USA > Massachusetts > Middlesex County > Newton > Town of Newton annual report 1889 > Part 11
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restrictive measures should be taken relative to isolation and disinfection.
"During the summer, I called the attention of this board to one disease that I felt ought to be added to the list of diseases which should be reported by the physicians to the Board of Health. That disease was membranous croup. Be- fore and since that time this disease has been placed among diseases dangerous to public health, by town, city and state Boards of Health.
This has been classed with reportable diseases from the fact that some physicians believe it to be one form of diph- theria, even if diagnosed under the head of laryngeal diph- theria, trachial diphtheria, diphtheritic croup or membranous croup.
I gave it as my opinion at the time that true membranous croup was a distinct disease from diphtheria, resulting from a distinct cause ; and farther, that I did not consider it infectious or contagious, although there is no doubt that membranous croup is sometimes followed by true diphtheria, but this results from another cause and a distinct infection.
Sometimes cases of membranous croup are reported to Boards of Health resulting fatally, or in recovery as the case may be, which are immediately followed by cases of true diph theria, ending fatally, in other members of the same family.
To show the close connection between these two diseases, I will quote from the latest and perhaps the best monograph on diphtheria, by Dr. C. E. Billington. He writes as follows : 'Moreover, it seems a very probable supposition that a particular case of disease, occurring in places in which diphtheria is endemic or epidemic, or in which septic influences are present, may begin as a local, non-infectious membranous croup and subsequently become infected by those agencies and thus con-
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verted into true diphtheria, since croupous inflammation must furnish an especially favorable soil for such infection.' Again, after discussing the differences and similarity of these two diseases, he writes : 'Membranous croup as above described, and diphtheria, are two distinct affections. Simple mem- branous croup is a comparatively rare form of disease. In regions in which diphtheria is endemic or epidemic the two affections are so liable to be inter-complicated or confounded that the distinction is practically valueless.' And in reference to this same obscureness, in another plice he says : 'Reasons have elsewhere been given for the belief that there is a mem- branous croup which is not diphtheria, but yet that under ordinary circumstances the two affections are so liable to be complicated or confounded that the diagnosis of the former can rarely be a positive one.'
One more quotation and I leave Dr. Billington, although I could quote from scores of pages, added words and testimony corroborative of what has already been given : 'While there may be, and probably is such a disease as acute non-specific mem- branous croup in children, there is not a single sign or symp- tom by which it can be distinguished from diphtheria beginning in the glottis. The only plan, therefore, comportable with safety is to isolate every case in which there is even a suspicion that pseudo-membrane may be developed in the larynx, and then contradictory opinions (as to the identity or non-identity of the two diseases) may be entertained without injury to any one.'
I understand the State Board of Health classes mem- branous croup with diphtheria, as also do the Boards of Health of Boston,, Lowell, Lynn, and many other cities of the Com- monwealth, -that is, classes it with that disease in requiring the reporting of such cases to the Board of Health as one of the 'diseases dangerous to the public health.'
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This board has taken the same course and included it among the diseases which must be reported. The testimony is so strong it appears to me obligatory upon Boards of Health to order the same restrictive and precautionary measures in cases of membranous croup that are pursued in cases of diphtheria.
Gentlemen, I bring this matter thus lengthily to your attention because some have taken exception to the action of the Board in including membranous croup with 'diseases dangerous to the public health,' and directing the same sanitary and precautionary measures as are required in cases of diph- theria. I have supported the opinion I gave when this matter was first brought to the attention of this Board, and the action then taken, by the opinion of the foremost writer on the sub- ject and the position taken by the various Boards of Health in this Commonwealth."
Scarlet Fever.
Scarlet fever has been much less prevalent than for two years previous, there having been about the same number of cases as in 1886. It is not known that the sanitary condition of a house or premises around it, have any influence on this disease unless it my possibly be in controlling its severity. Il. fact, science as yet has not been able to settle upon any well recognized conditions for the inception of the disease although it has clearly shown many of the channels by which it may be spread and that isolation and proper disinfection controls and stops its progress. A study of the chart accompanying this re- port would apparently indicate that when scarlet fever is prevalent to an unusual extent, there seems to be a disappear- ance of diphtheria and vice versa. On the other hand when one prevails to a moderate extent only, the other seems to accompany it to an equal degree. To demonstrate whether there is really any connection in this manner between the two
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diseases necessitates observations covering a series of years and there is not dat rough at hand to reach any definite conclus- ions upon this . etter.
Typhoid Fever.
