USA > Massachusetts > Bristol County > Attleboro > Reports of town officers of the town of Attleborough 1931 > Part 4
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Health Department Nurse MARY E. McMAHON, R. N.
Registrar of Deaths STEPHEN H. FOLEY
Clerk DOROTHY McNERNEY
Associate Physician at Diphtheria Prevention Clinic JAMES H. BREWSTER, M. D.
Associate Physician at Tuberculosis Dispensary F. V: MURPHY, M. D.
53
ANNUAL REPORT
SEVENTEENTH ANNUAL REPORT OF THE HEALTH DEPARTMENT
To His Honor, the Mayor, and to the Municipal Council, Attleboro, Massachusetts.
Gentlemen:
In this report of health department activities for the year ending December 31, 1931, an attempt is made to present a review of the measures employed in conserving the health of our citizens by preventing unnecessary suffering, illness, and death.
The phases of local public health work showing signs of marked improve- ment are described, and mention is made of those services which are in need of further development. Prevailing local health conditions during the past year are pictured in the appended tables of vital statistics and communicable diseases. This report also includes a financial record, the reports of sub-departments, and certain specific recommendations.
ORGANIZATION
There have been no changes in organization since the last report. The routine work of the department has received necessary attention, the clinics have shown a satisfactory growth, and the financial, nursing, educational and clerical work of the department has, we feel, been carefully administered.
THE CITY'S HEALTH
The community furnishes evidence of a relatively good health record for the year. Mortality statistics compare favorably with previous annual figures. Contagious diseases have shown less than a normal incidence with an unusually small number of cases reported in the latter half of the year. Epidemics have been fortunately avoided. We have noted with satisfaction and relief that for many successive weeks in the summer, fall, and early winter, periods occurred during which no homes were quarantined for scarlet fever or diphtheria.
In recording certain outstanding features of the year's work, it may be mention- ed that these are the results sought by the department in its aim to supply the people with information and service relating to health, and the prevention and control of diseases. Marked progress has been made in health educational work carried on in the clinics, and in the homes. Within the last few months there has been a greater effort made than in any previous year to immunize children, especially those in the pre-school group, against diphtheria.
Another noteworthy advance that gives promise of future improvement in local public health work was the entrance of the city into the Health Conserva- tion Contest. The data obtained in preparing for this contest affords an oppor- tunity for thought, and plans concerning certain items which are in need of immediate attention.
The Health Camp had during the past year the most successful season in its history.
OUTSTANDING VITAL STATISTICS
In Attleboro during 1931 there were 269 deaths; 131 deaths occurred in males, 138 were females.
The crude death rate based on the estimated population of 21,982 was 12.2 per 1000. The largest number of deathsin any one month occurred in March when there were 28. Including non-residents there were 32 deaths from pulmonary tubercu- losis, 20 from cancer, 45 from heart disease, and 15 deaths from the different forms of pneumonia.
54
ANNUAL REPORT
COMMUNICABLE DISEASES
An analysis of communicable disease incidence shows average figures for the first half of the year, with an unusual low morbidity during the last six months. The total number of contagious diseases reported was 455; 341 cases were reported up to July with 114 reported in the latter half of the year. Eight cases of diph- theria were reported with no deaths. There has been one death in the last four years from diphtheria. Measles cases reported totaled 57 with no deaths. 151 cases of scarlet fever were reported with one death; most of these cases occurred in March and April and only seven were reported in the latter half of the year. Fourteen cases of whooping cough and six cases of mumps were reported. There was an incidence of 39 cases of German measles, and 26 cases of chicken pox. Six cases of infantile paralysis were reported with no deaths. Local pulmonary tuberculosis cases showed a slight decrease over recent years. Sixty-nine cases of this disease were reported. Excluding non-resident cases reported from the Bristol County Hospital, gives us a total of seven local cases.
The usual visitation and care of all quarantined cases was observed, and practically all cases of active pulmonary tuberculosis were hospitalized.
POPULAR HEALTH EDUCATION
There has been a rapid advance and real progress in the care of human health in this country within recent years. This development has been due to many comparatively new discoveries in the realm of preventive medicine, and their more or less successful application.
