Report of the city of Somerville 1909, Part 22

Author: Somerville (Mass.)
Publication date: 1909
Publisher: Somerville, Mass.
Number of Pages: 510


USA > Massachusetts > Middlesex County > Somerville > Report of the city of Somerville 1909 > Part 22


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4


21


XII. VIOLENCE.


Automobile


1


Alcoholism


1


1


1


1


Railroad .


1


1


2


1


1


S


Suicide


1


1


1


3


Suffocation


1


1


Fracture of hip


1


1


Fracture of skull


1


1


2


1


1


6


Fracture of ribs


1


1


Fracture of thigh .


1


1


1


3


Injury to pelvis


..


1


1


Total


90


109


86


78


54


87


62


GS


83


87


988


Stillborn


6


3


5


-1


5


3


3


10


5


S


64


Population ( estimated ) Death rate per thousand


75,500


13.1


1


2


1


. .


4


Nephritis


1


. .


1


Premature birth and congenital debility


5


15


2


1


2


2


2


1


1


9


1


2


1


1


5


Burning


1


1


1


3


Sunstroke


1


.


1


2


1


5


Icterus neonatorum


1


3


Enteritis


1


1


2


Abscess gall bladder


Cirrhosis liver


1


1


1


Drowning


.


. .


1


Diarrhea


1


97


289


HEALTH DEPARTMENT.


Social Relations of Decedents.


Married


299


Single


424


Widow


186


Widower


77


Divorced


2


Unknown


0


Total


988


Nativity of Decedents.


Somerville


257


Massachusetts


201


Other New England states


124


Other states


79


Canada


88


England, Scotland, and Wales


41


Ireland


128


Italy


26


Norway and Sweden


13


Russia


9


Other countries


17


Unknown


5


Total


988


Nativity of Parents of Decedents.


Father. Mother.


Somerville


24


31


Massachusetts


148


161


Other New England states


162


139


Other states


41


32


Canada and provinces


96


121


England, Scotland, and Wales


58


61


Ireland


287


263


Italy


49


47


Norway and Sweden


39


41


Russia


17


15


Other countries


50


56


Unknown


17


21


Total


988


988


Of the parents of the stillborn, 33 fathers and 39 mothers were na- tives of the United States, and 26 fathers and 25 mothers were of foreign birth.


Diseases Dangerous to the Public Health.


This board has adjudged that the diseases known as acti- nomycosis, Asiatic cholera, cerebro-spinal meningitis, diph- theria, glanders, leprosy, malignant pustule, measles, scarlet fever, smallpox, tetanus, trichinosis, tuberculosis, typhoid fever, typhus fever, varicella, whooping-cough, and yellow fever are infectious, or contagious, and dangerous to the public health and safety within the meaning of the statutes. Physicians are required to report immediately to the board every case of either of these diseases coming under their care, and postal cards con- veniently printed and addressed are supplied to them for the


290


ANNUAL REPORTS.


purpose. On receipt of a card from a physician, the superin- tendent of schools, the principal of the school in the district in which the patient resides, and the librarian of the public library are notified, and state board of health.


Scarlet Fever .- Three hundred twenty cases of scarlet fever have been reported during the year, nine of which resulted fatally. In 1908 there were 283 cases, four of which resulted fatally.


Diphtheria .- Three hundred thirty-four cases of diphtheria have been reported during the year, twenty-seven of which were fatal. In 1908 there were 278 cases, eleven of which proved fatal. Anti-toxin has been provided by the state board of health, and placed by this board in central locations for use by physi- cians in cases where people are unable to purchase the same. Culture tubes for diphtheria and sputum bottles for suspected tuberculosis have been obtainable at the same stations.


Warning cards are used in dealing with scarlet fever and with diphtheria, and the premises are fumigated by the use of the formaldehyde gas regenerator, immediately after the termi- nation of the case. An inspection is made by the agent of the board of the premises where diphtheria is reported, and all sani- tary defects discovered are required to be remedied as soon as possible.


Tuberculosis .- One hundred forty-four cases of tuberculo- sis have been reported during the year. There were seventy- seven deaths from this disease.


Typhoid Fever .- Ninety-nine cases of typhoid fever have been reported during the year, eight of which have proved fatal. In 1908 there were sixty-four cases reported, nine of which were fatal.


Typhus Fever, Cholera .- No cases of typhus fever or cholera have been reported the past year.


