USA > Massachusetts > Bristol County > Attleboro > Reports of town officers of the town of Attleborough 1932 > Part 4
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One family dwellings
17
$52,950.00
Garages.
24
6,245.00
Minor Buildings.
48
12,001.00
Store.
1
800.00
Alterations
46
11,046.00
136
83,042.00
During the year I have made 151 inspections.
Respectfully submitted,
FRED A. CLARK, Building Inspector
54
ANNUAL REPORT
Health Department
ORGANIZATION OF THE HEALTH DEPARTMENT, 1932
Health Officer WILLIAM O. HEWITT, M. D.
Inspector of Milk and Authorized Agent ERNEST W. DOYLE
Inspectors of Plumbing ARTHUR B. READ JOHN.W. BULLOCK
Inspector of Slaughtering FREDERICK L. BRIGGS, D. V. M.
Inspector of Animals FREDERICK L. BRIGGS, D. V. M.
Health Department Nurse MARY E. McMAHON, R. N.
Registrar of Deaths HON. STEPHEN H. FOLEY
Clerk ALFHILD E. JOHNSON
Associate Physician at Diphtheria Prevention Clinic JAMES H. BREWSTER, M. D.
Associate Physician at Tuberculosis Dispensary GARNET P. SMITH, M. D. Supt. Bristol County Tuberculosis Hospital
55
ANNUAL REPORT
EIGHTEENTH ANNUAL REPORT OF THE HEALTH DEPARTMENT
To His Honor, the Mayor, and to the Municipal Council, Attleboro, Massachusetts,
Gentlemen:
The Health Department presents its eighteenth annual report including a records of its activities for the year ending December 31, 1932. In addition to the reports of sub-departments and the usual tables of statistical data, there. is first submitted a comparison of department expenditures for the past ten years during the service of the present Health Officer. Those interested in: municipal expenditures will notice from these figures that local health work has been carried on over that period on a gradually decreasing budget. A tabulation of expenses for the care of local patients at the Bristol County Tuberculosis Hospital over the same period also shows a sizeable reduction from the funds demanded for such care ten years ago.
Department Expenditures 10 Years
1923
.$18,596.48
1928
$13,060.96
1924.
18,975.44
1929
14,251.26
1925
18,115.53
1930
13,019.74
1926.
16,154.99
1931
14,677.61
1927
12,099.81 1932
11,440.32
Costs for Care of Patients at Bristol County Tuberculosis Hospital-Ten Years
1923
$9,345.70
1928
$2,904.20
1924
9,162.40
1929
3,762.20
1925
8,535.80
1930
3,035.50
1926.
5,491.20
1931.
3,530.80
1927
1,945.30
1932
1,892.80
A fair consideration of these reduced expenditures over a ten-year period must, we believe, result in the conclusion that public health work, is after all, a good investment.
Proof is here submitted that amounts spent for tuberculosis care and control have diminished the number of cases to one-fourth of these who received care in 1923.
Health officials throughout the country are seriously concerned with the present tendency to curtail budgets. The fact is surely accepted that health workers are not overpaid. Public health work has been carried on with a mini- mum of expense compared with the amounts paid for other public service, and what public service is more important than the one engaged in reducing the amount of illness, and guarding human lives? Expenditures in public health here, and in many other communities, have amounted to only a fraction of what might have been profitably spent. Our health facilities must be kept intact. We do not yet face a situation which makes it advisable to cut down on disease prevention.
THE YEAR'S WORK
Notwithstanding the adverse, economic conditions of the past year, the worst, perhaps, in the city's history, the health of the citizens has been securely maintained. The incidence of all of the preventable diseases has kept at an unusually low level.
56
ANNUAL REPORT
Measles and mumps were somewhat prevalent in the first three months. During the remainder of the year, a relatively small number of contagious diseases was reported. Our mortality statistics offer a favorable comparison with those of other years.
Health organizations, even in periods of depression, must continue to func- tion, for ground lost may never be recovered. Several constructive public health measures received attention during the year. In addition to routine department work, popular education in health was continued through the usual channels of publicity. The Chamber of Commerce has been of great assistance to the department at a time when its organized help was needed and appreciated. The Chamber, through its Health Committee, sponsored a campaign urging use of morc milk, and cooperated with the department in a successful effort to promote a more general use of pasteurized milk.
