USA > Massachusetts > Middlesex County > Newton > Town of Newton annual report 1889 > Part 10
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1885.
Mayor J. WESLEY KIMBALL, JESSE F. FRISBIE, M. D.,
J. FRANKLIN FULLER, CHARLES C. BARTON,*
Alderman BENJAMIN S. GRANT. Councilman JOHN F. HECKMAN.
1886.
Mayor J. WESLEY KIMBALL. OTIS PETTEE, JESSE F. FRISBIE, M. D., J. FRANKLIN FULLER, Councilman FRANK EDMANDS.
Alderman BENJAMIN S. GRANT,
1887.
Mayor J. WESLEY KIMBALL, OTIS PETTEE, JESSE F. FRISBIE, M. D, J. FRANKLIN FULLER, Councilman HEMAN M. BURR.
Alderman BENJAMIN S. GRANT,
1888.
Mayor J. WESLEY KIMBALL, OTIS PETTEE, J. FRANKLIN FULLER,
JESSE F. FRISBIE, M. D.,
Alderman JAMES H. NICKERSON, Councilman HEMAN M. BURR.
* Resigned Sept. 1. Otis Pettee appointed to fill vacancy Oct. 19.
+ Resigned Oct. 12. Frank Edmands appointed to fill vacancy Oct. 19.
REPORT.
"It has been proved over and over again, that nothing is so costly in . all ways as disease, and that nothing is so remunerative as the outlay which augments health." -Parkes.
To HIS HONOR THE MAYOR AND THE CITY COUNCIL :
Gentlemen :- In conformity with law and usage the Board of Health herewith submits its annual report for the year ending Dec. 31, 1889.
The ordinary work of the Board has been carried along under the same general policy as in preceding years. There has been a large increase however in the amount of work done by the Board during the year which has just closed, making large demands upon the time and patience of the individuals composing the same. In consequence of this the membership has changed somewhat during the year, as two members from the Board of Aldermen found that they could not give the necessary attention, in conjunction with their other duties as members of the upper branch of the city government.
Several times during the year the Board has found it necessary to exercise the powers conferred upon it by the Public Statutes and while unfavorable comment has been received from some who were ignorant of the necessity for so doing, or else were parties affected by the proceedings, yet on the other hand the public sentiment has been favorable to the
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course taken, and a strong feeling thereby created that the Board were endeavoring to protect the city from the ravages and encroachments of disease.
Diseases Dangerous to the Public Health.
The experience of all Boards of Health has clearly shown the necessity of restrictive measures against the spread of diseases dangerous to the public health. The statutes specify three diseases, - small-pox, diphtheria and scarlet fever-as being dangerous to public health, and confer upon the local Boards the power to decide what other diseases are to be so considered. Whenever any such disease breaks out in a town or city, the Board of Health is at once required by the same law to provide hospitals for the proper care of persons affected, and to enforce such quarantine regulations as in their judgment may seem necessary. Public sentiment has been educated to that point that it heartily endorses all measures, even to force, to suppress small-pox whenever it appears, and yet the statistics of this country and the experience of all physicians clearly show that small-pox is not to be dreaded one-tenth part as much as diphtheria. Small-pox is a loath- some disease, whose progress is in certain clearly defined channels thoroughly understood and controlled by the physi- cian. Diphtheria on the other hand is a treacherous foe, working in the most underhand manner, often deceiving the experienced physician and baffling the most skilful treatment. Consequently of late years the attention of Boards of Health throughout the country has been earnestly directed towards stamping out and preventing the spread of diphtheria.
During the year an exceptionally large number of cases of diphtheria have occurred, yet as a rule they have been local and specific rather than epidemic. During 1888 the rainfall was much more than the average, and the number of cases was
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considerably increased over each of the three preceding years. In 1889 the rainfall was again very heavy and the cases increased to such an extent as to give the Board unusual diffi- culty, to prevent its spread. From the experience of the last five years there would seem to be good reason for believing that a heavy rainfall, increasing as it must the humidity of the soil as well as the atmosphere, is a potent factor in the prop- agation of diphtheria, while the atmosphere under such conditions may oppose its spread much less than has been usually supposed.
