USA > Massachusetts > Middlesex County > Newton > Town of Newton annual report 1890 > Part 10
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At the present time there is scarcely a disease which is so dreaded as this. Oftentimes it starts with what is apparently a cold, and is allowed to run until suddenly white spots are developed, and then a physician is hastily summoned and his
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REPORT OF BOARD OF HEALTH.
decision awaited with bated breath. Its virulence is In- questioned, and it always means that stern measures have got to be taken to overcome its effects. It moves as stealth- ily as a thief in the night, and while apparently loosening its hold on one point of attack is perhaps undermining the system at another.
Investigations are constantly being made to give a more complete etiological history of this disease. Perhaps the most important results of any have been obtained by Dr. T. Mitchell Prudden of the College of Physicians and Surgeons of New York, assisted by Dr. Northrup. He states that in his bacterial cultivations from known diphtheria he has always found present large numbers of streptococci, while cultivations from parties affected by other diseases have either shown only a small number of them or none at all. One of the most important points which has been determined is the extreme vitality of this streptococcus diphtheria. Dr. Prudden shows in his experiments that diphtheritie membrane could be cultured and produce virulent results after being dried and exposed eighty-five days, and the facility with which the cultures were developed showed that they would withistand the elements for a much longer time.
In view of this startling statement would it not be quite possible for exhalations from diphtheritie patients to become dried and by casily understood methods reach the outer air, being wafted to and fro until they come into contact with a lesion of the throat or nasal passages of some person, which furnishes the right media for culture and thus developes, apparently de novo, a new case ?
Recognizing to a greater extent than ever before the necessity for the same, our citizens have of their own accord, and under the direction of their physicians, taken care to give the patient as thorough isolation as possible. Consequently the Board has not been obliged to use any unusual restrictive measures.
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Careful isolation and prevention of communication be- tween the room of the patient and other rooms, previous to final disinfection, are of the greatest importance and necessity in preventing the spread of this disease.
Membranous Croup.
During the year six cases of this disease were reported to the Board. In sharp contrast to the preceding year there was but one death recorded. At first thought one might say that the position taken by this Board during the preceding year was hardly tenable ; but a careful perusal of the reasons given in our preceding report will easily show that this supposition is not true. Our experience has shown that membranous croup, so-called, has afterwards developed diph- theria, and that in the majority of cases it has terminated fatally. May not this apparent change for the better in the last year be due to the fact that the same precautions have been required and taken as in diphtheria, and that perhaps our physicians may have been led to recognize at least the close resemblance of the two diseases, and to treat croup medicinally as one form of diphtheria? We see no reason to change our opinion already expressed, and feel that the same restrictive measures should be taken with this disease as with fully declared diphtheria.
Scarlet Fever.
In comparison with the preceding five years this disease has been far less prevalent, only twenty-eight cases having been reported during the year, one-third of them being in the month of January. The directions of the Board relative to isolation were observed with one exception. In this case, notice was given that unless the directions were carefully obeyed the family would be placed under police quarantine. This proved sufficient and no further trouble was experienced.
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Typhoid Fever.
Typhoid fever was not as prevalent in 1890 as for the preceding two years, there being but thirty-four cases re- ported against forty-two the year before, and forty-nine in 1888. The disease made its appearance about the usual date, and was the heaviest during September and October. Until the middle of September the cases could not be con- sidered as having any connection one with another, and seemed to be local rather than general. From this time until the middle of November, however, cases were occurring at Nonantum in such close proximity and frequency as to excite suspicion of there being a common cause. An inves- tigation of all the premises where typhoid had occurred was made and careful inquiries instituted on certain lines for future development. From these it became apparent that local causes could not be found to account for each case. Some of the places were not in a perfect sanitary condition, but these did not affect cases in other places. In no instance could any of it be traced to drinking impure waters, as in every case only the city waters of Newton and Boston had been drank. But another line of investigation revealed the fact that every family in this neighborhood where typhoid appeared were supplied with milk from the same individual.
