commissioner.
DEAR DOCTOR FITZGERALD :- The following is a report of the Quincy Habit Clinic from January 1, 1928 to December 31, 1928 respectfully submitted.
Number of weekly clinics held 43
Number of new cases referred
49
Number of children attending (new)
56
Number of children attending (old)
78
Number of visits made by child 173
Number of visits made by social worker
216
Referred by:
Mother
20
Dr. FitzGerald
7
Schools
7
Neighbor
5
School nurse
2
Relative
3
Physicians
2
S P. C. C.
1
D. C. Q.
1
Father
1
Total
49
Interest in Mental Hygiene has shown a steady growth in Quincy during the past year. Parents and others interested in the welfare of children, have responded in a most encouraging manner to the Educational activities along the lines of Mental Hygiene and to the Clinic's Program. They appreciate the rela- tionship between the mental and physical aspects of the child's life and the incompleteness of a child welfare program which does not consider both.
The close co-operation of the Health Department and the School Department with the Clinic has made it possible to reach those needing education in this particular field.
The Clinic personnel wish to express appreciation to those who have co-operated to make the Clinic a success and an essen- tial part of the Health activities of Quincy.
Respectfully yours,
OLIVE A. COOPER, M. D.,
Assistant to Director, Division of Mental Hygiene.
142
CITY OF QUINCY
REPORT OF DISPENSARY PHYSICIAN
DECEMBER 31, 1928.
DR. EDMUND B. FITZGERALD, Health Commissioner.
DEAR DOCTOR :- Before submitting my report for the current year I take this opportunity for expressing my appreciation to yourself, the city council, and the Mayor, for the splendid co-opera- tion and generous financial assistance extended the clinic during the past year. Without this help the marked improvement could not have been attained.
The past year we have increased our work and attendance over one hundred per cent. Most of our time, as is the present day cus- tom in the campaign against tuberculosis, has been devoted to the juvenile or glandular type of the disease. During the year fifteen hundred and twenty-nine attended the clinic whereas six hundred and fifty were enrolled for 1927. As you see this is a very credit- able increase for our first year of intensive work and promises much for the future.
The routine adopted in all cases is to give a complete physical examination, tuberculin test to all that have not had it recently, X-ray of chest of all suspicious cases for classification, and rectify all defects such as diseased tonsils and bad teeth. This past year we had seventy-six tonsil operations and one hundred and seventy- four tuberculin tests and referred over one hundred children for bad teeth.
We next refer as many children as our funds permit to summer camp for an intensive eight weeks' treatment, and, upon their re- turn, these children are supposed to report to clinic every two weeks for "follow up" treatment and advice. This practise is the most feasible method of treatment and we are getting results. Of course for definitely established diagnosis of Hilum disease con- tinuous sanatorium treatment is preferable. The public is not yet wholly receptive to this preference for Hilum tuberculosis but I believe it will accept it eventually and the immediate transfer of these cases to sanatoria will become the usual procedure.
Then we can devote our camps exclusively to suspicious cases, contact and undernourished children, for it is in these groups you get the best and most permanent health results and you accomplish them quickly and economically. In a word this procedure offers you a means of anticipation and prevention of the disease and, as in all diseases, time and method spent in their prevention are more ideal and profitable than in their cure.
During this past year the nurses have made more than fifteen hundred visits into the homes and have obtained much information and valuable experience in welfare work. An outstanding con- clusion was the importance of giving out milk liberally to needy families. Milk is the cheapest and economically the best builder of bodily resistance we have in our fight against tuberculosis. Many children showed almost immediate gain in weight when we added an extra quart of milk daily to the diet. We gave out over three thousand quarts in the past year, all of which expense was supplied by a private organization. I consider it economically sound for the city to appropriate a definite fund for this purpose and much good will obtain.
While on the subject of welfare work I also think the time has arrived when the city might well consider the advisability of em- ploying a trained social worker. The rapidly increasing population and a growing city hospital bring up many problems which a
143
REPORT OF DEPARTMENT OF HEALTH
trained worker would handle better and more economically than under the present regime.
Owing to increase in attendance, Miss Keeley has transferred to our department and has proven a very efficient tuberculosis nurse. The children like her and she has put her heart and soul into the work. In fact Miss Russell and Miss Keeley work so well together that the clinic has reached a very high standard. With the two nurses the routine of the clinic is speeded up, and much of the necessary confusion and delay under one nurse regime has been eliminated.