The open winter of 1888-'89, evidently had some influenc upon the prevalence of typhoid fever, for although this is pre- eminently a fall disease, yet cases of it were reported during all the winter and spring months, and in fact, in every month dur- ing the year except November. Its height was from the middle of July till the middle of September, a month or two earlier than is customary. While the number of cases was but a few le , than during the previous year, their character was much more virulent and fatal. Unquestionably the unusually heavy rain-fall of the last two and a half years has aided the local causes in producing these results, by raising the level of the ground water to such an extent that the drainage of cesspools and the like, has often burst forth or else been brought so near to the surface that slight disturbances even of the soil would bring the deadly germs of this disease into active existence. Had it not been for the fact that more than half of the cases of typhoid reported were promptly removed by order of their physicians to the Cottage Hospital, where they could secure the very best of care and nursing, there is n knowing what propor- tions the death-rate fiom typhoid might have reached. All sections of the city were visited to some extent, though Thompsonville still seems to be one of the worst localities for developing this disease. No epidemic has existed and upon our atmospheric conditions much of the responsibility for our typhoid can be placed.
Disinfection.
Too much care cannot be taken in preventing the spread of the various diseases considered dangerous to the public health.
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The Board do not feel justified in interfering with the instruc- tions (" recommendations of the physician in charge, during a case of sickness, although frequently additional remedies or precautions are suggested as being desirable, which are usually accepted and adopted. But when the physician surrenders the case, the attention of this department is given to it in such cases as require it.
In typhoid fever after the use of chlorides or other disin- fectants recommended by the physician, about the only thing to be suggested has been the burying of the dejections, in places where this could be done with safety.
In diphtheria, membranous croup, and scarlet fever, how. ever, placards are put up on the house with the name of the disease, and these are not removed until word has been received from the physician that the house is ready for disinfection. The method employed is to fumigate the house thoroughly with burning sulphur. In doing this work it has been found that there is no room or series of rooms that are or that can be made absolutely air-tight. In consequence there is always an escape of some of the smoke, varying in quantity according as the rooms are more or less tight. To ascertain the quantity of sulphur necessary to be used, the cubic air space of the rooms to be fumigated is first determined and three pounds of sulphur taken for every 1000 cu. ft. of space. To this is added sufficient sulphur to allow for what will inevitably escape.
Many times the statement has been made that altogether too much sulphur is used for the purpose required. In answer to this it may be well to state that experiments have proved that the use of from one to two pounds per 1000 cu. ft. of air space is practically of no value whatever. The use of over two and less than three pounds is of some value, but its extent depends on circumstances that can not be estimated for. But all the better authorities and all expert testimony agree that the use of
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three to four pounds gives a reasonable guarantee of success and that nothing less than this quantity should ever be used. This disinfection of premises at the close of a case of sickness has received much thought and attention and the rule adopted by this Board has been the same as that adopted by Boston, New York and other places, and also promulgated by the American Public Health Association, composed of the most well-known experts in sanitary measures in the country. The only point in which a difference is made between Newton and Boston is on the question as to who shall bear the expense. Boston fumigates at its own expense when requested to do so in writing by the householder ; at other times it is at the expense of the house- holder. The majority of our citizens contend, however, that disinfection is largely a public protective measure, and that, as they are obliged by the statutes to have their premises disin- fected to the satisfaction of the Board of Health, and as the city assumes no risk of loss or injury to articles disinfected, it is only right and just that the Board should bear the cost of the disinfection, taking care that it shall be done thoroughly and with the least amount of damage possible. In this view the Board have acquiesced and have endeavored to do their work with as little annoyance as possible, and at no expense to the individual.
Hospital for Contagious Diseases.
The lack of proper hospital accommodations for the care of persons sick with diphtheria and scarlet fever, has been forcibly brought to the attention of the Board during the past year. Several cases have been sent to the Boston City Hospital and cared for at our expense, but the admittance of such patients by them is only an act of courtesy and is liable to be refused at any time. Many times had we possessed the proper accommodations, cases of di. ' neria would have been removed.
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immediately from their poor surroundings to where they could receive care and treatment that was practically impossible in the average home. Could this have been done at the proper stage of the disease probably several lives would have been saved. It is therefore very essential that something should be done as soon as possible to have suitable accommodations pro- vided in our own city for such diseases. The trustees of the Cottage Hospital have offered to give the use of the land free, and provide the proper attendance and nursing at a nominal cost, provided the city will erect the lildings. Early in May a communication was sent from this Board to your Honorable body indorsing the above and requesting your favorable con- sideration of the same. We understand that the committee having this proposition before it, has as yet submitted no report. We hope that early in the coming year you will take favorable action towards providing a ward for contagious dis- eases.
Ashes.