There are but a few places in the state that have a hos- pital properly equipped and ready for the care of contagious diseases. Undoubtedly the usual custom among Boards of Health is to allow a patient siek with diphtheria to remain in the house where he is taken siek unless some peculiar circum- stanees exist which compel removal to some other place. The great objection to this plan is that except in extremely rare ›cases, the proper quarantine regulations cannot be enforced without creating hardships greater than to remove the patient. Hence in the ordinary house, and with the usual care given a patient, isolation often becomes a snare and a delusion. Even under the care of a trained nurse, the doors are frequently left open, the members of the household pass in and out of the siek-room into others, and the germs of this dreaded disease are carried in one way or another from room to room until portions of the house supposed to be carefully guarded are contaminated and another member of the household is stricken in a mysterious manner and frequently with fatal results. Household pets, especially cats, are to be particularly looked after when this disease appears in a house, and yet they are seldom if ever thought of, and frequently have the full run of the house. While the Board of Health cause placards with the name of the disease to be placed upon the house, so as to
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warn the public, the friends of the family can heed that warn- ing or not as they choose. There is nothing, unless it is fear, to prevent them from entering the house and seeing the patient and then going out and mingling with the public. If people feel like taking their own lives in their hands, they ought not to do so at the risk of others. A notable case coming under these conditions developed in a family in Ward Four, where two children, the mother and finally the nurses came down sick and the mother very nearly lost her life. After passing through this terrible and trying experience, when it came to disinfecting the premises, the mother seemed to think more of saving a little of the personal clothing from possible injury than of doing all she could to free them from possible or even probable contamination, even though by so doing another child might eventually be exposed to the dread disease. Fortunately however such instances in our community are rare.
About the middle of January, diphtheria suddenly appeared at Newton Centre in its most virulent form and before the case was known to either any physician or to the Board, the germs of the disease had undoubtedly been carried to various sections of the city and even into an adjoining town, and the disease was rapidly becoming epidemic, with great fatality, especially among the children. Stringent measures were taken to control the spread of the disease, even to the establishment of a police quarantine, where it was evident that parties would not observe the rules laid down by the Board. By means of these restrictive measures the course of the disease in direct channels was undoubtedly arrested.
Several requests have been made, especially by some of our physicians, that a full account of this threatened epidemic and the measures taken to avert it be published, and the account may prove of interest to the public generally. On the morning of January 14th, the agent received notice from
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Dr. Loring that Mrs. Dubois of Station street, Newton Centre, had died from malignant diphtheria, that her child one and a half years old was siek with the same disease, and that an immediate inspection of the premises was desirable. The inspection was made and the premises were found to be in a deplorable condition. Steps were immediately taken to see that an improvement was made and at the first opportunity the place was put in good condition. Later in the day first mentioned, the little one died while the physicians were per- forming tracheotomy as a last resort. On the morning of January 18th, the agent was called to Newton Centre by Dr. Bodge to again visit a diphtheria case, this time in the family of Wm. Hockridge on Station street near Thompsonville. No perceptible cause for the disease could be found around the premises. Upon leaving this house the doctor and the agent went to the house of Mr. Fred Balders, one of the village barbers, he having been sent home the night before by the doctor with a suspicious looking throat. Upon examination the doctor at once pronounced this also to be a genuine case of diphtheria. In both cases the usual precautionary measures were at onee taken. The Board also closed the barber shop immediately and thoroughly disinfected the same before allowing it to be again used.
