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 1948 > Part 3
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The third feature noted is the fact that only one case of diphtheria was reported during the year, continuing the City's low incidence in spite of the alarming increase in the frequency of this disease in peril- ously close parts of the State . This is undoubtedly due in part to the high rate of immunity in children and younger adults in the City.
CONTAGIOUS DISEASES
1944 - 1948 (Selected Diseases) City of Quincy
Disease
1944
1945
1946
1947
1948
Yearly Average 1944 - 1948
Animal Bite
209
23.
229
179
196
209
Chicken Pox
1320
92
223
729
703
613
Measles
530
42
1020
134
2331
801
Mumps
71
559
86
307
926
390
Scarlet Fever
311
123
96
141
62
147
Whooping Cough
53
59
98
172
14
79
CHILD WELFARE: This division conducts six well-baby clinics a week, an orthopedic and pre-school clinic monthly and has charge of school nursing in the City's three Parochial Schools.
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QUINCY HEALTH DEPARTMENT Clinic Reports 1948
Type
Number
Attendance
Examined
New
Well-baby
321
2338
2331
675
Pre-school
10
76
61
47
Orthopedic
12
48
48
32
Totals
343
2462
2440
754
DENTAL: Dental clinics are conducted daily for Public and Parochial School children in the first three grades, and for children of pre-school age, twice weekly.
SCHEDULE OF ACTIVITY Dental Clinics Quincy Health Department 1948
School
Pre-School
Total
Number of clinics held
181
92
273
Individual cases treated
333
180
513
Appointments given
2434
2434
Appointments cancelled
31]
157
468
Emergency appointments
41
41
Children attending
2164
658
2822
TUBERCULOSIS CONTROL: During 1948 ,55 cases of all types of tuberculosis were reported to the Department. Of this number, 51 were of the pulmonary type. There were nineteen deaths caused by tuberculosis to Quincy residents in 1948. This figure is identical with the total deaths from tuberculosis occurring in 1947. Thus, for the second consecutive year, tuberculosis mortality was reported at an abnormally low level.
As of December 31, 1948, there was a total of 515 cases of tuberculosis on the Department's register. These are classified as follows:
TUBERCULOSIS REGISTER City of Quincy 1948
Active pulmonary cases 120
Arrested pulmonary cases 317
Quiescent pulmonary cases
12
Pneumothorax cases
15
Extra pulmonary cases
51
Active extra pulmonary 6
Arrested extra pulmonary
45
Total 515
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Adult tuberculosis clinics were held once a week at the Quincy Dispensary. At these clinics, 38 new patients were admitted, 66 old patients were re-examined and four diagnoses of tuberculosis were made. "Undernourished and Contact Children's Clinics" were held weekly, also at the Dispensa.y. Eighty-five new cases were admitted and forty old cases were re-examined. The facilities of this clinic were used to give physical examinations to all children chosen under the Department's re-established program of aiding children who need a few weeks of sunshine and fresh air at summer camps.
INSPECTION: One of the more important phases of Public Health work is that of inspection. In this regard the Health Department employs a staff of inspectors who maintain constant vigilance over all plumbing installed in the City, milk and milk products, food and places where food is served, and all conditions which are potentially insanitary and hence hazards to the health of the people in the community.
During the year, 1,290 applications to do plumbing were received by the Plumbing Inspector. Permits for plumbing were issued for 1,471 buildings; permits were also issued for 32 sewer connections, 27 cess- pool connections, and six for connections to septic ianks.
The Food Inspector made 2,939 regular inspections, 206 inspec- tions of bakery trucks, and he acted on 97 complaints. In the per- formance of his duty, 4,275 pounds of meat, 2,957 pounds of fish, 115 bushels of fruits and vegetables, and 211 miscellaneous uni's of food were condemned as being unfit for human consumption.
The Milk Inspector reports an average of 35,000 quarts of milk (all pasteurized), 1,762 quarts of cream, and 1,100 quarts of buttermilk sold daily in the City. A total of 222,000 quarts of ice cream were sold in Quincy during 1948. A total of 809 licenses, permits, and registrations were issued for the sale of milk, ice cream, and oleo- margarine during the year.