Smallpox .- One case of smallpox has been reported during the year.


Number of persons with diphtheria or scarlet fever taken in am- bulance to hospital by agent 220


Number of cases of scarlet fever and diphtheria for which houses were placarded 654


Number of premises disinfected by agent 1,016


It will be seen by the foregoing figures that, in addition to the 654 premises infected with scarlet fever or diphtheria, 362 other premises were disinfected. Thirty-five disinfections were made at the request of attending physicians whose patients had been ill with typhoid fever or cancer. One hundred and eighty- eight schoolrooms were disinfected, 1177 for scarlet fever, sixty- eight for diphtheria, and 139 premises for tuberculosis, in com- pliance with the regulations passed by this board.


291


HEALTH DEPARTMENT.


Many library books have also been disinfected, and quan- tities of infected bedding and other material have been burned.


TABLES.


The prevalence of scarlet fever, diphtheria, and typhoid fever in the city during the several months of the year 1909 is shown by the following table, and in the table next following is given the number of deaths from these three diseases, by months, during the last ten years :-


Scarlet Fever, Diphtheria, and Typhoid Fever Reported in 1909.


SCARLET FEVER.


DIPHTHERIA.


TYPHOID FEVER.


MONTHS.


Cases


Reported.


Number of


Deaths.


Percentage


of Deaths.


Reported.


Number of


Deaths.


Percentage


of Deaths.


Reported.


Number of


Deaths.


Percentage


of Deaths.


January


53


2


3.8


38


4


10.5


1


..


February


31


1


3.2


23


4


17.4


March


30


3


10.


23


3


13.


1


April


24


2


8.3


29


2


6.9


4


1


25.


May .


41


...


.


1


5.9


28


2


7.1


4


..


..


....


July .


12


....


. . .


39


2


5.1


3


....


....


August


12


....


....


22


3


13.6


5


....


....


September.


12


....


....


22


2


....


....


....


October


25


....


....


31


...


35


4


11.4


November .


29


....


....


32


1


3.1


15


2


13.3


December .


34


....


....


20


3


15.


8


1


12.5


Total .


320


9


2.8


334


27


8.1


99


8


8.1


Deaths from Scarlet Fever, Diphtheria, and Typhoid Fever in the Last Ten Years.


SCARLET FEVER.


DIPHTHERIA.


TYPHOID FEVER. .


MONTHS.


1900.


1901.


1902.


1903.


1904.


1905.


1906.


1907.


1908.


1909.


1901.


1902.


1903.


1904.


1905.


1906.


1907.


1909.


1900.


1901.


1902.


1903.


1904.


1905.


1906.


1907.


1908.


1909.


-


-


-


1


-


-


1


-


-


1


-


January


February


HA.


.. -. :


3


5


2


2


2


1


5


2


2


May


5


3


2


2


3


2


1


1


1


June


3


1


1


1


2


1


1


2


2


1


July


4


1


1


1


2


1


1


1


1


1


2


1


2


1


3


1


2


1


1


9


1


2


1


3


1


2


1


1


1


6


3


2


2


2


2


3


1


2


4


1


4


November


2


1


1


3


2


3


2


3


1


1


2


1


2


3


3


3


1


2


December


1


1


3


1


..


.


4


1


5


2


2


3


1


4


2


3


3


1


1


1


1


Total


7


5


3|10


3


4


1 12


4


9


49


29 19


19 14 17 15


9 11 27


9 12| 6 10 11 '9 11 11 9


8


-


-


1


4


·


1


March


April


2


. . :


1


2


1


3


1


1


: :


1


.


1


1


August


September


1


1


1


1


1


2


-: : :


: : :


2


1


1


1


2


October .


1


2


1 :


-


-


-


-


-


-


--


1900.


27


1


3.7


6


..


...


June .


17


17


10


1 1 111. 20 1


1


1908.


Cases


Cases


292


ANNUAL REPORTS.


Table of Deaths During the Last Ten Years.


Year.


No. of Deaths.


Rate per 1,000.


1900


967


16


1901


831


13


1902


890


13


1903


955


14


1904


964


14


1905


968


14


1906


1,004


14


1907


997


14


1908


903


12


1909


988


13


Average death rate per 1,000 for ten years


14


Table Showing the Five Principal Causes of Death in Somerville in 1909.


PNEUMONIA.


HEART DISEASE.