In the Health Conservation Contest, the two organizations worked harmoni- ously in preparing the city's fact finding schedule, and in reviewing the de- ficiencies pointed out in the previous year's report of that contest.
Early in the year a new milk regulation, requiring pasteurization or certifica- tion of all milk sold in this city, was adopted by this department after conference with the Mayor. The local milk producers effected an organization, and several meetings were arranged with the department. The matter of compulsory pasteurization was freely discussed at these meetings. Representatives from the State Department of Public Health, and from the Fall River and Ayer Boards of Health spoke in favor of the measure. Because of financial difficulties, which seemed to confront some of the smaller producers, it was decided toward the end of the year to postpone immediate enforcement of the regulation.
Diphtheria prevention work has now concluded its tenth year of successful immunization service. An unusual amount of interest was shown in this year's clinics, which were crowded each week.
The tuberculosis clinic, conducted weekly, has been reorganized. By arrangement with the Bristol County Hospital, its Superintendent, Dr. Garnet P. Smith, will act as consultant at these clinics. The city is very fortunate in this arrangement, as Dr. Smith's assistance is entirely voluntary.
The Attleboro Health Camp had a very successful year, as shown by its descriptive report in another page.
OUTSTANDING VITAL STATISTICS
The total number of deaths during the year was 284. The crude death rate, based on an estimated population of 22,187, was 12.8 per 1,000. The largest number of deaths in one month occurred in October, when there were 32. The major causes of deaths arranged in order, and including non-residents, were as follows: Heart disease-49, cancer-33, pulmonary tuberculosis-32 (27 of these non-resident), cerebral hemorrhage-19, lobar pneumonia-12, and automobile accidents-7.
MILK CONTROL
In last year's report it was announced that measures would be taken to insure a safer milk supply for the city. The department has given considerable attention to this important work during the year, and progress has been made. The original plans for compulsory pasteurization have been temporarily modified, an additional period of adjustment having 'been allowed the producers, many of whom are at present confronted with financial difficulties. In the next few months, however, we hope to bring about the removal of all tuberculous cows from the herds supplying our local market. As soon as practicable, thereafter, the remaining thirty percent of our milk now sold raw will be safeguarded by pasteurization.
57
ANNUAL REPORT
Public health control of our milk supply is extremely important, as this food is consumed by every family, by persons of all ages, and is a necessary article of diet, especially for infants and children.
If milk is not properly handled, it becomes easily contaminated, disease germs multiply it is rapidly, and such milk serves as a medium for the spread of several diseases. Tuberculosis, typhoid, diphtheria, scarlet fever, septic sore throat, undulant fever, and gastro-intestinal infections may be transmitted through milk.
Early in the year, when the department made public its intention of re- quiring the pasteurization or certification of all local milk, the producers organized, and immediately started a movement to have their cows tuberculin tested. The elimination of tuberculosis from local herds meets with the department's entire approval, and we propose to give every possible assistance to the producers in their enterprise.
In the present situation, it seems advisable to put off the immediate enforce- ment of pasteurization until the producers, by their own initiative, have screened out all tuberculous cattle from their herds. If their plans are carried forward, we will have a cleaner milk supply from healthy cows in the near future. Tuber- culin testing of herds at frequent intervals, while not one hundred per cent effective in the prevention of milk-borne human tuberculosis, is essential for the best interests of the public and of the dairy industry. We regard it as a pre- liminary to pasteurization, which is a necessary added factor of safety to our milk supply.
COMMUNICABLE DISEASES
A comparatively small number of the contagious diseases of children has been reported. An unusually low morbidity rate is recorded for all of the com- municable diseases with the exception of measles and mumps, several cases of which were reported early in the year.
The total number of contagious diseases reported in 1932 was 552. No local cases of typhoid were reported; one case of this disease was admitted to the Sturdy Hospital from a neighboring town.
No Infantile Paralysis occurred. There were 43 cases of scarlet fever compared with 151 cases in the previous year. Measles cases numbered 224, mumps 83, and whooping cough 35. Nine cases of diphtheria occurred among our non-immunized group.