MILK INSPECTIONS
Health Department 1948
Processing plant inspections 524
Vehicle inspections 864
Milk and ice cream cabinet inspections 809
Dairy and dairy barn inspections 542
Out of state plant inspections 18
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Quincy City Hospital
The Quincy City Hospital is one of the few municipally owned hospitals in the Commonwealth and, as such, it is confronted with problems peculiar not only to hospitals in general, but also those such as financial, personnel and policy-making, which are always present in the operation of a City Hospital.
The Hospital is a fairly large institution, but it does not have the ratio of beds per population that it should have to meet the medical demands of a large and growing population. As long as this situa- tion exists, the City Hospital must maintain a bed capacity below all accepted standards for modern American hospitals.
As a solution for some of the many problems which are present in the Hospital today, the following recommendations are submitted: (1) A building program which should include a new power plant, a new nursing wing, and a new surgical unit; (2) Additions of a full time Roentgenologist and a purchasing agent to the staff; (3) The establishment of an "out patient" department and (4) A revision of the "method of salary payment" for nurses.
The foremost problem of the Hospital was the continued rise in cost of operation. As a result, an increase in charges to patients was necessary thus increasing receipts for the year.
There is still an acute problem of personnel at the Hospital; a shortage of nurses, nurses' aids and orderlies exists and there are too few nurses being trained at the Nursing School to alleviate this condition. During the year, many improvements were made in the working conditions of the personnel, but certain problems in this regard still exist. The adoption of the "forty-hour week" created a new difficulty in the method of salary payments to nurses. Many nurses prefer to live outside the nurses' home and eat some of their meals "outside." Therefore, a great deal of time was spent in con- sidering the advisability of changing nurses' salaries from a "cash plus maintenance" basis to one of wholly "cash" system. As many of the nurses are leaving the Hospital for military service, an early consideration of a "method of salary payments" is recommended for 1949.
Another problem was that of encouraging the Medical Staff to revise their rules and regulations in order that the Hospital can maintain the highest standards of service to its patients. Many extra meetings and conferences were held on this matter resulting in the adoption on August 8, 1948, of a new and highly satisfactory set of rules and regulations.
During the year, the Hospital was able to secure the services of a full-time pathologist. This is truly a forward looking move, medically, and incidentally, receipts in this Department have shown an increase of many thousands of dollars in 1948.
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The Hospital is pleased to report that during the year 1948 it received the approval of the American Medical Association and the American College of Surgeons for residency training in Surgery, in addition to previous approval for training in Gynecology, Obstetrics, and X-Ray.
The year 1948 shows a continuation in the trend of high patient admissions and a correspondingly high increase in the volume of work performed at the Hospital. Associated with this situation is the ever-present picture of overcrowded conditions, much too crowded to be safe.
The following are some of the factors contributing to the con- tinuing high level of patient admissions to the Hospital: (1) Member- ship in prepayment hospital plans, (2) The Medical Staff finds it less arduous and time consuming to have their patients hospitalized, (3) Pressure from the home for hospitalization of the patient, (4) Impor- tant tests performed by the Laboratory following treatment with the newer drugs, (5) Long continued care for the chronically ill because of scarcity of convalescent facilities.
In order to accomodate the community, it has been necessary to ask the physicians to help the Hospital by sending in only the acutely ill on the days when the accomodations reached capacity. This re- quired cooperative work from all concerned. The Hospital has refused no emergencies, but when overcrowded conditions existed, utilization of corridors and porches was necessary, a hazardous practice not conducive to good patient care. Limits to physical facilities of the present Hospital plant and to the "human frailties" of the nursing staff and other personnel, have been reached long ago.
The year 1948, though showing improvement in the procurement of Resident Medical Staff personnel, did not come up to the expecta- tions in the number of internes needed for proper staffing. Comple- menting the Resident Staff were several displaced physicians. The physicians, arriving into unfamiliar circumstances, soon acquitted themselves very capably and were deeply appreciative of the op- portunities offered to them to become acquainted with American Medicine.
Plans are in process of compiling an illustrated information booklet on "Internship at the Quincy City Hospital." This booklet will be distributed to various medical schools and other interested sources.
The teaching program for internes and residents brings benefits to the patient, to the visiting staff, and to the resident staff. An edu- cational program for the Medical Staff has been instituted. This program, reflecting the various professional activities of the staff, is intended to offer to the busy physician an opportunity to refresh and siimulate his professional thinking.