In the course of investigations as to the cause of these cases, it was found that Mrs. Dubois had really been siek with what was supposed to be only a sore throat for nearly a week before she died. She did not, however, give up and take to her bed until the night of Jan. 11th and called her physician the next day, the disease resulting fatally in the night of the 13th. On the afternoon of the 11th, just before Mrs. Dubois gave up, a West Newton baker by the name of Barthelmes called at the house, talked with Mrs. Dubois for some moments and sold her some goods from his team. It was also found
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that the Hockridge family were among the customers of Mr. Barthelmes, and that he had been in the habit of stopping there upon his trips to Newton Centre, and also that Mr. Balders was a half-brother of Mr. Barthelmes and that they usually met once or twice a week and sometimes oftener.
On the evening of Jan. 19th notice was received from Dr. O'Reilly of Waltham that James Ryan of Cherry street, West Newton, was sick with diphtheria. Upon visiting the Ryan house the next morning it was found that the sick boy worked on the Barthelmes' team and had been with him on his trips in almost every case. While here the agent learned that one of Mr. Barthelnes' children had died early that morning. While ordinarily no suspicions would have been aroused, yet considering all the circumstances, the agent felt that he ought to inquire into the cause of the last death. The agent was assured by the physician upon visiting him, that, in his opinion, it was only a case of croup; that circumstances were some- what against the child, and that he had not seen the first symptom that would cause him to say or think it was diphthe- ria. Upon this statement no further investigation or action was considered necessary.
On the 21st, notice was received that Robert Waite, resid- ing on Fern street, Auburndale, a fine young lad attending the High school and whose system had become run down from too close application to his books, was ill with diphtheria, which resulted fatally on the 26th. On the 22d the Board were notified that Rhoda Eastabrook, five years old, living at the Upper Falls on Chestnut street, was also sick with the same disease which resulted fatally that same night. On the 23d Susie Eastabrook was reported sick and died Feb. 1st. On the 28th the third and last child was reported sick, but after a long and dangerous illness and the utmost care, the little girl finally recovered. The last two cases undoubtedly
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' developed from the preceding one. At each of these houses no local cause could be found and there was no known expos- ure other than to this same Barthelmes or his helper, Ryan, as in both families food had been purchased from the team and the children had come into contact with one or the other of the two parties. One other family, that of Peter White of Wes- ton, was also attacked by the disease after being visited by the baker. When our agent learned of the latter case, he imme- diately sent the facts in his possession to the Weston Board of Health, who immediately took prompt action and only two cases developed.
On the afternoon of the 22d the agent was hastily sum- moned to his office where he found Dr. O'Reilly waiting, who reported that he evidently had two cases of diphtheria in Mr. Barthelmes' family across the street. Dr. Jarvis of Waltham had been called in consultation with him and both agreed as to the diagnosis of the cases. The doctor desired the Board to im- mediately open up the small-pox hospital and remove the in- fected family thereto, as he feared that otherwise the house would become the centre of a large amount of infection and sickness. Not knowing in what condition the hospital might be, the agent in company with Dr. O'Reilly, drove there and examined the premises. After inspecting the same the agent stated that if the doctor still felt that it was desirable to put the patients there he would obtain furniture, bedding, etc., and make the place comfortable. The doctor still adher- ing to his opinion, npon request of the agent, Mr. Moody of the almshouse had a fire built up, bed linen taken over and the place swept up and cleaned. Upon returning to the City Hall the doctor saw his patients again and informed the agent that the family were willing to go, and for the agent to get them there as soon as possible. Some second hand furniture was purchased at Waltham and carried to the hospital and at
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eleven o'clock that night the rooms were in readiness to receive their patients, but the agent refused to move them in the dead of night on his own responsibility. Early the next morning a man was sent to the hospital to replenish the fire, and reported on his return that everything was all right. A team was se- cured, and under the immediate supervision of Dr. O'Reilly the removal of the Barthelmes family was made to the hospi- tal with their own consent at noontime on a warm, sunny day. After arriving at the hospital the doctor thought it would be advisable to have a nurse to assist the mother and asked if the Board would be responsible for the pay if the family did not meet the bill. The agent assured him that it would, although Mr. Barthelmes told him that he would pay for one. When the agent left the physician had gone with the promise to return in a couple of hours with a nurse and with other assist- ance, as he felt it would be necessary to perform an operation, while the mother was in charge of the sick children. The disinfection of the infected house was begun immediately upon the return of the agent.