All cases under quarantine have been frequently visited by the nurse, and known contacts excluded from school. It is evident that careful supervision of these cases has dimished the local incidence of scarlet fever.
DIPHTHERIA CONTROL
We have now completed ten years of immunization service. Diphtheria is still with us, but it is no longer a prevalent disease in the community. Sporadic cases occur, the sources of which are usually discovered, and epidemics have been thus far avoided. Nine cases have been reported during the year, all in non-immunized children. There have been four deaths from diphtheria here in ten years, and no death since 1929.
In 1931 a local survey showed 66.6% of the school population, and 60.8% of the preschool group to be immune. These figures aligned against a standard allowed this city 100% attainment for immunization work in the Health Con- servation Contest.
An intensive drive was carried on in October, November, and December. Our efforts were concentrated on infants, and preschool children as this younger age period is the one of greatest susceptibility to diphtheria. A list of families
58
ANNUAL REPORT
was compiled from the birth records of the last three years. All these homes were visited by the department nurse or other nurses working under her direction, who stressed the importance of immunization. A systematic follow-up on delinquents was instituted, and some of the homes were visited several times. Free trans- portation was furnished to and from the clinics.
Our weekly clinics at the hospital were unusually well attended, often over- crowded, and special clinics were held in the Finberg and Washington Schools for residents in those sections.
In 1932, 515 children were immunized, and of these 333 were of preschool age. A larger percentage than ever of those immunized were babies in arms. We are confident that ten years of effort in diphtheria prevention will soon be rewarded with a marked dimunition in the incidence and mortality of this disease.
DIPHTHERIA PREVENTION CLINIC RECORD
1932
Total number of treatments at clinics
1441
Total number completely immunized.
515
Number immunized with toxoid.
20
Number immunized with toxin antitoxin 495
450
New schick tests
21
Reschick tests . 429
Positive reschick tests.
13
Negative reschick tests
416
Not read.
21
New cases under 6 years immunized
333
Under 2 years.
130
2-4 years
126
4-5 years
36
5-6 years.
41
DIPHTHERIA IN ATTLEBORO Rates per 100,000 population
Year
Cases
Case rate
Deaths
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
1932
9
40
0
Total number tests.
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ANNUAL REPORT
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
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
1932
3
4
2
0
0
0
0
0
9
38
43
18
9
10
6
7
2
133
TUBERCULOSIS
Tuberculosis is still the most important disease demanding public health attention despite the fact that there has been such a marked dimunition in its fatality. The prevention of this disease continues to be a major problem. In 1923 there were 38 cases of pulmonary tuberculosis reported with 15 deaths. In 1932 we had 9 cases and 5 deaths. This pronounced reduction in the local incidence and death rate from tuberculosis over a ten-year period is due to in great measure, no doubt, to our continued policy of prompt investigation, and hospitalization of all discovered cases. Efforts adopted to prevent the disease in children by the follow-up of all contacts and by appropriate treatment of the undernourished and contact cases in our two health camps and the open air schoolroom, during the past ten years, have been important contributing factors .
At present, considerable attention is being given to childhood tuberculosis, and, while there has been a gradual lessening of the death rate in young persons, tuberculosis still remains one of the most important of the communicable diseases affecting children. The prevention of the disease in our susceptible child popula- tion is the goal toward which we must direct our future efforts. Some of the measures employed in its control will prevent other diseases as well. Tuberculosis of bones, joints and glands is often of bovine origin, and these cases have been reduced in all localities. where the milk supply is pasteurized. The eradication of tuberculosis among cattle and the rigid application of milk pasteurization must be enforced, if we are to stop this type of infection among children.
The clinic, which is held each week for the examination of contact cases, and of all discharged sanatorium patients, has been well attended throughout the year. Satisfactory arrangement for X-Ray service in this clinic has been made with the Bristol County Hospital. This indispensible aid in diagnosis will now be available without added expense to the city.
Very few open cases of tuberculosis are now cared for in their homes in this city, and no such cases are allowed to remain in contact with young children.
Further reduction in the incidence of tuberculosis infection may be expected if we continue to isolate as far as possible all our open cases and if, as is now planned, all the tuberculosis cows in the city are eliminated. The employment of public health measures of prevention are doubly important at this time, because of the possibility of a higher tuberculosis incidence in the near future among individuals whose resistance has been lowered by worry, and an inadequate supply of food.