Epidemics of small-pox, bubonic plague, yellow fever, typhoid, typhus, scarlet fever, and diphtheria may now be controlled and greatly limited. The greatest gains undoubtedly have been made in the prevention of childhood diseases. As a result of further research and study of other diseases now going on throughout the world, we may expect in the next few years a similar reduction of many illnesses with which mankind is today aff icted.
Our great difficulty among health workers in these days is getting the proven measures of disease prevention applied. Much knowledge pertaining to disease control is available. The people must be taught how to make use of it.
A properly organized health department finds its duties more and more concerned with much needed education in public health. As the laws of health and hygiene are better understood, the control of disease becomes a simpler and more effective procedure. When health education is extended to arouse an increasing interest in health, a public demand will be created for better health standards.
Our program of health education during the past year has included the publication and distribution of literature and reports, as well as newspaper publicity through articles and paid advertisements. A thorough house-to-house canvass of the whole city was carried out as a part of our diphtheria prevention program. Several extra nurses were employed in this work of giving first hand information, and advice by direct talks with parents in their homes.
The health camp as usual has furnished daily instruction to its quota of forty boys, who not only learn but also live health habits during the camp season. The teaching of these boys is continued through the winter in special weekly class meetings at the Y. M. C. A.
The department nurse, through daily contacts with families where there are patients ill with communicable diseases, is able to point out and emphasize the important measures to be observed in disease prevention.
HEALTH CONSERVATION CONTEST
The city was entered in the 1930 Inter-Chamber Health Conservation, conducted by the Insurance Department of the United States Chamber of Com-
55
ANNUAL REPORT
merce and cooperating health organizations. Our city was placed in group five competing with other cities of 20,000 to 50,000 population. There was a total enrollment of 208 with 31 cities in our group. The purpose of this contest is "to induce communities to effect improvements and to awaken community interest in reaching a reasonable measure of public health efficiency."
While our score of nineteen in a list of thirty-one cities was perhaps creditable, a higher score might have been gained had it not been for difficulties experienced with an unfamiliar fact finding schedule which will not present similar difficulties again. An important advantage in this contest has been gained in the appoint- ment by the local Chamber of Commerce of a Health Committee which will continue to become better acquainted with our local health problems.
An analysis of the local health service by the Field Director of the Contest with his suggestions for future improvement is given in part :-
"This city made a very creditable score as a new entrant in the 1930 Health Contest. There were several items on which no definite information was given, which prevented the city from having as high a score as it might have had if figures had been given on items calling for statistics.
I. The city met all requirements for medical examination of pre-school children, for vaccination against small-pox, diphtheria immunization and medical examina- tion of school children, nurses visits to tuberculosis cases, to other communicable disease cases and to pre-school children, registration of infants and pre-school children, registration of infants and pre-school at medical conferences, visits to tuberculosis clinics, and for reduction in death rates for typhoid, small-pox, diphtheria, tuberculosis and diarrhea and enteritis.
II. The deficiencies were: sewerage connections, very much below 95%; milk consumption, low, tuberculin testing of cows and pasteurization of milk, each below 100%; diphtheria immunization of the pre-school group, health teaching in schools, less than forty minutes per week; visits to school children, prenatal cases and infants; use of laboratory facilities and registration of prenatal cases at medical conferences. No data on V. C. or dental clincs, nothing done on an adult periodic health examination program, and popular health educational program somewhat incomplete. Reductions in maternal and infant mortality were not sufficiently great to qualify for a full score. The budget for public health is well up to the average for cities of the size of Attleboro but it is only about 65% of the amount considered necessary to provide reasonably adequate public health service.'
SUGGESTIONS
I. That the diphtheria immunization program for the preschool be ex- tended so as to equal or to exceed the program already carried out for the school children.
II. That health teaching in the schools be allotted more time on the curri- culum. (Some states require for all schools a minimum of one hour a week for health teaching.)
III. That efforts be made to have a greater percent of the milk supply pasteurized and encouragement be given those responsible for endeavoring to get all dairy cows tuberculin tested.
IV. That as fundamental safeguards to the public health more general connection with the public water supply and public sewerage systems be urged.