Inquiry also developed the fact that typhoid had existed in the vicinity of this milkman's farm, and also to quite an extent in Watertown. To follow up this clue would neces- sitate considerable expense in bacteriological work, and visits to the farm from which the milk was sent out. A consulta- tion was accordingly held with the State Board of Health, and they have taken up the investigations from this point, with such assistance as could be given by this Board.
A visit to the farm showed that on the estate adjoining there had been some three or four cases of typhoid during the summer, one of them fatal; that about the middle of August the well used by the milkman on his own estate had
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given out and he had been obliged to dig a new one. While digging the new well, which took him from a month to a month and a half, he had used a well on the estate adjoining. where typhoid existed, although it was not the well used by that family. This well is situated about twenty-five feet from the manure pit under the cow barn and abont fifteen feet from the barn yard, and is under what was formerly used as a milk room. The water from this well had been carried by the milkman to his house for household purposes, but he contended that none of it had been used around his milk room or pans. On a second visit the gentleman's wife, how- ever, stated that some of the water had been used in washing cans, etc. If he had used his water at a boiling temperature to wash his cans and other utensils, there might be some reason for believing that this would have killed all germs of the disease, provided any were there, but, unfortunately, this was not the case. The water was not so hot but what one could hold one's finger in it, and was certainly not suffi- ciently warm to kill the germs of disease. It was also found that some of the cases in Watertown were in families on this milk route. Of course this Board has no right to make any sanitary examinations there. From these investigations it seems very probable that the primary cause of this outbreak was through the milk delivered by this milkman. The State Board are still at work on the problem, and while no positive results may be obtained owing to the lapse of time before the facts were known, still enough circumstantial evidence may be obtained to corroborate the above conclusion.
With the exception of this outbreak the cases reported have been scattered throughout the city and apparently have had no relations with each other.
Influenza, or "La Grippe."
This city, in common with all places in the zone affected, suffered severely from the epidemie of "la grippe " during
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the seven weeks from Dec. 20, 1889 to Feb. 11, 1890 : new cases not appearing to any extent subsequent to the latter date. The epidemic followed the great lines of travel and its consecutive appearance and spread on this side of the Atlantic can be accounted for in the same way as the exten- sion of other zymotic diseases, i. e., by personal contagion.
But comparatively few deaths from influenza alone are reported. The complications, and particularly pneumonia and bronchitis, were largely responsible for the fatal results as learned from the returns of our Newton physicians. The ordinary mortality from these diseases for the season was more than doubled during the epidemic in question. There was a marked increase, also, in affections of the air passages and of the circulatory system.
Many of the deaths which occurred were of persons previously affected with chronic chest trouble, persons of advanced age, or of those with health impaired from other causes. Many of our citizens suffered from the consequences of the epidemic for many months, and some are still out of health from this cause.
Disinfection.
The records of Boards of Health throughout the country clearly show the advantage of isolation and disin- fection in stopping the ravages of contagious diseases. Isolation without disinfection accomplishes a certain amount of good. Disinfection at the close of a case without isolation previously is worth almost nothing. The two together have succeeded, when thoroughly enforced, in controlling the spread of diseases and saving the lives of many. The effi- cacy of burning sulphur has sometimes been questioned, but its use in Newton has certainly been attended with good results. Only a very small percentage of cases have been recurrences after fumigation, and the greater proportion of the few that have occurred were undoubtedly due to innocu-
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lation before disinfection. In the light of Dr. Prudden's researches, as given you in our remarks on diphtheria, may not all of the remaining cases which have appeared in places after fumigation have received the streptococcus into some fold of the tonsillar crypts, and there been kept concealed and pre- served until some cold produced the proper cultivating fluid, and thus the disease have been reproduced. On the other hand, allowing that the fumigation fails to accomplish all that is expected of it, what surer thing shall we substitute in its place. While experiment and even practice may show that our ordinary system of fumigating may fail occasionally, our experts have not succeeded in finding anything practical that will kill the disease germs, where sulphur only wounds. Until a better and surer method is given us, this Board intends to do all in its power, with as much care and attention as possible, to prevent the spread of diphtheria, membranous croup, scarlet fever, and small-pox should it appear, by the use of sulphur in fumigation. The greatest difficulty is experienced when, through the force of circum- stances, we are obliged to fumigate a portion of the house at a time, the remainder being occupied by the family. The greatest objection that has been raised by our citizens against the necessity of fumigating has been in cases of membranous croup, but the Board feel that it is equally as important as in diphtheria.