60
ANNUAL REPORT
HEALTH CONSERVATION CONTEST
Attleboro ranked 20th in group five in the 1931 Inter-Chamber Health Conservation Contest among 46 cities in this group with population of 20,000 to 60,000 submitting schedules for grading. In the previous years contest Attleboro ranked 19th with 31 cities participating. Progress in this contest is to be meas- ured by a community's improvement on its own past, rather than by comparison with its competitors. Our 1931 score showed a 19 per cent increase over that of 1930.
The city was commended for attaining 100 per cent on life loss statistics, for its new proposed milk regulation, and for its diphtheria survey.
The 100 per cent attainment in life loss statistics was based on favorable comparison with a standard death rate per 100,000 population for such diseases as typhoid fever, small-pox, diphtheria, tuberculosis, infant mortality, maternal mortality, and enteritis under two years, and for standard percentage reduction of rate for the present year over average for the preceding five years. Attainment of 100 per cent was also earned in the following preventive measures:
Diphtheria immunization in both preschool, and elementary school children, small pox vaccination, medical examinations for all entering school children, visits to communicable disease, tuberculosis, and preschool cases, infant and preschool conferences, visits to tuberculosis clinics. The annual report of the Health Department meets the requirements of the Committee on Annual Health Department Reports. Certain deficiencies were observed in reviewing the schedule submitted. These related to the following items: Too few dwellings connected with public water supply, and public water system; consumption of milk less than one pint per capita. All the milk is not yer pasteurized, and only a small percentage of the dairy cows are tuberculin tested. Health instruction in the schools, and visits to school children in homes are below the required standard. Pre-natal and dental hygiene, and laboratory examinations do not meet standard requirements. Per capita expenditures for public health are below the reasonable standard of $2.00 per capita.
Efforts are already being made to correct many of these deficiencies.
ATTLEBORO HEALTH CAMP Established 1923
The Health Camp for undernourished boys has been conducted under the. direction of the department for ten years. The Lions Club first made this camp possible by providing its buildings and equipment, and has since shown an active interest in its management. The funds for its maintenance are furnished through the Community Chest.
The Health Department examined a large group of malnourished children this year before the final selection of forty boys was made. Considerable of the department's time was spent not only in the examination of candidates, but in home visits by the nurse, and in arranging for correction of remediable defects.
The Camp, in all respects this year, was a very successful one; the weight gains were unusually good, and at the end of the camp season, the selected group of boys was discharged much improved in physical and mental health.
The report of the Supervisor follows:
REPORT OF CAMP SUPERVISOR
I herewith submit the report of the Attleboro Health Camp for the season of 1932.
In reviewing the work of the Attleboro Health Camp for the last eight years, the time during which I have been privileged to act as supervisor, there
ON ADMISSION
AT DISCHARGE
ON ADMISSION
AT DISCHARGE
ATTLEBORO HEALTH CAMP-1932
Marked improvement in nutrition and posture is shown in comparative photographs. The forty boys gained 3701/4 pounds in six weeks. One boy made the tremendous gain of 233/4 pounds
62
ANNUAL REPORT
seems much in the way of encouragement. While the aims and objectives of the camp have remained the same and the regular camp routine has been varied but little during this same period, the details of operation have improved. Each year has brought new experiences and as a result new methods have been evolved, all of which, I feel, have contributed to the more efficient management of the camp. With this thought in mind, it seems fitting to review some of the out- standing features of the 1932 camp.
In spite of the economic depression the camp season was for the usual six weeks' period. Every effort was made to keep the cost of operation down and within the limits of the budget, which was considerably less than that of previous years. The drop in the price of food stuffs helped to effect a saving. On the other hand, the financial status of many of the families of the boys made it impossible for them to pay for camp uniforms. Less than thirty-three per cent paid for uniforms as compared with approximately ninety per cent last year. A washing machine loaned by the Maytag people assisted in reducing the laundry bill. The difficulty, however, of using the machine in an already overcrowded kitchen makes the value of this economy questionable.