NEPHRITIS.


CANCER.


TUBERCULOSIS.


Number of Deaths.


Number per 10,000 of Pop.


Number of


Deaths.


Number per


10,000 of Pop.


Number of


Deaths.


Number per


10,000 of Pop.


Number of


Deaths.


Number per


10,000 of Pop.


Number of


Number per


10,000 of Pop.


113


14.9


112


14.8


94


12.5


83


11.


77


10.2


Medical Inspection of Schools.


The medical inspection of the schools of Somerville, which was instituted in December, 1907, has been continued during the year. The value of the system has been constantly demon- strated, and the work has been done in a very satisfactory man- ner. There has been harmony of action between the board of health and the school board, and the school principals and teachers have very generally co-operated with the inspectors in making the system as successful as possible.


The inspectors make daily visits to the schools under their charge, and to them are referred all children who show evi- dences of disease or abnormal conditions. Children who are found to be unfit to remain in school are sent home, accom- panied by a slip properly filled out advising that the family physi- cian be consulted. The inspectors also make an annual inspec- tion of all the children in the schools, and any defects discovered are called to the attention of the parents. Monthly inspections of the school buildings and premises are made, and suggestions or criticisms are referred to the proper authorities. Every effort is made to protect the health of the children and to co- operate with the parents in keeping the children in as normal a condition as possible.


Deaths.


293


HEALTH DEPARTMENT.


In accordance with the provisions of the statute, tests of sight and hearing are made by the principals or teachers.


During the year 6,051 children have been referred to the in- spectors during their daily visits, and 865 have been sent home because of illness.


The following list will show the classes of diseases and de- fects which have been found in the schools, except defects of sight and hearing :-


LIST OF DISEASES AND NUMBER OF CASES REPORTED.


1. Infectious diseases :-


Measles


. 29


Whooping cough


7


Chicken pox


42


Mumps


79


Scarlet fever


5


Diphtheria


1


Total


163


Enlarged tonsils and adenoids


718


Inflammatory diseases


177


Other abnormal conditions


8


Total


903


3. Diseases of the eyes :-


Inflammatory conditions of the eyes and lids 20


Foreign bodies and injuries


7


Other abnormal conditions


56


Total


83


4. Diseases of the ears :-


Inflammatory condition .


17


Other abnormal conditions


29


Total


46


5. Diseases of the skin:


Pediculosis


693


Impetigo


55


Scabes


40


Eczema


32


Tinea


7


Herpes


12


Miscellaneous conditions


146


Total


985


6. Miscellaneous diseases :-


Constitutional diseases


40


Diseases of the digestive system


61


Diseases of the respiratory system


63


Diseases of the circulatory system


21


Diseases of the lymphatic system


74


Diseases of the nervous system


28


Diseases of the urinary system


58


Wounds and injuries


42


Other conditions


119


Total


. 506


Total number of diseases reported


. 2,686


.


·


·


.


2. Diseases of the nose and throat :-


294


ANNUAL REPORTS.


The districts and inspectors are as follows :-


District No. 1 .- Prescott, Hanscom, Davis, and Edgerly schools. Inspector, Dr. Francis Shaw, 57 Cross street.


District No. 2 .- Baxter, Knapp, Perry, and Bell schools. Inspector, Dr. Edward J. Dailey, 46 Bow street.


District No. 3 .- Bennett, Pope, Cummings, and Proctor schools. Inspector, Dr. L. H. Raymond, 66 Highland avenue.


District No. 4 .- Morse, Carr, Durell, and Burns schools. Inspector, Dr. W. L. Bond, 322 Highland avenue.


District No. 5 .- Brown, Bingham, and Forster schools. In- spector, Dr. H. M. Stoodley, 383 Highland avenue.


District No. 6 .- Lincoln, Hodgkins, Highland, and Lowe schools. Inspector, Dr. H. Cholerton, 396 Highland avenue.


District No. 7 .- Glines, English High, and Latin High schools. Inspector, Dr. R. F. Gibson, 108 Highland avenue.


Parochial Schools .- Inspector, Dr. M. W. White, 42 Bow street.


Hospital for Contagious Diseases.


