USA > Massachusetts > Bristol County > Attleboro > Reports of town officers of the town of Attleborough 1911 > Part 12
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The Board of Health must depend much upon the co- operation of the public, as to the amount of efficiency and thoroughness with which its work is carried out. 'Every Health Department, on the other hand, is con- stantly hampered by opposition or by lack of assistance from individuals in its work of disease prevention. A
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few of the many instances may be cited: vaccination without a question should be general, to protect us from epidemics of that dread disease, small pox, which has already recently appeared near our borders, and the seri- ousness of which is not given proper consideration by our inhabitants, for the only reason that vaccination has for- tunately kept us free in recent years from this disease. Why then, will parents, with nothing but silly reasons, and against the advice of reputable physicians, persist- ently attempt to prevent their children from obtaining that immunity which rightfully and legally belongs to them? It is a fact to be deplored in many communities, that some physicians will give certificates of unfitness for vaccination to children in the public schools, who for their own and others protection, should be vaccinated. We are glad to note that locally such a condition of affairs if it obtains at all, exists in a very limited degree.
The above-mentioned lack of co-operation between parents and the health authorities, with the inevitable results that always follow in its wake, is further illus- trated by the unsuccessful attempts to control the spread of the so-called less dangerous contagious dis- eases ; whooping cough, measles and the milder cases of scarlet fever and diphtheria. Many of the parents are careful, and show some consideration for the well being of others, but there are examples where important health rules are totally disregarded. It is due to such careless- ness, that epidemics occur. Parents should keep their children when ill, strictly away from all other children, not only at school but at Sunday school, moving picture shows and elsewhere. It is becoming a more and more difficult problem to control these conditions, more especially because we have no isolation hospital. The quarantine established in the average house is at best a very unsatisfactory and incomplete method of disease prevention.
It may be truthfully stated that every case of con-
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tagious disease is due to the carelessness of someone. even more than that in many instances, it is due to crimi- nal negligence because of the disregard of the health laws. Many of the milder cases are not attended by a physician. the Board of Health is not notified. the other children in the family go to school and various public places, and there we have the source of our most frequent epidemics.
Recommendations.
Under this head. it seems logical for us to consider sanitary and hygienic problems that are crying out for solution. At this time when we are contemplating a change in the form of government of our growing town, is it not wise to hear from the different departments. whose members must have had ample opportunity. while in office, of observing under the present system of gor- ernment. certain principles that might well be improved upon : Few towns of our size, have ideal health condi- tions. It is difficult. because of ever changing beliefs, governing the principles of disease prevention, and in this State at least. because of the frequently amended health laws. for a Board of Health to offer to the people a simple and definite plan to safeguard the public health.
At present. widely divergent opinions are held in re- gard to such important health matters as pasteurization. quarantine, disinfection and sanitary plumbing. There are. however. certain measures. the adoption of which might well be considered by every community. Attle- boro must in the near future find it necessary to give at- tention to many of these.
There is need for more ample medical inspection of the schools. and for the provision of school nurses. The Acts of 1906 provided that a system of medical inspection of schools should be established in every city and town in the Commonwealth, and that one or more school phy- sicians should be appointed by the school committee.
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As Attleboro had previously adopted no inspection, it became necessary for the school committee to appoint a school physician. This was done and while the school officials have shown good judgment in the selection of their appointee to that office, and the town is rendered valuable service in return for which it pays a very inade- quate salary, the fact is apparent that medical inspection in the schools here could be made much more efficient by the employment of one or more school nurses.
The object of school medical inspection is two-fold; to prevent the spread of communicable diseases in the schools, where undoubtedly a large proportion of the cases of contagious diseases originate, and to examine for and attempt to correct physical defects in the pupils. It is quite generally agreed that the part of the work of school inspection relating to contagious diseases, is best looked after by boards of health, while the correction of physical defects, and the bearing of such on the future development of the children, physical, mental and educa- tional, is plainly a measure closely related to the other work of school authorities, and is best administered by the school physician and school nurses under their direction.
The following up of cases in their homes, and the in- struction of the parents, is an absolute essential to proper medical inspection, and the employment of the school nurse to attend to this branch of the work is quite neces- sary if positive results are to be expected. There can be no deserved criticism made of the school committee in its efforts thus far to provide medical inspection in our schools, but it may be desirable soon for the school and health authorities to combine, in an effort to improve the system.