After spending a number of years in this work some conclusions may be drawn. The problem of juvenile tuberculosis in the light of our present knowledge cannot be solved by the summer vacation camp alone. These children in their eight weeks intensive treat- ment get a wonderful start on the road back to health but it is not sustained. For, on resuming school work in the fall practically all their rest periods, forced feeding, etc., are lost and many of the health habits disappear together with some of the excess weight gained in camp. The camp idea is undoubtedly good and well worth the time and expense, but it should be supplemented by the open air schools when the children come back in the fall. In this way health and education would go along together with mutual benefit. It is my belief that only in this manner will juvenile tuberculosis be stamped out and, as juvenile tuberculosis is the source of all pulmonary tuberculosis, this seems to be the best plan to eliminate that far greater economic problem, adult tuberculosis. I can vis- ualize cities adopting some such procedure, I trust Quincy will be one of the first.
The story of adult tuberculosis in this city, like all other places, is still unsatisfactory. The fundamental reason for this is the lack of legislative power to forcibly segregate all active pulmonary tu- berculosis. Home treatment of this condition implies contact and this usually means an increase in your total cases. Early diagnosis and immediate sanatorium treatment is the right way to treat pul- monary tuberculosis. But in practise this theory fails or at least is long delayed in application. Usually we are unable to prevail in our advice to go to sanatoria until cases are far advanced and this in turn usually results in contact cases and thus your general total is always increasing. The urge to stay home, the desire to con- tinue working, the anxiety about those left at home, all these fac- tors prevail against you when you suggest sanatoria for incipient tuberculosis. Under these conditions satisfactory progress in hand- ling active adult tubercular patients will be slow, until and unless, some brave state legislature will adopt by law forcible segregation. Would that Massachusetts would be the first state to so act.
Our total registration of tuberculosis is four hundred and thirty- nine, one hundred and twenty-six more than last year. But our total of one hundred and seventeen active cases is fifty-four less than last year. Also we have nineteen more of our cases hospital- ized this year than in 1927. This is progressive but not ideal. Another good feature of our total number registered four hundred and thirty-nine, one hundred and thirty or nearly 30% were Hilum tuberculosis, and this condition is not a menace to the community.
To save duplication the nurses are sending you complete tabula- tion of both our juvenile and adult clinics.
Very truly yours, C. J. LYNCH, Dispensary Physician.
144
CITY OF QUINCY
REPORT OF DISPENSARY NURSES
DECEMBER 31, 1928.
DR. EDMUND B. FITZGERALD, Health Commissioner.
DEAR DOCTOR :- We herewith submit to you our annual report for the year ending December 31, 1928.
Cases of tuberculosis in the city
439
Active cases 119
Arrested cases
114
Hospital cases
65
Hilum cases
130
New cases reported during the year.
169
Pulmonary tuberculosis
62
Hilum tuberculosis 103
Tuberculosis other
4
Disposition of new cases-pulmonary :
Admitted to sanatoria
31
Died
17
At home
14
Moved away
0
Diagnosis revoked
0
Disposition of new cases-Hilum
Admitted to sanatoria .
23
At home in care of family physician
30
Attending dispensary clinics 42
8
Disposition of suspicious cases-pulmonary Admitted to sanatorium.
2
Discharged well non-tubercular
1
Disposition of suspicious cases-Hilum
166
Admitted to sanatoria.
15
Admitted to dispensary clinics.
121
No medical check-up-nurses attend.
20
Admitted to summer camp-Braintree
10
Condition on discharge from sanatoria:
Arrested
3
Improved
3
Against advice
12
Dead
14
Absconded
2
Unimproved
2
Quiescent
2
Transferred to other sanatoria
3
Own request
11
All ex-sanatorium cases were visited except three who were dis- charged to another city from the sanatorium. All homes were vis- ited after death of a patient and sanatorium cases, and disposition of clothing advised, etc. Sputum cups, paper napkins, and large paper bags were provided patients free of charge.
Deaths
1 50
In New Hampshire while visiting
At home
17
At sanatoria
16 N.C.H.
At Lunenberg (private hospital) 1
At Rutland Veteran's sanatorium 2
At Tewksbury
2
103
Admitted to summer camp-Braintree
2
145
REPORT OF DEPARTMENT OF HEALTH
At Mattapan Sanatorium 3
At Peter Bent Brigham Hospital
1
At Children's Hospital, Boston 1
At Quincy City Hospital 2
At Westboro State Hospital.