The hospital has continued to demonstrate its value to the city during the past year. Many of the cases treated could not have been properly cared for at home, and undoubtedly their re- moval to the hospital reduced the danger of the spread of the diseases. Additional rooms were needed for nurses and help, besides laundry and storage accommodations, and on October 1, 1909, an appropriation of seven thousand dollars was made to provide for an addition to the hospital. This has been con- structed and furnishes rooms for fourteen additional nurses and attendants, and a new laundry, besides increased accommoda- tions in the wards. The diet kitchens have been placed in the wards, thus making the serving of food much more advantage- ous than before.


On October 15, 1909, the board received and accepted the resignation of Miss Nellie J. Van Cor, who had conducted the care of patients and the business management of the hospital as its matron from the opening of the institution with marked success, and she severed her connection therewith on Decem- ber 2, 1909.


On November 3, 1909, the board appointed Miss Edith M. Grant, from the South Department of the Boston City Hospital, as matron, and she assumed her duties on November 27, 1909.


The statistical report of the hospital is included in the re- port of the medical inspector.


Bacteriological Department.


The work of this department was performed by Frank L. Morse, M. D., medical inspector of the board, whose report is appended to this report :-


295


HEALTH DEPARTMENT.


Specimens will be received at the laboratory at the city hall daily, including Sunday, at any time, and they will be examined and reported upon the morning following their reception.


SPECIMENS AND ANTI-TOXIN.


Outfits for specimens for tuberculosis, diphtheria, and typhoid fever, and diphtheria anti-toxin and vaccine lymph may be obtained at the laboratory and at the following places :-


Adams Pharmacy, Willow and Highland avenue.


Claude Curtis, 154 Perkins street.


Bay State Pharmacy, 173 Washington street.


Edward E. Edwards, 25 Union square.


Fred W. Gay, 524 Somerville avenue.


Hart Brothers, 263 Highland avenue.


Percy A. Hall, 2 Studio building, Davis square.


Herbert E. Bowman, 529 Medford street, Magoun square.


Eugene B. Carpenter, 10 Broadway.


Julius E. Richardson, 310 Broadway.


Paul S. Eaton, 693 Broadway.


Willis S. Furbush & Co., 1153 Broadway.


After the specimen is collected, it must be taken or sent directly to the laboratory at the city hall.


Undertakers.


Under the provisions of section 44 of chapter 78 of the revised laws of 1902, twenty-one persons have been duly licensed as undertakers.


Examiners of Plumbers.


The public statutes provide for a board of examiners of plumbers, consisting of a chairman of the board of health, the inspector of buildings, and an expert at plumbing, to be ap- pointed by the board of health. This board appointed Duncan C. Greene, the inspector of plumbing, to fill the place of expert. The number of licenses granted will be found in the report of the inspector of buildings.


Financial Statement for 1909. HEALTH DEPARTMENT.


CREDIT.


Appropriation


$8,000 00


Receipts :-


Milk fees


353 35


Permit fees .


56 00


Witness fees returned


6 15


Sundry cities and towns, for care of dis-


eases dangerous to public health .


248 43


Total credit


$8,663 93


296


ANNUAL REPORTS.


DEBIT.


Salaries


$5,203 10


Repairing and painting vehicles


83 60


Repairing generator


24 00


Repairing harnesses and new harness .


68 20


Horseshoeing


32 50


Burying dead animals


103 75


Office expenses, milk inspector


149 39


Books, stationery, printing, and postage


289 53


Bacteriological laboratory


80 93


Board of agent's horse


312 30


Telephones


90 69


Care of diseases dangerous to public health (settlements in Somerville)


5,143 09


Incidentals


165 77


Total debit


$11,746 85


Amount overdrawn


$3,082 92


Health Department, Collection of Ashes and Offal.


CREDIT.


Appropriation


$50,000 00


Sale of offal, rags, etc.


8,649 76


Received from Lord. & Webster (bill paid twice)


368 50


Total credit


$59,018 26


Salary of superintendent


$1,400 00


Collection of ashes .


29,440 20


Collection of offal


17,694 75


Stable expenses


2,186 00


Four new ash carts .


450 00


Repairing wagons


911 52


Tools and repairing same


158 47


Harnesses and repairing same


809 33


Six new horses


1,578 96


Horse doctoring


150 18


Board of superintendent's horse .


288 93


Horseshoeing


938 39


Hay and grain .


7,862 05


Incidentals


222 47


Total debit


$64,091 25


Amount overdrawn


$5,072 99


Health Department, Hospital for Contagious Diseases.


CREDIT.