In our last report, attention was called to the need of an isolation hospital for the reception and care of con- tagious cases, and for the establishment of a bacterio- logical laboratory in connection therewith. While the
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Board feels that this need should be kept in mind, it now seems desirable to first ascertain what is to be the out- come of a bequest recently made of land and buildings to the town for hospital purposes. In the event of this town acquiring in the near future, control of the estate above referred to, and establishing thereon a general hos- pital, a very happy solution of the problem in part, at least, would be immediately made possible. The location is ideal, and there would be plenty of room to erect build- ings suitable for an isolation hospital. At a recent con- ference with the State Inspector of Health, at which the town of North Attleboro was also represented, this Board assumed, in what in its judgment, was for the town's best interests, the attitude that under present conditions. it would be unfair for the State Board of Health (which has authority under recent enactment). to insist on the imme- diate establishment of an isolation hospital in Attleboro. and the hope was expressed to the State Inspector of Health, that a reasonably sufficient time would be al- lowed the town to determine whether or not such a loca- tion as before referred to, might be acquired.
The Board would recommend if this site came into the towns possesion, that an appropriation be immediately made for the construction of a modern isolation hospital, to provide for all diseases dangerous to the public health, including tuberculosis. It is possible that a major part of the cost of maintenance of such an institution would be provided for by the receipts that would accrue from the payment made to Attleboro by the surrounding smaller towns for the care of their contagious cases. An example of such a hospital maintained without expense in this way may be found in Brighton.
The Board would also call attention to the need of a system of drains of permanent construction in that part of the town near the centre bordering on the Thacher Brook Drain. The removal of sewage from that locality will no doubt be a great improvement on present condi-
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tions, but the construction of a system of surface water drains to be connected with the Thacher Brook, will we believe, be a good investment, as it will increase the valu- ation of taxable property, and at the same time, add to the healthfulness and attractiveness of that portion of the town.
Contagious Diseases.
The following list of rules printed on cardboard, is left at every house where it is necessary to quarantine patients :
I. The sick person is to be kept in a room by himself.
2. No one but the nurse and the doctor should be al- lowed in the room.
3. Your own children must be kept at home. They may play in their own yard, but must be kept off the street.
4. Other people's children must not be allowed to enter your house.
5. Adult members of the family will be allowed to work provided they have absolutely nothing to do with the sick person. They must keep out of the sick room.
6. It is a bad plan to have the neighbors running in. Talk to them through the window.
7. All children in the house are to be kept from school until a certificate to return is granted by the Board of Health. This applies to Sunday school also.
8. Toys that the patient plays with should be burned.
9. Do not use handkerchiefs for the patient. Use old, soft linen, and burn the linen as soon as used.
10. The patient should not use the same eating uten- sils that are used by the family. Give him separate ones.
II. The sick person will not be allowed to leave the house until the card is removed from the door.
12. Public Library books, Public and Sunday School books must not be used by the patient nor left in the
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sick room. nor should they be returned except with our permission. Give us a list of such books.
13. All school books and Public Library books if they have been used by the patient. may be ordered burned by the Board of Health.
14. Do not send laundry out of the house where there is contagious disease.
15. Do not allow the milkman to leave a bottle or other milk container at a house where there is contagious disease : the milk should be poured from his can or bottle into a receptacle provided by the family.
There were reported during the year, sixty-three cases of scarlet fever : more than the usual number : fortun- ately, however, the cases were for the most part, of a mild type. There was one death from scarlet fever dur- ing the year. The measles cases totalled forty-four for IgII, against one hundred and eighty-three cases the year before. There were nineteen cases of varicella or chicken pox reported. This is without doubt a small number of the cases that actually occurred. but which were of so mild a nature that they were not recognized. or if so, were not reported. There was one case only of infantile paralysis, which was promptly quarantined when discovered. There were four cases of ophthalmia reported in infants. A recent provision of the statutes calls for prompt action by health authorities. in such cases, to prevent blindness. and the Board is able to report good results in all the cases. two of which, because of their serious nature. having been sent by the Board to the Massachusetts Eye and Ear Infirmary. There were only five cases of diphtheria reported. Many mild cases of this disease doubtless are unrecognized. It is quite possible for children with diphtheria to feel well enough to attend school and other public places. These cases are much more dangerous to the public than the severe cases which are isolated. and probably are often responsi- ble for the spread of the disease. The quarantined cases
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are not allowed to go free until negative cultures are ob- tained from their throats, and this rule often necessitates keeping the patient in quarantine many days after the other symptoms have disappeared. Whooping cough has been rather prevalent; thirty-one cases were re- ported, but many more had the disease, often as a compli- cation of one or more of the other children's diseases. There were two cases of tetanus reported, both of which were fatal.
Pulmonary Tuberculosis.
There were thirty-four new cases reported, and twelve persons died in the town during the year from this dis- ease. Considerable progress has been made in the fight against this affection in Attleboro. A local Anti-Tuber- culosis Society has been recently organized, and through its district nurse will doubtless prove to be of great assistance in the work of relief and prevention of this disease in particular, and of other diseases, in a general way. This organization's campaign for the education of all persons about consumption, and its prevention, and the policy adopted by the society in caring for needy cases, as well as their families, meets with the hearty ap- proval of this Board, as it should merit the endorsement of every person interested in efforts made to check the ravages of this preventable disease.