The size and general appearance of the boys on entrance was about as usual. The median age of the boys was 11 years; height. 55 inches; weight 68 1-2 pounds; underweight 13 per cent as compared with last year's group of 10 years; 55 inches; 76 pounds, and 13 per cent. The higher age level is desirable inasmuch as older boys make better campers.
The season was unique in that it was the first year since a nurse has served as supervisor that any boy has been discharged because of illness. Two boys, who developed mumps the fourth week of camp, were sent home because of the difficulty of keeping quarantine in a place such as camp. In view of the fact that approximately fifty per cent of the boys were not immune, it was most gratifying that more did not contract the disease. A third boy was transferred to the Sturdy Hospital because of a serious ear infection.
Despite the fact that the enrollment was only thirty-seven the last two weeks of camp, the aggregate gain of the season was 370 1-4 pounds, 11 3-4 pounds less than that of last year, which was the record year in the history of the camp. One boy made the tremendous gain of 23 3-4 pounds in the six weeks' period, a gain of 4 pounds over the greatest individual gain of last year. The lowest gain was 4 3-4 pounds as compared with 3 1-2 pounds last year.
The counselor staff this year represented an especially well trained and experienced group. The fact that three of the four counselors were experienced teachers and that all four had had previous experience at the Attleboro Health Camp added much to the efficiency of the camp progress.
The posture work carried on under the direction of Miss Turner was of an unusually high quality. A system of awards was found advantageous. After having been drilled thoroughly in the fundamentals of good posture, so that every boy was posture conscious, a tag was awarded each week for improvement. Boys receiving all the tags were given posture pins the closing night of camp. Seven boys won pins. A silhoutteograph picture of each boy taken the begin- ning and end of camp would provide a permanent record and might serve as a means of interesting the boy in his posture.
Excellent work was done in the various handcraft classes where the boys were taught many useful arts and crafts. The exhibition of their work and their participation in the program the closing night of camp is a thing which the boys look forward to with eager anticipation almost from the very beginning of the camp season.
The continued interest and support of the Tuberculosis Society and the Lions' Club is a source of gratification. The confidence of the Lions' Club as expressed by their willingness to assume any financial deficit incurred during the season was a challenge to each and every worker in camp. May I take this
63
ANNUAL REPORT
opportunity, on behalf of the boys who have been privileged to attend the Attle- boro Health Camp, to express appreciation to them, as well as to Dr. Hewitt, and to Mr. Hicks, chairman of the Camp Committee, for the unfailing interest and service to the camp.
Respectfully submitted, MABEL M. BROWN, R. N., Camp Supervisor.
CONCLUSION
During the past ten years several important health projects have received the department's attention. A large amount of sewage, which was formerly emptied into the Ten-Mile River, from factories on its banks, and from other sources, has been diverted to the municipal sewerage system. During the same period, 360 undernourished children have been treated at the Health Camp under the department's direction. Immunization service to prevent diphtheria has been carried on each year. Positive measures are now under way to safe- guard our milk supply. Tuberculosis has shown a marked reduction in incidence, and a definite program of health education has been conducted. These attain- ments should encourage us to increase our efforts in the interests of public health.
Disease prevention work in a small city must, of necessity, develop rather slowly, but with a definite objective, it must move forward. Every health organization worthy of the name has a carefully prepared future program for the protection of its community against disease. If such an organization has shown a fair degree of efficiency, and merits public confidence and support, it should demand a reasonable appropriation for public health service. No community can afford to hamper its necessary health activities by providing insufficient funds for their continuance. Such a course might mean that diseases now under complete control, like typhoid, diphtheria or smallpox, might visit us again in epidemic form, spreading sickness, and death in their wake, and delaying our economic recovery.
Disease prevention work properly administered makes for less sickness and longer lives. A half century ago, diphtheria exacted its toll among many of the childhood population; typhoid fever was often a prevalent menace due to lack of knowledge for its control; tuberculosis attacked young adults, spread through whole families and caused much misery, suffering and deaths. Few families, indeed, under former conditions, escaped the ravages of these now preventable diseases. Today, under public health control, all is changed. Absolute pro- tection is now afforded by communities against diphtheria, and this disease occurs only among the few children remaining unprotected. Typhoid is a rare disease among us today, and tuberculosis has been reduced to a fraction of its former incidence.
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