The advisability of placing the collection of ashes under the control of this Board was brought to its attention early in the year. It was argued that the Highway Department needed all their men and teams for the legitimate work of that depart- inent. The removal of ashes and other refuse was considered to be a health measure just as much as the removal of night- soil or collection and removal of swill.
If the work of removing ashes was to be placed in charge of this Board, either the work must be done b contract, or else a thoroughly equipped Health Departme , plant must be furnished. The latter course would necessitate the erection of stables and other buildings, the purchase of horses, teams and other equipments, and the employment of a considerable num- ber of men to perform the work. In case the first method should be decided upon, several petitions were presented asking
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that before letting out the contract, the Board advertise for proposals. The argument in favor of this method was that under our method of requiring parties to set out their barrels, a contractor could do the work just as efficiently and with much less cost to the city.
In order to get at the methods pursued by our sister cities, a set of questions was prepared and sent out and answers requested. Replies were received from twenty-one cities and one town. Of these twenty-two places, six had no collections at all. The health department had control of the work in ten places and the highway in six, the work being done in thirteen places by the city or town and in only three by contract. One of these three was in favor of the work being done by the city, and a second also, unless the contractor was paid enough to force him to attend to the work, leaving only one city unquali- fiedly in favor of contract work. With these results and ex- periences before them, the Board carefully considered the ques- tion of change of management and finally decided that it would be as well to let things remain as they were until such time as the growth and requirements of the city shall demand a com- plete working department, which can then embrace all work legitimately appertaining to this Board.
The removal of ashes has therefore been carried along by the Highway Department in its usual admirable manner, giving complete satisfaction to our citizens so far as is known. The great trouble has been to impress upon the householder and more particularly the servants, the absolute necessity of keeping the garbage out of the ash barrel. No dump can be allowed to receive decaying vegetable matter, unless desirous of receiv- ing complaints relative to the same, and strict instructions have been given the teamsters to refuse all ashes or refuse con- taining the same,
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Co-operation of Physicians.
Our physicians have evidently appreciated the work of the Board during the past year, and the difficulties it has had to contend with. They have followed closely the lines of work adopted by this Board with contagious diseases and have greatly assisted it by the prompt reportal of all cases coming under their observation. They have also greatly aided the Board by carefully instructing their patients in the use of disin- fectants and the value and necessity of disinfection. Many requests have also been received from them to examine the sanitary condition of houses where the recovery of their patient was often delayed or vitiated in some mysterious manner. It is with pleasure that the Board acknowledge the many kind acts and information received at the hands of the physicians. It is to be hoped that the pleasant relations now existing will be continued and that the same care will be taken with those diseases which may by neglect become epidemic as is taken with those that are considered more severe and important.
Cottage Hospital.
Although a comparatively new institution, this hospital has outgrown its accommodations. While distinctively a pri- vate corporation, yet the benefits derived have been so largely public that it is not inappropriate to say a few words here in reference to it. During the last year the beds at one time were nearly all filled with typhoid fever patients. Many of the cases were of a very severe type, and but for the unceasing care and intelligent work of the attendants, many more fatalities would have to be recorded than has been the case. The majority of the typhoid patients were poor people, whose surroundings were not of the best and would have worked against them, had they remained there. In other departments as well, the work has been successfully carried forward by the
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efficient matron and her assistants, and our city can well feel proud of this noble institution, which is doing so much to re- lieve the pain and suffering in our midst by its own special line of work.
Drainage of Wet Lands.
A subject to which the Board has devoted much time and labor during [the past year, has been the drainage of lands coming under the provisions of what is known as the wet land act. The method of procedure and the steps necessary to be taken have been determined and carried out under the ad- vice and direction of the City Solicitor. There are many places in the various wards where lands having insufficient drainage have either been built upon or adjacent thereto. The owners have now begun to realize the extent of the annoyance or injury that is caused them, and the dangers to health which exist, and therefore apply to the Board for relief, expecting in many instances, that the city will abate the trouble without any expense to them. "It is, consequently, a delicate question for the Board to decide where the line between public neces- sity and private improvement is to be drawn, as it is this which practically determines the amount of the assessments which are levied upon the completion of the work. The City Solicitor has decided that the only way by which such troubles can be remedied, where more than one estate is affected, is through the Board of Health acting in accordance with Chap. 80, Sections 28 to 33 of the Public Statutes. Under this act seven petitions have been prepared and presented to the Board for their con- sideration. Upon five of these petitions the parties interested have been heard as to the necessity and advisability of this Board abating the nuisance complained of. In two instances (Knowles street and Clinton street) the Board have completed the work of abatement and have levied the cost of the same upon the parties benefited. In both of these nuisances the tes-
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timony of the complainants was reinforced by the fact that several cases of diphtheria had developed in the immediate vicinity. In one other case an appropriation has been granted and the work will be done in the spring. No definite action has been taken yet on the other petitions. Undoubtedly, as there are a great many places that come under the provisions of this act, petitions having similar objects in view will be pre- sented from time to time, and the Board be obliged to ask for an appropriation to do the work.