V. That as soon as practical, dental services be provided for the school children.
VI. That provision be made for full-time dairy and inspection service.
56
ANNUAL REPORT
DIPHTHERIA PREVENTION
The rapid decline in diphtheria due largely to immunization is one of the triumphs of preventive medicine. Reports from all over the country show that the tendency is downward, and that absolute control of diphtheria is now possible.
This year the department has conducted its most effective campaign of diphtheria prevention since the work was started here in 1923. Several nurses were employed to carry out a plan of systematic house-to-house visitation. The whole city including the sparsely settled portions was thoroughly covered. South Attleboro which was canvassed last year, was visited again after Dodge- ville and Hebronville had been visited. A careful follow-up of all objectors, and delinquents was instituted. Free transportation to and from the clinic was provided. The nurses employed in the campaign, some of whom have had a few years of practical experience in this work, carried on an extensive educational program instructing parents about diphtheria, pointing out the importance of having all children protected, especially the babies and younger children, and arranging for transportation.
A child census of different age groups was taken by the workers, and data secured for use in follow-up work by the department nurse. A record form used by each worker included street and number, name of family, number of children under six years of age, number between six and ten, and of those, the number immunized and the number not immunized was recorded. The attitude of each family toward immunization was also noted.
Each Saturday during the last quarter of the year two physicians, two nurses, and a clerk were kept busy at the clinic, which had a record attendance. 702 children received complete protection in the clinic this year with three doses of toxin antitoxin or toxoid. It is difficult to determine the exact number, but many other children were probably made immune by private physicians in their offices. 421 of those treated were in the preschool group. It is estimated that approximately 66.6% of the children in the city are now protected against diphtheria. 60.8% of children under six years of age are now immunized. As this preventable disease is more common and has a greater fatality in children under six years of age, it is obvious that more attention must be given and more stress applied to the immunization of infants and the younger childhood group. Between four and five hundred children are added to this group annually, nearly all of whom are susceptible to the disease. It is quite evident then that we must protect about four hundred or more preschool children each year if thorough service is to be rendered. All children should be immunized against diphtheria during the first year of life. If such a custom is universally adopted, diphtheria will soon be as rare among us as small-pox.
The record of the clinic in diphtheria prevention for the year is shown in figures together with 11 year records of rates per 100,000 and cases arranged in age groups.
DIPHTHERIA PREVENTION CLINIC RECORD 1931
Total number treated at clinics 2568
New toxin antitoxin (3 doses) 687
New toxoid cases-complete immunization 15
New schick tests . 19
Reschick tests 328
Negative reschick tests 272
Positive reschick tests 5
New cases under 6 years receiving toxin antitoxin 415
57
ANNUAL REPORT
DIPHTHERIA IN ATTLEBORO Rates per 100,000 population
Year
Cases
Case rate 185
2
1922
11
54
0
1923
13
63
0
1924
6
29
1
1925
8
38
0
1926
9
42
0
1927
23
109
2
1928
20
93
0
1929
20
92
1
1930
6
28
0
1931
8
36
0
CASES OF DIPHTHERIA IN ATTLEBORO By Age Groups
Year
0-4
5-9
10-14 15-19 20-29 30-39 40 plus Unk'n Total
1921
4
16
9
0
0
0
1
7
37
1922
4
2
2
1
1
0
0
1
11
1923
5
3
2
1
1
1
0
0
13
1924
2
1
1
0
1
0
1
0
6
1925
3
2
0
1
0
0
1
1
8
1926
4
4
0
0
1
0
0
0
9
1927
5
8
1
4
1
3
1
0
23
1928
4
6
4
0
4
1
1
0
20
1929
4
10
2
2
1
0
1
0
20
1930
1
3
1
0
0
1
0
0
6
1931
3
0
3
0
0
0
2
0
8
39
55
25
9
10
6
8
9
161
ATTLEBORO HEALTH CAMP Established 1923
The results obtained by the 1931 camp in its ninth season were a source of gratification to all those interested in its activities. The record weight gain of 382 pounds for forty boys during the six weeks period was phenomenal. The camp regime and health teaching was supervised in a commendable manner. It was the camp's most successful year. The objective of the health camp may be summarized as an effort-
I. To select from the community a group of forty children of seven to fourteen years most in need of treatment; each individual of which is manifestly underweight, undernourished, and generally under par, as compared with the usual standards set for normal healthy children.