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DEPARTMENT OF NURSING
Ths Department is classified into two major categories, one the School of Nursing, the other the Nursing Service. Separate though these may be in some respects, yet, nevertheless, they have a definite relationship with one another in their fields of endeavor. In order that a student may become an efficiently trained nurse she must have practical training to supplement her schooling. The student must see good nursing and have the opportunity to practice it if she is to learn effectively. Hence, the faculty of the Nursing School is in- terested not only in training, but also in maintaining high standards of nursing service throughout the Hospital.
STUDENT NURSES
Quincy City Hospital 1948
Third year students 8
Students affiliating
Second year students 24
Butler Hospital 3
First year students 21
Chapin Hospital
0
Peclinical students 25
Children's Hospital 5
Mass. Eye & Ear 1
Total 78
Quincy Visiting Nurses 2
Leaves of absence 4 Total 11
The following changes have been made in the curriculum of the School:
(1) Twenty-five week pre-clinical period to include one week vacation.
(2) History of nursing changed from first year to third year subject.
(3) Pathology to be taught as an individual course.
(4) Sociology and psychology will be taught in two courses, basic and advanced.
(5) An affiliation in psychiatry has been made possible for the Class of 1950.
(6) An affiliation has been established with the Quincy Visiting Nurses Association. Eight senior students each year will have an opportunity to elect this affiliation (two students every three months.)
(7) A modified block system became effective in the Fall of 1948. Students have classes concentrated into two days a week, providing the student with a better learning situation, and allowing for better patient care.
Several additional offices have been made available for the nursing staff and the Faxon House was renovated to some extent, adding greatly to the general appearance and comfort of the building.
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The following are some of the changes, affecting the nursing staff, which were made during the year:
(1) Work day for all nursing personnel begins at 8:00 a.m. except in special departments.
(2) Elimination of split shifts by working a straight eight-hour day.
(3) Vacation allowances increased one week for all full-time nurses, including student nurses.
(4) Five-day, forty-hour week approved; time and one-half salary for overtime after forty hours.
(5) Staff education programs each month provided for nurses on their "on duty" time.
LABORATORY
The activity of the Laboratory showed an overall increase of 55% for 1948 over the work done in 1947. This increase is not only nu- merical in its scope, but the variety of examinations made also show a marked increase.
The Laboratory was reorganized resulting in more reliable reports and faster, more efficient service. All requisitions which reach the Laboratory before 3:00 p.m. are honored on the same day, except during week-ends, and surgicals are reported within twenty-four hours.
In 1949, applications will be submitted for approval of a School tor Medical Technologists. The establishment of a Residence in Pathology is most desirable as the organization of the Department and the material available makes for excellent training facilities.
X-RAY DEPARTMENT
During 1948, this Department handled a total of 8,457 patien's making the sum of 9,573 examinations, 978 of which were treatments. The number of examinations indicate an overall increase of 10.9% over those given in 1947.
Of the total number of patients examined during 1948, 62.1% were private cases, substantially the same as in 1947. The remainder was composed of service cases, nurses and hospital employees.
Serious consideration should be given to the overall problem of personnel, space, and physical equipment. The adoption of the forty-hour week has caused complications in the personnel set-up of this Department. This new schedule leaves the Department which formerly worked a five and one-half to a six day program, with an understaffed secretarial force for four of the six days. The solution to this problem would be either the addition of personnel or the
49
changing of work hours to a forty-four hour week with overtime pay. The latter solution seems to be the more desirable. The physical space of this Departments has been essentially unchanged for twenty years, and the great increase of work taken on since then has made the amount of space available at the present time wholly insufficient. The Department is technically up to date in the equipment being used at the present time; but the purchase of certain types of equipment such as those for filing purposes, a Soundex system and a system for micro-filming records is recommended.
ANESTHESIA DEPARTMENT
This Department, one of the newest in the Hospital, made rapid strides in its struggle for recognition.
The quality, as well as the quantity of the work, improved during the year. "Oxygen Therapy and Service" became a sub-department managed and controlled wholly by the Department of Anesthesia.