Field Day.
The usual custom of having out-door or field meetings has been adhered to during the past year. In the latter part of May a circle of the entire city was made, visiting many places and examining the general sanitary condition of the city as covered by the route taken. In September, a similar meeting was held, although not of so extensive a character. In addi- tion to these, several short trips were made, which were necessi- tated by the filing of drainage petitions. These meetings are of great practical value, and as the work of theBoard develops, their number will necessarily be increased.
Glanders.
During the year two suspicious cases of sick horses were reported to the Board, the first being by the surgeon having it in charge. Dr. Winchester, State"Cattle Commissioner, was immediately notified in both cases as required by law. In the first case he coincided with the veterinary that it was a very suspicious case, and ordered it isolated and put through a special course of treatment. In two weeks the symptoms of glanders had all disappeared and the animal was allowed to leave quarantine and be put to work.
The other case was so clear and positive in the mind of the veterinary called by the Board, that the owner decided to have
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the animal killed, which was done. Dr. Winchester upon ex- amining the septum of the nostril after the horse was killed, also pronounced it a clear case of glanders. In this instance the evidence showed that the horse had been ailing for nearly three months, and during that time had frequently drank at the public fountains. The stable premises were thoroughly dis- infected, and so far as is known, no other cases have developed from it.
House-Offal.
The contract for the collection of house-offal expired on the first of May. During the existence of this contract, with the exception of the last six months, there had been a great many complaints as to the efficiency of the work and it cer- tainly had not given the satisfaction that was expected of it. The trouble undoubtedly was due in a large measure to the fact that the contractor had made a losing bargain. Any one who is working at a loss is not apt to give the same energy and efficiency as when he knows that he has a good thing and is getting fairly well paid for the same. There was, however, a very marked improvement in the last six months, owing to the fact that the Board had granted an increase in the compensation. As the time approached for deciding whether the contract should be renewed or not, the same points arose as had devel- oped in connection with the removal of ashes and especially as to the advisability of having the work done by the city.
At the time that answers were requested relative to ashes, similar answers were requested relative to house-offal. Of the twenty-three places sending answers only three had no collec- tions. Of the other twenty places,the city through various depart- ments performed the work entirely in twelve cases, and in two cases it was performed by a combination of city and contract work. In four places it was done entirely by contract while the remaining two places had voluntary collections. Thirteen
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places expressed a preference for city work alone, one for con- tract work entirely, one for contract work when paid suffi- ciently,"and one for either method in preference to voluntary collections. After a thorough discussion of the subject the Board voted early in April to advertise for proposals for a term of three years from May 1st, 1889. Specifications for the same were drawn up and approved by the Board which in- creased the amount of work to be done over preceding years and required greater efficiency in performing the same. Only two parties offered bids, Mr. Mague at the rate of $3,000 per year and the Messrs. Gannon at the rate of $1,680 per year.
From the investigations made by a committee appointed in the autumn of 1888, and the answers obtained from sister cities, the Board had gained an approximate idea of what the cost of collections should be. They, therefore, unanimously voted to reject both bids, one because it was evidently too high, and the other because no contractor could afford to take it at the price named and give the efficiency that the Board desired.
A committee was appointed to look into the matter still farther, interview the parties desiring ?to contract and report to the Board. Both of the previous bidders appeared before the committee and gave the figures upon which they based their estimates. It was found that in the one case Mr. Mague had looked at the future with doubtful eyes and did not desire to get caught again in a losing contract. Mr. Gannon had formed his ideas from what Mr. Maguelhad been doing and re- ceiving, and thought he could do the work a trifle cheaper than Mr. Mague ; he also acknowledged that he expected the Board would be honorable enough to protect him if he had made a mistake in his calculations, and that they would not allow him to lose anything.
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From the developments at these hearings the committee de- cided that a one year's contract would be more advantageous to the city than a three years', and so reported. The Board co- incided in this opinion and asked for proposals upon that basis. Only one bid was offered, that of Mr. Mague at $2,400, Mr. Gannon declining to bid. The Board finally decided to accept Mr. Mague's bid and awarded him the contract.
While there have undoubtedly been times this season when the men on the work have been negligent and careless, yet the contractor has, as far as we know, attended promptly to all complaints received, which have been comparatively few, and the policy of the Board in not trying to get work done at starvation prices has been fully justified by the freedom from annoying and well grounded complaints to the Board, and the greater efficiency received by the citizens in the collections.
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