1
At State Hospital, Medfield
1
At Sharon-boarding
1
At Rutland State Sanatorium
1
Transportation provided patients to sanatoria.
11
Clinics held
51
Attendance at clinics
109
Clinic registration
58
Visits made
1,516
Referred to Welfare Department.
7
Referred to City Physician .
2
Cases closed during the year and address forwarded to State Department.
19
Milk provided patients by Norfolk County Health Association (quarts)
3,500
Information received from doctors regarding condi- tions of private patients .
10
Cases re-opened
3
Number of sputums examined during the year
184
Contacts of tuberculosis
164
Contacts examined
98
Referred for X-ray
20
Result of X-ray:
5
Tuberculosis other
0
Pulmonary
1
Suspicious
12
Negative
2
Number of X-rays taken for the year at N. C. H.
55
Undernourished and Contacts clincs-children :
Clinics held
91
Attendance
1,529
Clinic registration
332
Referred to Q. C. H. for tonsils and adenoids
76
Referred to school dentists and own dentists
10
Vaccinations done on city cases
5
Von Pirquet tests done
174
Positive
38
Negative
136
Undernourished children sent to Deaconess Home, Natick
3
Transferred to Westfield Sanatorium.
1
Hilum tuberculosis cases discharged from Sanato- rium well
8
Our work during the past year has been a source of great satis- faction to us. Naturally at times we were faced with trying situ- ations, due to a variety of conditions arising from social problems, poverty and disease, etc., but their satisfactory solution usually justified our efforts. We were materially aided in these problems by calling on outside agencies such as the probate court, welfare department, private physicians, and others, all of whom furnished cordial support. Frequent contact with these conditions has taught us much and we trust our zeal and efforts have accomplished worth while results.
Hilum
146
CITY OF QUINCY
We fully appreciate the scope, possibilities and importance of tubercular dispensary work and how futile it is to attempt to give full expression to all the good accomplished in a mere concise sum- mary of visits made, patients transferred, etc. and all else that figures in a tuberculosis clinic. All that is mere detail and tabu- lation and essential, of course, but it does not begin to explain the work done, the effort expended, the good accomplished, both as re- gards personal and family welfare, together with prevention of spread of diseases and much else besides. The benefits derived are what make the work worth while, and if success and efficiency de- pends upon efforts we intend and expect to qualify.
As you know in our work we must render an account of our stewardship to State Department of Public Health as well as to our city. In addition to our weekly reports we must account in great detail of all cases, contacts, both private and clinic trans- fers, and very much clerical detail is necessary. Due to school survey work of 1927 our 1928 regular work in clinic visits etc. did not start until May 1st. But despite this delay we have made over fifteen hundred visits this year and have fulfilled our schedule for both city and state.
And you will be pleased to know that during this current year, two different state officials visited our clinic and admitted that our clinic has one of the highest ratings in the state.
In closing we would like very much to acknowledge our appreci- ation for attending your conferences during the latter part of this year. We found them enjoyable and very helpful and trust during the coming year you will continue these for the full fifty-two weeks.
Trusting you will find our report in order, we remain
Very truly yours,
MARY E. KEELEY, R.N., GERTRUDE T. RUSSELL, R.N., Dispensary Nurses.
147
REPORT OF DEPARTMENT OF HEALTH
REPORT OF CONTAGIOUS DISEASE NURSE
DECEMBER 31, 1928.
DR EDMUND B. FITZGERALD, Health Commissioner.
DEAR DOCTOR :- I herewith submit my fourth annual report of contagious disease work for the year ending 1928.
2,534 cases were reported as follows:
Measles
1,855
Scarlet fever
241
Diphtheria
19
Chicken pox
196
Whooping-cough
91
Mumps
6
Lobar pneumonia
49
Influenza
37
Dog bite
22
German measles
8
Septic sore throat.
4
Cerebro-spinal meningitis
2
Malaria
1
Trachoma
1
Anterior poliomyelitis
1
Smallpox
1
Nursing Visits
By contagious nurse
By other nurse
Total
Measles
1,615
2,125
3,740
Scarlet fever
1,138
39
1,177
Whooping-cough
124
26
150
Diphtheria (cultures 58)
72
3
75
Chicken pox
33
Typhoid (laboratory tests)
3
Cerebro-spinal meningitis
1
Anterior poliomyelitis
2
Smallpox
1
2,989
2,193
5,142
Measles
There was an epidemic of measles affecting all wards of the city during January, February and March, with a total number of cases, 1,855. During these months two other nurses assisted. Eight cases were sent to Brighton Hospital. There were seven deaths in the city and one in the hospital.