For the first time since its organization, the Department was assigned an interne for a period of one month, during which time he received didactic and practical anesthesia teaching. This procedure began in July 1948, but because of an acute shortage of internes, it was short-lived, the assignment being terminated in December 1948. During this time, however, six internes were thoroughly trained.
Weekly lectures, one hour each were given to the internes. These lectures included didactic and practical anesthesia, resuscitation and oxygen therapy.
Resident training is still pending.
DEPARTMENT OF PHYSICAL THERAPY
During the year this Department handled a total of 5,485 patients, giving a total of 11,001 examinations and treatments.
Examinations and Treatments (Partial List)*
Department of Physical Therapy 1948
Short Wave Diathermy 1786
Ultra Violet, Air Cooled
1118
Sinusoidal, Electro-therapy
1362
Radiant Light
Exercises 1256
1515
Massage
2364
*Includes only types of treatments given most frequently.
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SOCIAL SERVICE DEPARTMENT
The Social Service Department consists of two professionally trained medical social workers and an office secretary. The Depart- ment is also used by Schools of Social Work for field training.
During 1948, a total of 486 patients, averaging 40 patients a month, were assisted by this Department. Their problems made it difficult or impossible for the patients to obtain the maximum benefits from their medical care.
Services given by Social Service complemented medical care and were an aid in diagnosis, treatment, and discharge. Patients were referred to this Department by physicians, nurses, administra- tion officers and other Hospital personnel. In addition, there were requests for services from patients, their families, the clergy, and others. Services are available to all patients whether private, semi- private or service. This is consistent with the best medical practice of providing all preventive diagnostic and treatment aids necessary to insure as good medical care as is possible.
During the year, seven lectures were given to student and gradu- ate nurses and residents and internes. In addition the Department was called upon to speak to social service students, church groups, and others. A program of mutual benefit to this Department and the Hospital's neuropsychiatrists is being worked out at the present time.
PERSONNEL DEPARTMENT
One of the newest of Hospital departments, the Personnel De- partment is already an efficient operating unit and an integral part of the Hospital structure.
One of the major achievements, during 1948, was the improve- ment in hours of work. This was effected gradually, starting with the elimination of split shifts and staggered hours in many Departments until by the end of the year, all Departments were operating on a forty-hour, five day week in accordance with the forty-hour law adopted by the City of Quincy. The only employees exempted were the hourly part-time workers whose total hours of work were less than forty hours a week.
Salary schedules for clerical workers and laboratory technicians were prepared. Civil Service ratings were compared with jobs actu- ally being performed and as a result, higher ratings were obtained for some positions. Promotional examinations, as well as examinations covering provisional appointments, were obtained from Civil Service, in order that personnel may become permanent as soon as possible. Job classifications and salaries were studied and adjustments were made to obtain better internal alignment of positions and rates. A
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survey was made of salaries and benefits paid to nurses at hospitals in the Boston Area to give a basis for comparison of the salaries at Quincy City Hospital.
Plans have been made to effect a stricter control over the number of personnel to be employed in each Department by means of a quota system. A weekly check of payrolls will accompany this and together, they should provide a complete labor control.
DIETARY DEPARTMENT
The change in Hospital working hours to a forty-hour week effected a radical change in this Department's working schedule. To meet this change, additional help was necessary so that the kitchens and dining rooms could be operated for the twelve-hour period of 6:00 a.m. to 6:00 p.m.
In June 1948, a system of issuing meal tickets to the staff and certain other employees was started. This system, though it can be improved upon, has nevertheless been helpful in providing the De- partment with accurate information on the number of meals served daily. It also gives a good indication of the "heavy" and "light" meals of the week which serves as a guide in the buying of food. The meal ticket system appears to be a stepping stone to the "pay cafeteria" which seems to be the only solution in controlling food costs of hospital dining rooms.
MAINTENANCE DEPARTMENT
During the year there were 749 written requisitions and more than 6300 telephone calls for repairs, alterations, and minor equipment from various Hospital departments.
The following are some of the major projects which were com- pleted during the year.
Insulation was installed in the third floor walls and ceilings of the Faxon Home in compliance with requirements of the Massachu- setts Department of Public Safety. Plaster was repaired and replaced in the Home and all ceilings and wall areas were painted. Linoleum was installed on all floors and stairways in an extensive maintenance project carried on at the Faxon Home.