About five o'clock in the afternoon the agent returned to the hospital and found that the physician had not returned, the oldest child was dead and the parents nearly wild with grief. After trying to calm them and persuade them to do everything they could to save their third and last child, the agent left stating that he would return as soon as possible and bring help. He immediately called Dr. Frisbie for consultation as to the proper steps to be taken, and while talking together at West Newton they were greatly astonished to have Mr. Barthelmes appear beside them. He was told to immediately return to his wife and child, as they were supposed to be at the hospital. Word was at once sent to Dr. O'Reilly that he was needed here immediately.
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The agent upon returning to the City Hall after supper found the doctor awaiting him and was greatly surprised to learn that Mr. Barthelmes, wife and living child were in the bake-shop, as they were unable to enter their house on account of the fumigation that was going on. Upon inquiring as to how they had returned it was found that they had crossed the fields from the hospital through a light snow to a carriage which he had kept waiting all the afternoon, an eighth of a mile distant. Mrs. Barthelmes was almost crazy, even threat- ening to take her life and that of her child, so that it was thought advisable to administer an opiate to quiet her nerves.
The Mayor was at once notified of the condition of af- fairs and a special meeting of the Board called for the next morning. Late in the evening the house, bake-shop, and houses in the same yard were roped off and a police officer stationed there day and night. At the meeting of the Board on the morning of the 24th, the action already taken was rati- fied, the police quarantine was ordered to be continued as long as was necessary and a trained diphtheria nurse put in the house, the family being under the care of Dr. Thayer, who had been called by Mr. Barthelmes upon his return. On the 27th the third little one died, leaving the family childless. The mother's throat showing signs of the same trouble, the quarantine and nurse were continued until Feb. 3rd, when Mrs. Barthelmes had sufficiently recovered to be about and out of danger. During the week the bake-shop had been thoroughly cleansed and all the cooked food destroyed. Feb. 3rd a sister of James Ryan was reported sick, the case result- ing fatally on the 8th. On the 4th Michael Ryan was also reported sick but he recovered.
In view of the fact that Mr. Barthelmes visited so many families in various parts of the city it is fortunate that the disease did not spread any more than it did. Many may per-
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haps feel inclined to doubt that the disease was carried from place to place as outlined in the foregoing account, yet a care- ful scrutiny into the history of each case shows that there is strong circumstantial evidence to induce that belief, and that in but one or two of the houses attacked could any local cause be found to which it could be ascribed, nor was there any other known exposure to the disease, and the inference may well be that there were others attacked with throat troubles which were not pronounced enough to be recognized. Mr. Barthelmes and his assistant thus became the innocent and at the time the unknown probable cause of the introduction of the disease into various parts of the city, as when they were first exposed to contamination the disease had not been recog- nized and no physician had been called. We do know, however, that Mr. Barthelmes came into direct communica- tion with the specific poison of the first case, that he and his assistant visited all the families attacked and in from three to eight days thereafter (the usual time for development) the disease appeared. The clothes worn by both parties were greasy and dirty and the germis of the disease once in contact found rich soil in which to grow and develop. While the house of Mr. Barthelmes was dirty in the extreme, yet it may be considered doubtful if the disease would have appeared there had it not been brought from outside sources.
One family completely broken up by the loss of the moth- er and two children, leaving only an infant six months old to the care of the father ; one family rendered completely child- less and another almost so ; two houses darkened and hearts made sore from the loss of bright and beautiful children ; three others made anxious and burdened by the hand of sick- ness laid heavily upon them, besides those unknown circles shadowed by the intrusion of this unwelcome guest ; eight families with nineteen cases and ten deaths ; such is the record
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of this dread disease so far as it is known to be linked in this chain of circumstantial evidence.