II. To determine if possible, after a careful physical examination and observation of home conditions, the underlying cause or causes of the trouble, for a reason exists in each instance. If remediable physical defects are found,
Deaths
1921
37
5S
ANNUAL REPORT
such as defective teeth, they are corrected; if diseased tonsils are present and this is a common condition, they are removed. The applicant is made free to gain.
III. To teach as the camp's instructional objective each child to assume a reasonable amount of responsibility for his own health, to improve his extreme lack of good nutrition, and proper posture and to be assured that he is correctly informed concerning good manners, and personal and community hygiene to a degree that might be expected of any intelligent child of his age.
A considerable amount of necessary detail in preparation for the camp requires that the work of selection be started by the department early in the year. This preliminary work of careful selection is, we feel, an essential part of the whole camp program.
The illustrations shown on another page give some idea of the improvement obtained in general nutrition and posture.
The report of the Supervisor follows:
REPORT OF CAMP SUPERVISOR
I herewith submit my seventh report as supervisor of the Attleboro Health Camp.
The usual number of forty boys, of whom fifteen had had previous health camp experience at the Attleboro Health Camp, arrived at camp July 6th, to remain for a period of six weeks. The boys were a representative underweight group, ranging from 8-20% underweight according to the Baldwin Wood Age Height Table. On the whole, the boys were heavier than the group last year, the median weight being 76 pounds as compared with 65 pounds last year. The median age was ten years and the height 55 inches.
The entire camp season was marked by either extremely hot or rainy weather. Both of these conditions are trying because of the lack of shade and the scattered outlay of the camp buildings. Located as the camp is on a practically barren slope, the buildings are afforded no protection from the sun and, during a con- tinued hot spell, are often oppressively hot. Little, if anything, can be done to relieve this situation. The problem, however, arising from rainy weather could in party be solved by the erection of a recreation building where the boys could work and play on rainy days.
In spite of the weather, the gains for the season were unusually good, the aggregate gain exceeding any previous year's record by 12 1-2 pounds. One boy made the phenomenal gain of 19 3-4 pounds, two others attaining 16 pounds. The weekly distribution of gains was as follows.
Total Gain
Total Loss
Net Gain 109}
Gain
Gain
Average Gain
1st week
1091
0
8
1
2.72
2nd week
664
0
66
6
1.69
3rd week
522
0
524
41
0
1.31
4th week
541
31
511
3
0
1.28
5th week
35
41 4
31%
25
0
.78
6th week
63
3
624
1
1.55
SEASON
382
81 4
3734
23
193 4
31
9.03
: 3
We were fortunate in having two of last year's counselors with us again this year, Miss Helen Allard and Miss Gladys Gibbons, both graduates of Salem Normal School and teachers of experience. Miss Allard, in addition to acting as camp reporter, had charge of dramatics and basketry. Miss Gibbons con- ducted classes in health education and nature study. Miss Josephine Turner of Reading, a graduate of Nissen School, replaced Miss Edith Burkland and had charge of corrective posture work and toy making. Mr. John MacDonald, a resident of Attleboro and a student at Colgate College, taught restic wood work
Greatest Lowest
4
4
59
ANNUAL REPORT
and camprcaft as well as having general supervision of the boys at night. The success or failure of any camp is in a large degree dependent upon the counselors. These counselors, because of the excellent preparation that each had for his respective duties and because of their interest and enthusiasm, were able to give the boys an unusually well rounded and enriched program. The other members of the staff were Mrs. Elizabeth Turner of Attleboro, who served in the capacity of cook, and her assistant, Miss Hazel Handy, also of Attleboro.
During the six weeks in camp the boys acquired considerable knowledge and skill in the various crafts taught at camp. An exhibition of their handwork the closing night made a very creditable showing. This phase of the camp pro- gram has become increasingly important in that it has provided an outlet for creative effort and has helped to solve the problem of keeping the boys quiet.
It has been a pleasure to have been associated with the Attleboro Health Camp for so many years. During the time the camp has developed and improved in many of the details of organization and program. One of the most encour- aging outcomes, I feel, has been the building up of an understanding and apprecia- tive attitude on the part of the parents and boys in regard to the aims and ideals of the camp.