The Board has under consideration, a plan which com- prises the establishment of a hospital for the care, isola- tion and treatment of tubercular patients. Recent legis- lation provides for the payment by the State of a subsidy to towns having such a hospital. We believe that in many cases the expense per capita will be less than is now paid for the care of these patients in other institu- tions, and in their homes. Whether or not this may be so, it is evident that little can be accomplished in the work of eradicating this disease, until the incipient cases are promptly placed under institution care where most
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of them will recover, and until the advanced cases are removed from surroundings where unsanitary conditions and careless management shorten their lives, and en- danger the health of others, and particularly of little chil- dren exposed to the infection. While cases are at pres- ent sent to Lakeville and Rutland, so far as is practicable, this plan is the opposite from ideal. The waiting list is long at both these places, incipient cases waiting for ad- mission losing valuable time, and advanced cases becom- ing worse, and endangering others by such delay. In the work of prevention of consumption, it is also well for us to consider its relation to school inspection. The habits of living which protect one in later life, must be formed in youth. Reference has already been made to the value of the school nurse ; the education of the child in the prin- ciples of hygiene, as well as the education of the parents in their homes, might well receive some needed attention. Open-air schools for such children as show any tendency to consumption or diseases of malnutrition must soon be a subject for thought, and the measure of its value to the health of the community taken. These opinions are mentioned for consideration because it is felt by medical authorities who father these ideas that it is a matter of economy to take care of the health of the inhabitants of any town. Municipalities are learning the lesson that in- surance companies long since were taught, and just as the insurance companies realize that it is better to care for their policy holders, than it is to allow them to die, and necessitate the payment of death claims, so the town should learn that to grow in population and importance, it is unquestionably not only necessary to attract new citizens, but it is also essential to care for the health and lives of its residents. So these principles must some day be endorsed even by the type of citizens who do not ap- prove of expenditures except those demanded by neces- sity and economy. This plan has an economic as well as a social value.
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There were fifty-one cases of typhoid reported, forty- nine of which occurred in August and September. Fol- lowing is a complete account of the outbreak.
Typhoid Fever.
During the months of August and September, an out- break of typhoid fever occurred here, which, from a pub- lic health standpoint, proved to be one of the most im- portant in the town's history. It is doubtful if many in the community gave the matter more than a passing thought at the time, and the incident is now probably almost forgotten. The town was, however, in a very serious situation for several days in so far as the health of its inhabitants was concerned. It was very fortunate that early detection and abatement of the source of the trouble was possible. The importance of milk inspection was dwelt on in last year's report, and the following ex- ample of what we may under present methods, again ex- pect, should stir some one to action. The occurrence of these typhoid cases and the yearly roll of diarrhoea in children may be usually ascribed to dirty milk, the sale of which is not as yet strictly under the control of any state or municipal authority.
On August 4, 1911, the town having been free for months from typhoid fever, and several years having passed with only an occasional case being noted, the first of a series of cases of that disease was reported to this Board. On August 15, two more cases appeared, followed on August 23, by two more, an incident to make any Board of Health anxious, and on August 26, eight cases were reported, removing all doubt that the town was now the seat of what might prove to be a serious epidemic. On August 26, what appeared to be a probable source of the outbreak, was discovered by the chairman of the Board, and promptly dealt with, and immediately the cases reported began to diminish in number. Five cases
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on the 29th, and four on the 3Ist of August were re- ported. In September, there were reported three cases on the 2d. three on the 5th, two each on the 6th, 7th and 8th. three on the IIth and one on the 19th. The period of incubation from the time of suppressing the supposed cause on August 26th. now being over. only an occasional case was reported. two on the 22nd and one each on the 28th and 30th, when the forty-seventh case in the out- break was reported. Two more straggling cases, whose symptoms dated back many days, were reported in the first part of October, and on the 7th of that month. the outbreak finally ceased with the reporting of the forty- ninth case.
The sudden occurrence of these widely distributed cases in a town where the disease had never before gained such a foothold. and where for years only sporadic cases had occurred at irregular intervals. pointed to some com- mon source of infection. Persuing the policy already previously adopted in dealing with this disease. the Board of Health made a visit to each case reported. and gathered data as to the probable origin of the patient's illness. Few visits had been made before the Board was furnished with what seemed to be striking and unmistake- able evidence that it was dealing with a milk borne epidemic and. moreover. it was apparent that the product of one dealer was responsible. This dealer. "A." de- livered daily in Attleboro, to houses, stores and restaur- ants. five hundred and fifty quarts of milk. This output. he obtained from seven farms. six of which were in Reho- both. It was found that thirty-one patients used milk that was purchased only from Dealer "A." and which they had drank at home or in a boarding place or drug store. Several patients had used milk from "A's" sup- ply in addition to that obtained from other dealers; three patients used milk exclusively from other dealers. One patient was found in Rehoboth who had used milk purchased direct from Producer "J." Over forty cases
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were shown by the facts obtained, to have used milk which came directly or indirectly from Dealer "A."