Appropriation


$1,000 00


Received from sundry persons, cities and towns, and commonwealth of Massa- chusetts


6,781 71


Total credit


$7,781 71


DEBIT.


297


HEALTH DEPARTMENT.


DEBIT.


Salaries of employees


$5,300 80


Supplies


683 90


Groceries and provisions


1,981 49


Incidentals


524 64


Total debit


$8,490 83


Amount overdrawn


$709 12


Health Department, Medical Inspection in the Public Schools.


CREDIT.


$1,500 00


Salaries of inspectors


$1,400 00


Printing


27 45


Total debit


$1,427 45


Balance unexpended


$72 55


Appropriations Overdrawn.


Health Department


$3,082 92


Health Department, Collection of Ashes


and Offal .


5,072 99


Health Department, Hospital for Conta- gious Diseases


709 12


Total overdrawn


$8,865 03


Balance unexpended, Health Depart- ment, Medical Inspection in Public Schools


72 55


Net amount overdrawn . $8,792 48


ALLEN F. CARPENTER, Chairman, ALBERT C. ALDRICH, M. D., ZEBEDEE E. CLIFF,


Board of Health.


Appropriation


DEBIT.


REPORT OF THE MEDICAL INSPECTOR.


Somerville, January 10, 1910.


To the Board of Health of the City of Somerville :-


Gentlemen,-I herewith present the report of the medical inspector for the year 1909, including the statistics of the con- tagious disease hospital and the bacteriological laboratory.


Scarlet Fever. During the year 320 cases of this disease were reported in the city, an increase of thirty-seven in number over the previous year. Every case has been inspected, before the house was fumigated, and 348 visits were made at resi- dences to determine when desquamation was complete.


Diphtheria. During the year 334 cases of diphtheria have been reported in the city, an increase from the previous year, when 278 cases were reported. The same restrictions are placed upon all cases, and before patients are released from quarantine two successive negative cultures must be obtained. It is optional with the attending physician to take the first culture, but the second must be taken by the medical inspector, and during the year 444 visits were made at houses for this pur- pose.


Typhoid Fever. During the year ninety-nine cases of this disease were reported, an increase of thirty-five cases from the previous year.


Tuberculosis. One hundred and forty-four cases of tuber- culosis were reported during the year, an increase of eight over the year previous. In November, 1906, following a conference with the overseers of the poor, these cases, which had been pre- viously cared for medically by the city physician, were trans- ferred to the board of health and the medical inspector in- structed to care for them. During 1909 288 visits have been made to thirty-nine patients.


Contagious Disease Hospital.


In September, 1906, following a change in the city charter, the city physician, who, up to this time, had treated the cases at the hospital, was relieved of this duty, and the care of the pa- tients transferred to the medical inspector on October 1. Dur- ing 1909 this arrangement has continued, 421 visits having been made at the hospital during the year.


Scarlet Fever. During the year seventy-nine cases of scarlet fever were admitted, seven of which proved fatal. Thirty-five of these cases were among males, and fifty-two


299


HEALTH DEPARTMENT.


among females. Twenty-three were under five years of age, thirty-five from five to ten years, and the remainder were over ten years. Vomiting was a constant symptom, it occurring in forty-eight cases, and a sore throat in sixty-six cases. In eleven cases the rash occurred on the first day of the illness, in fifty-five cases on the second day, and in eight instances on the third day. There was membrane present on the tonsils in thirty-three cases ; in thirteen cases the disease was complicated with nephritis ; in eleven cases with rheumatism, in six cases with discharging ears, in twenty-six with enlarged cervical glands, and in addition five had diphtheria, and one had mumps. The average stay in the hospital was forty-one days.


Diphtheria. During the year 137 cases of diphtheria were admitted, nineteen of which proved fatal. Of these patients, seventy-one were among males, and seventy-three among females. Fifty-seven were under five years of age; fifty-nine were from five to ten, and the remainder were over ten. Thir- teen entered the hospital on the first day of their illness, and all recovered. Sixty-nine entered the second day of the illness, and four died; twenty-four on the third day, with five deaths ; sixteen on the fourth day, with six deaths ; four on the fifth day, with two deaths ; five on the sixth day, with one death, and three on the seventh day, with one death. The importance of early treatment with anti-toxin is thus very obvious. Of the laryn- geal cases eighteen came to intubation, thirteen of whom re- covered. In forty-two patients the membrane extended over both tonsils, uvula and palate, sixteen of whom died from sys- temic infection involving both the heart and kidneys. In fifty-eight cases the cultures were positive. The throat was clear of membrane in five cases on the first day, in twenty-two cases on the second, in eighteen cases on the third, in eleven cases on the fourth, in twenty cases on the fifth, in six on the sixth, and in six on the seventh. In fifty-seven patients erup- tions appeared on the body due to the use of the anti-toxin, and in five patients joint pains occurred from the same cause. The average stay in the hospital of 126 patients was twenty-two days. Of the nineteen deaths during the year four died within twenty-four hours of admission and were hopeless at that time, and were complicated with nephritis.