May I take this opportunity to thank you for your continued loyalty and support.
Respectfully submitted,
MABEL M. BROWN, R. N. Camp Supervisor
A RECORD OF WEIGHT GAINS FOR SEVEN YEARS Attleboro Health Camp
1925
1926
1927
1928
1929
1930
1931
1st week.
85 lbs.
81} lbs. 992lbs.
994 lbs. 1334 lbs 1314 lbs. 1092 lbs.
2nd week
331
47
47折
62
54
65
66
3rd week
40%
392
47
36號
591 4
59.3
523
4th week
514
473
481
433
26 1
33
54 를
5th week
24%
331
31
49를
44%
401
35年
6th week
334
42
373
283
43
241
63
Total.
2684 lbs. 2914 lbs. 3124 lbs. 31941bs. 3614 lbs. 354 lbs. 382 lbs.
OUR MILK SUPPLY
Efforts will be made very soon to further improve and safeguard our milk supply. Despite the lack of funds for proper inspectional service and for the enforcement or proposed local regulations, certain measures will of necessity be adopted and after proper notice to producers and dealers they will be put into effect.
An insistent demand for safer milk here will have the support not only of the local health department, and the State Department of Public Health, but also that of the consumer public, and many of the milk dealers and producers as well.
Little more than one-half of our local supply is now safeguarded by pasteuri- zation. There is rapidly accumulating and convincing evidence that pasteuriza- tion is the only practical method of insuring a safe milk supply. Attempts will be made to increase the proportion of pasteurized milk sold here, and to have pastuer- ized all milk excepting a small amount of the highest grade of raw milk.
It is believed that the present producers of the better grades of raw milk will soon see the necessity of still further safeguarding their product by pasteuriza- tion.
It is also planned to carry on during the coming year an educational program in reference to the value of pasteurized milk.
60
ANNUAL REPORT
RECOMMENDATIONS
Milk and Food Inspection :-
For several years the department has requested that a sufficient appropria- tion be allowed for the appointment of a full-time milk, food and sanitary inspect- or. It can be repeated now with emphasis that this is the department's greatest need. The field worker in the health conservation contest after a survey of the city's health service concluded his report with the suggestion "that provision be made for a full-time dairy and inspection service."
In the next few years, possibly in the next few months, certain radical changes must be made and measures put into effect to improve our local milk supply. More rigid inspection will be made of our dairies, lunch carts, markets, bakeries, restaurants, and other places where food is sold.
The city laboratory should be enabled to offer available laboratory and diagnostic service to physicians as an encouragement to them in reporting cases of communicable diseases. The laboratory should also render better service to the milk producers and dealers. Further delay in these services may easily lead to serious consequences.
Dental Clinic :-
Adequate provision should be made for the care of teeth of our school and preschool children. The dentist today is indispensable in any organized child health program. It is again suggested that as soon as practicable some workable plan be submitted to the Mayor by the Superintendent of Schools and the Health Officer.
Sewerage System and Water Supply Connections :-
The planning of a sewerage system for South Attleboro and the more general connections of homes with the municipal sewerage system, and with our public water supply are matters which should receive deserved attention.
Isolation Facilities :-
The Sturdy Hospital should provide adequate facilities for the proper tempor- ary care and isolation of patients ill with communicable diseases who may un- expectedly be admitted to that institution or who may become thus afflicted while patients or residents in the hospital.
Provision for the local hospitalization of contagious disease cases is needed, and would result in better control and a lessened mortality of these diseases.
CONCLUSION
At this time when the possible effect of economic distress and unemployment on public health is being freely discussed a brief review of the favorable results obtained in the prolongation of life over the last half century furnishes confidence in the future.
In this country fifty years ago the life expectancy at birth was about forty- three years. The average life span has now increased to fifty-eight years, and it is reasonably supposed that this figure may still be lengthened. Some of the reasons for these changes in life expectancy are obvious. We all know that modern surgery has saved many lives. Deaths in childhood from preventable diseases have been greatly reduced. Almost complete control of typhoid fever, diphtheria and small-pox is now possible. The tuberculosis death rate is at present only one third of that at the beginning of this century. More and more lives of the younger generation are spared, and middle age is attained by a larger proportion.
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