Scarlet Fever
There were 241 cases reported, a decrease of 135 cases as com- pared with last year's record. The majority of the cases were of a mild type which caused many contact cases in the same family. The greatest number of cases were reported from Wards One and Two. Thirty-five cases were cared for at Brighton Hospital. There were three deaths from this disease in the city.
Diphtheria
There were 19 cases reported, thirty-five cases less than 1927. 58 cultures were taken in connection with these cases. 11 cases
148
CITY OF QUINCY
sent to Brighton Hospital. Carrying on the program of diphtheria prevention, T. A. T. clinics were held once a week in the various wards of the city. Total number of complete immunizations, 772; of this number 485 were of pre-school age, nearly 200 more than last year, the remaining 287 were of school age. Thirteen re- Schick clinics were held. Re-immunization cases totalled 59, of school age 57, and 2 of pre-school age. There were two deaths from this disease, one in Quincy and one in Brighton Hospital. Neither child had had T. A. T. treatments.
Anterior Poliomyelitis
Only one case reported during the year. One death occurred, the case being transferred from out of town to the Quincy Hospital.
Mumps-Chicken Pox
Very few cases of mumps were reported. A marked increase was shown in the number of chicken pox cases reported. One child died from this disease in the hospital.
Typhoid Fever
For the first time in the history of the city, not a case of typhoid fever was reported.
Lobar Pneumonia-Influenza
There were 49 cases of Lobar Pneumonia reported, with a total number of 30 deaths.
37 cases of Influenza reported. Eight deaths from this disease.
Whooping-Cough
91 cases were reported. Four children, all under two years of age, died from this disease.
In connection with the follow-up work 2,989 visits were made, including the checking up of quarantine rules, taking of cultures, examination of contacts and releases from quarantine.
The contagious disease nurse assisted at the examination of the first grades in the parochial schools. Daily visits have been made at St. John's school in connection with this work as well as the con- tagious work and home visits made when necessary.
Thirteen baby clinics were attended during the year. One after- noon a week spent at the T.A.T. clinic and Saturday A. M. at the re-Schick clinics.
Office hours were held daily from 9-9:30 A. M. and 1-1:30 P. M. in the Health Department.
Respectfully submitted,
CATHERINE F. COLEMAN, R.N., Contagious Disease Nurse
149
REPORT OF DEPARTMENT OF HEALTH
REPORT OF SANITARY INSPECTOR
JANUARY 1, 1929.
DR. EDMUND B. FITZGERALD, Health Commissioner.
DEAR SIR :- Herewith is submitted my report for the year ending December 31, 1928.
Diphtheria Prevention
During the past year a diphtheria prevention clinic was held each week. These clinics were held in conjunction with the well baby clinics. As a rule these clinics have been well attended. We have continued the policy of sending personal letters to the children instead of to the parents.
The diphtheria morbidity rate for 1928 was 2.8 per 10,000 popu- lation, the lowest rate in the history of Quincy.
Previous to 1928, 65 per cent of all diphtheria cases occurred among children of school age. The records for 1928 show that only 36 per cent of the cases occurred in this group. It is significant that the greatest amount of diphtheria immunization has been carried on among this group of children.
It is also significant that not a single case of diphtheria was re- ported from Ward 6, the section of the city where more children were immunized than in any other section.
NO QUINCY CHILD WHO HAS BEEN SHOWN BY A NEG- ATIVE SCHICK TEST TO HAVE BEEN SUCCESSFULLY IM- MUNIZED HAS CONTRACTED DIPHTHERIA.
Culture Stations
An electric refrigerator where biological supplies are kept, was installed at the Police Department during the year. Sera and cul- ture outfits are now available to physicians at all hours of the day and night. Upon the installation of the electric refrigerator, seven of the eight culture stations were discontinued.
Mortality and Morbidity Reports
Mortality and morbidity reports are shown in another part of the department reports.
Publicity
The newspapers have been very generous in devoting space to the activities of the department. A report of communicable diseases and deaths was published weekly throughout the year. Special articles on various phases of public health activities were prepared and published from time to time.
Health Education
The Health Department booth at the Chamber of Commerce "Trading Post" acquainted a large number of people with the de- partmental activities. Talks were given during 1928 before more organizations than ever before.
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