TYPHOID FEVER IN ATTLEBORO
August.
September
Number of Cases reported
92
1951955
X
Cases who used A's milk either at home, drug stores or boarding houses exclusively
Cases who used more or less of A's milk in addition to that of other dealers.
Cases on other milk routes who used none of A's milk
Dealer "A" received milk from the farms above re- ferred to, every forenoon at a station in the east part of the town, where the whole supply was poured into one tank and mixed ; after being run through a coil of pipes and subjected for a short time to a temperature said to be less than 155 degrees Fahrenheit, the so-called pasteur- ized milk was then cooled and bottled. The empty bottles and cans were sterilized by live steam, dried, and the latter returned to the farms to receive the next days supply. A wet wash laundry was located in the same building with the milk station, and was connected with the bottling room by a door. This aroused some com- ment, but the Board could find no evidence that the laun- dry employees ever handled the milk. or that any of the persons employed about the milk station had recently been ill. The sanitary conditions at the dairy im- pressed the Board favorably. It was evident that the milk must have been contaminated with typhoid germs
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before it reached the dairy. Investigation was then made of the seven farms, supplying the product to Dealer "A," and while two of these in Rehoboth did not meet the usual requirements demanded for the production of clean milk, there was nothing more suspicious to be said of any of them, until investigation disclosed the fact that Producer "J" of Rehoboth, who sold milk daily to Dealer "A" of Attleboro, had at his home a daughter, "Mrs. B," who was said to be ill of typhoid fever. The examination later of this patient's blood by the State Board of Health, confirmed the diagnosis of this disease. While the cans brought to the farm by Dealer "A" every day were carefully sterilized before they left the milk station, the milk pails used by Producer "J" were washed in his house, where the case of typhoid lay, and with water from a well about ten feet from the back door. This well was not far distant from a spot where drainage from the kitchen sink was deposited on the surface of the ground. The water from this well, when later examined by the State Board of Health, was found to be badly pol- luted, and unfit for drinking purposes.
Several visits of inspection were made to the farm by members of the local Board, who were satisfied that the real cause of the epidemic had been discovered some time before the cessation of the trouble confirmed their belief.
It is doubtful if the direct responsibility for the occur- rence of these typhoid cases will ever be determined. The officials in the town of Rehoboth denied having had any knowledge of the case until advised by the State Inspec- tor soon after he had been notified of conditions by the Attleboro Board of Health. A joint investigation, which was immediately made by the local Board and the State Inspector, disclosed the fact that no action had been taken to prevent the sale of milk from this farm, until the Attleboro Board of Health started its investigation and discovered the trouble. The typhoid case, mean-
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while, had been under a physician's care for several days.
The State Board of Health commended in a letter to the Attleboro Board, its prompt action in controlling the epidemic. The State Board in its October bulletin de- scribes the outbreak and infers that a great lesson has been taught concerning the importance of proper milk inspection, and farm inspection, which it declares should be done under state supervision. Whatever conclusion may be drawn it is evident that we have had illustrated how easily under present conditions, our food supply can be contaminated, and the public has been brought to con- sider in a measure, a problem of vital importance to us all, which has in its solution, the proper regulation of our milk supply.
Vital Statistics.
The number of deaths occurring in Attleboro during IQII, was one hundred and eighty-six, of which ninety were males and ninety-six females. The death rate per thousand of population was 11.5.
There were fifty deaths under one year, and sixty three under five years. Sixteen died at the age of eighty or over. There were eleven deaths from pneumonia, se en from cancer, fifteen from heart disease, twelve from acci- dent, and twenty from tuberculosis in its various forins.
The following is a classified list of deaths occurring in I9II :
Table Showing the Number of Deaths from Each of the Following Causes Occurring in the Town During the Year, 19II. General Diseases.
Scarlet Fever
Typhoid Fever 2 Measles I
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Pertussis I
Tuberculosis Pulmonary
12
Tuberculosis General I
Tubercular Laryngitis
I
Tubercular Peritonitis
2
Tubercular Meningitis
3 I
Tubercular Fistula
Acute General Peritonitis
2
Cancer of Liver
I
Cancer of the Genital Organs
I
Cancer of the Stomach
3
Cancer of the Abdomen
I
Epithelioma of Neck.
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