300


Patients Treated at the Contagious Hospital.


Admission by Months.


Remaining


January.


February.


March.


April.


May.


June.


July.


August.


September.


October.


Total admitted.


Cured.


Died.


Remaining


January 1, 1910.


Percentage of Fatality.


Scarlet fever .


16


13


00


7


6


7


6


6


1


cr


2


co


00


79


78


7


10


8.2


Diphtheria


12


CO


10


13


10


13


16


20


11


4


13


12


6


137


125


19


5


13.2


Erysipelas


.


.


1


2


. .


.


1


4


3


1


·


Measles


·


.


. ·


..


.


·


·


:


·


. . ·


.


. .


. .


. .


·


.. ·


.


Totals


28


22


19


2


16


20


22


29


12


CO


15


21


15


220


206


26


16


ANNUAL REPORTS.


seven examinations were made for the diagnosis of the case,


Diphtheria. Fifteen hundred and thirty-seven cultures have been examined for diphtheria, 694 being in males, and 843 in


females. Diphtheria being a disease of children, 375 of these


examinations have been made in children under five years of


age, 657 in those from five to ten years of age, 206 from ten to


twenty, and 284 in adults over twenty years. In fifteen cases


the age of the patient was not stated. Six hundred and thirty-


Bateriological Department.


During the year 1909, 1,537 examinations were made of cultures for the diphtheria organism, 192 examinations made of sputum from patients suspected of having tuberculosis, and 150 examinations to detect the Widal reaction in typhoid fever.


DISEASE.


January 1, 1909.


November.


December.


·


.


·


301


HEALTH DEPARTMENT.


189 proving positive, and 448 negative. Of the positive results, fifty-four were of cases in which the attending physician's diag- nosis of diphtheria was confirmed, eighteen in which the clinical diagnosis was not diphtheria, and 117 in which no definite diag- nosis was made. Of the 448 negative examinations, twenty- eight were obtained in which the clinical diagnosis was diph- theria, 121 in which the diagnosis was not diphtheria, and 299 in which no diagnosis had been made.


Eight hundred and ninety-one cultures were taken for re- lease of patients from quarantine, 165 of which were positive, and 726 negative. The importance of taking release cultures is demonstrated by these figures, these patients showing the pres- ence of the bacilli in the throat after the clinical evidence of the disease had disappeared. In nine examinations there was no growth upon the serum tube.


Tuberculosis. One hundred and ninety-two examinations have been made of sputum suspected of containing the tubercle bacillus, fourteen of which were positive and 178 negative. In seventy-nine cases a definite diagnosis of this disease had been made by the attending physician, but in sixty-nine of them the organism could not be detected. In the remainder of the cases, sixty-eight were stated as not showing evidence of the disease, three being positive, and in forty-five cases no state- ments were made giving information as to its character, one of which was positive. One hundred were males and ninety-two females. Although printed directions accompany each outfit, telling how the specimen should be obtained, it has not been un- usual for specimens to be sent to the laboratory containing only saliva from the mouth, with no excretion from the lungs or bronchial tubes. Physicians should be urged to give definite instructions to each patient, relating to the collection of the sputum, for in some instances a negative report would mislead both physician and patient. Consumption to-day is recognized as an infectious disease, and all persons afflicted with it should be instructed in the modern methods for preventing its spread. In some cases this is not done by the attending physician, and during the past six years your board has required that this dis- ease be reported to you, as other infectious diseases are, and that printed instructions and advice be sent to each patient ill with the disease. The decrease in the death rate of consumption, and the cure of persons afflicted with it, is due to the improved and intelligent manner with which cases are treated, and the prevention of further spread of the disease is a subject which is of importance to all local boards of health.




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