In March a second opportunity for an epidemic occurred. The first of the month a child was reported sick on River street, was afterward reported well, and the house disinfected. On the 23rd it was found that the child was evidently suffering from a relapse and had been taken care of by the mother without calling a physician for about a week. Four out of five of the other children had been attending school all the week. On the 24th by request of the attending physician a trained nurse was placed in charge and by night every one of the six child- ren were suffering to a greater or less extent from the disease. The first case resulted fatally on the morning of the 25th, but the others all recovered, due no doubt in a great measure to the faithful care of their nurse. Upon consultation with the school authorities, the scholars attending the Franklin school were sent home on Monday the 25th without being allowed in the building, and the school closed for one week, as the April vacation came on the following week. The schoolhouse was then thoroughly fumigated and such of the school books as were known to have been used by the infected children were burned ; afterwards the rooms and furniture, entries, privies and floors of the basement were thoroughly washed with a solution of corrosive sublimate, and the basements were thor- oughly whitewashed. When it again became time to open the school, at the close of vacation, sixteen days had elapsed since there had been any exposure to the disease and no new cases had developed. As soon as the services of the nurse could be dispensed with here, another case had developed at Newton which required a nurse, and she was accordingly transferred there.
In another outbreak, upon the advice of the reporting physician, it was thought wise to place a police quarantine over
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the infected tenement. Here there were two cases existing at the time of the Board's notification, one resulting fatally an hour after the officer went on duty and five hours after notice of the sickness was received, while the other died the second day after. A third case developed the day after the first two were reported, but it proved to be only a light case. One of the two fatal cases had evidently been in existence for nearly ten days before it was known what the disease was, the physi- cian whom the family first employed evidently not recognizing it for some reason or other, or else not desiring to have the case on his hands. Fortunately no cases developed outside of this one family, although it was feared for some days that such would not be the result.
During the year 130 cases in 85 families with 29 deaths occurred in various parts of the city. While this may be a small number as compared with some of our sister places, yet for Newton it may be considered a heavy record. When the nature of this disease is considered, when its virulence, if allowed to go unrestricted is contemplated, surely the Board have been fully justified in taking all these precautionary measures. If, when so many homes have shivered at the touch of the invader, if, when death with its mailed hand has caused so many hearts to reel under its fierce and rapid blows, if, in the hour of anxiety and sorrow the work of the Board has tended to mitigate the force and prevent the spread of this terrible disease, then has all the labor, energy and money which has been put forth not been expended in vain. The Board feel that our citizens have looked to them to do all that is possible to prevent the inroads of diphtheria, and that feel- ing of confidence which has been engendered, the Board have endeavored to sustain, knowing if they did not they were cen- surable.
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Membranous Croup.
Closely allied to and by many physicians considered the same as diphtheria, is another disease known as membranous croup. [ Several times in the experience of the Board cases of diphtheria followed after cases of membranous croup and vice versa. Inquiries were made of vir sister Boards of Health and it was found that many of them had passed through the same experience. Authorities were consulte l and it was found that some who stood high "in the medical profession took the ground that membranous croup was only one form of diphthe- ria, while others equally high agreed that they were distinct diseases and that membranous croup was not contagious. The best authorities however, while admitting the difference in the two diseases, agreed as to the contagiousness of both and to the fact of true membranous croup being an exceedingly rare disease. Under these circumstances, without entering at all into the discussion as to whether they are the same or different diseases, the Board decided that for the protection of the pub- lic it was advisable to declare membranous croup a disease dangerous to public health and require prompt reportal and take such other precautions as may be deemed desirable. As reported to the Board there have been 12 cases in as many families with 11 deaths, which shows how exceedingly fatal this disease is.
The fact of membranous croup having always been con- sidered a non-contagious disease by the community led to considerable criticism of the action of the Board, especially in requiring the disinfection of premises where the disease occurs. Accordingly Dr. Frisbie prepared and laid before the Board on Dec. 11th, the following paper, setting forth the reasons for believing that so far as the public welfare is concerned, mem- branous croup is analogous to diphtheria, and that the same
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