In the M & S building, alterations were made to the Pathological Laboratory and Blood Bank to provide a photographic developing room for the Pathological Laboratory.
During the year, a building was constructed to house the animals used in the Laboratory.
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RECEIPTS AND EXPENDITURES
Comparative Expenses and Receipts
1947 - 1948 Quincy City Hospital
Salaries and Wages
$ 660,684.18
$ 794,500.52
General Expenses
377,239.62
447,232.68
Living Out
9,831.42
12,875.32
Pensions
3,502.81
3,742.35
New Equipment
15,915.27
19,458.76
Out of State Travel
200.00
88.72
Miscellaneous - deficit bills
5,300.61
Total Expenditures
$1,067,373.30
$1,283,198.96
Net Receipts
717,189.05
865,749.73
Excess of Expenditures
over Receipts
$ 350,184.25
$ 417,449.23
Sewer Division
(Department of Public Works)
Sewer construction and maintenance under direct control, as a Division, of the Department of Public Works is necessarily placed in the classification of "Health and Sanitation."
A city of any size with a fairly congested population, as is the case in Quincy, must have adequate sewerage. This being accomp- lished, it can be safely stated that a step has been made, in a forward direction, toward improved environmental sanitation and eventual public health improvement in the field of prevention of disease. Cess- pools and septic tanks widely used in rural districts have no place in urban localities. The presence of these outdated types of disposal, in any reasonably congested area, eventually become no'some and a source of filth. Past experience has proved, often tragically, that these inadequate means of disposal have been the cause of certain epi- demics. An outstanding example substantiating this theory is that typhoid fever, once a major contagious disease in this state, has been lessened to a considerable extent. An important factor in this decrease of incidence, second only to immunization, has been improved sanita- tion facilities made possible by local and state sewerage programs. Statistics prove that as recent as the past several decades, the rate of this particular disease has decreased greatly in cities where ade quate sewer systems have been constructed and the larger rate of incidence of this disease has now shifted to the rural areas where cesspools and septic tanks are the only means of disposal.
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The City of Quincy, like any modern and progressive municipality. is fast approaching its goal of complete sewerage facilities for every dwelling unit in the City.
The following comparative figures of sewer connection and sewer construction show a decrease in the amount accomplished during 1948 from that in 1947. This is due to the fact that Quincy is approach- ing the one hundred per cent mark and the remaining difficulties are those which require extensive sewer construction projects, several of which are confronted by engineering difficulties.
PARTICULAR SEWERS
1947
1948
Total Connections
324
274
Ward 1
97
94
Ward 2
17
13
Ward 3
32
21
Ward 4
64
44
Ward 5
39
45
Ward 6
74
57
Milton
1
Classification
324
274
Single Houses
251
208
Two Family Houses
5
6
Four Family Houses
21
13
Five Family Houses
2
Six Family Houses
1
Ten Family Houses
1
Business Buildings
47
42
Churches
1
There were 1.10 miles of sewers constructed in 1948 compared to the 2.13 miles in 1947.
Drain construction in 1948 amounted to .761 miles, the total of which is somewhat less than the 1947 figure of 1.19 miles.
Inspection, cleaning and flushing of sewer lines were carried on only when time would permit and only on those sections where it was absolutely necessary. The problem of maintaining the sewer lines in good condition has increased with the age of the sewer.
Sanitary Division
(Department of Public Works)
This Division of the Department of Public Works is responsible for the collection and disposal of rubbish and garbage and the clean- ing of vaults and cesspools.
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The adoption of the forty-hour week made necessary the complete re-routing of the entire City in the matter of rubbish and garbage col- lections; changing the collection period to once in every five days. Vault and cesspool cleaning was changed from an "after work day" duty to a regular work day routine under this new law.
The City disposes of its rubbish in the regular City dump, and garbage is disposed of by selling it to farmers from nearby com- munities.
The occurrence of a holiday within the work week always pre- sents a problem in the matter of adhering to a very strict schedule of garbage and rubbish collections. Every effort is made to collect the garbage as soon as possible in areas affected by collection days which fall on holidays. In the event that a rubbish collection is interrupted by a holiday, the public is notified by newspaper advertisement that the collection will be made on the regular day of the following week.
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