In the outbreak of typhoid all vaults of privies and contaminated places, so far as known, were specially disin- fected with a combination of copperas, carbolic acid and bi-chloride of mercury, and apparently with good results.
Ashes.
No change has been made in the methods of collecting the ashes throughout the city, and the work has been done in the usual satisfactory manner by the Highway Department. It is difficult to secure suitable dumping places near the
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centres of the villages, and in consequence of this parties who desire filling have been enabled to get the ashes for such purposes at no expense to themselves. Should it be thought advisable at any time to put this collection out under con- tract, the sale of the material collected will be found to be one source of revenue to the contractor. It would seem that if a contractor can realize anything from such sales as though the city might be able to get some kind of a return, instead of giving it to people whose estates are in reality benefited thereby, but from which the city does not even get a return in additional taxes. It would certainly seem that if private land is to be thus benefited, as though the collection of ashes could with propriety be transferred to this Board, and then it could have the power to either sell the material or use it for filling up wet and swampy lands which are becom- ing dangerous to public health. This Board has received several requests for such filling, but while the Highway Department has always sent such ashes as were in the immediate vicinity to such places, in answer to our requests, they have not felt at liberty to increase their haul at all if they had a place nearer the point of collection. If the different teamsters were required to keep a record of the number of loads collected, and a tabular statement was made of the same, some idea of the value of this filling could be obtained where it is now impossible.
Dumps.
Numerous complaints have been received by the Board relative to the ash dumps used by the city in various parts of Newton. These complaints are often well founded, and in the absence of any ordinances on the subject it is often difficult for this Board to meet the case. When the city commences to use any land for dumping purposes, it is the signal for every one in the village adjacent thereto, to carry all ·his refuse to the same place. Strict orders have been 2
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given to the teamsters collecting ashes to refuse to handle or take away any in which they may notice any perishable articles, such as vegetables, fruit, fish, meats, or the like. Consequently the storekeepers must dispose of such refuse as cannot be put in the swill-barrel in some way, and they send it off to the dumps, oftentimes after dark, so that it is next to impossible to tell who the offending individual may be. When the dumps become foul and a nuisance the Board can then step in and forbid any further dumping, and compel the owner of the property to abate the nuisance. But the accumulations of old papers, rubbish, and the like, and the piles of unsightly heaps in the immediate neighbor- hood of houses, constitutes an annoyance which the Board has felt reluctant to deal with, although they undoubtedly possess the power. If parties were compelled to pay for all filling placed there, a remedy would exist in refusing to deliver them any more unless it was properly taken care of. If this is not advisable, the Board would recommend the adoption of a suitable ordinance which would compel owners of property having dumps on them, either public or private, to take such care of them that they will cease to be an annoyance to the sight or a menace to the health of our citizens. During the year the Board has felt compelled to take action in reference to three such places, in one case ordering all dumping of ashes and objectionable matter stopped, in another requiring a sign to be put up stopping promiscuous dumping, and in the third allowing it to con- tinue through the winter but to be stopped in the spring.
Drainage.
Several petitions for relief under the "wet land " act have been presented to the Board, and some are on the table awaiting action. Action had been taken the year previous on one presented by Mr. E. P. Bond, but before the work was completed it became necessary to give an additional
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hearing to the interested parties, after which the work was finished under the direction of the City Engineer, and the benefits for the same have been duly assessed. A hearing was also given on the petition of Alvah Hovey, for drainage between Centre street and Grant avenue, but the Board laid it upon the table at the close of the hearing and no action has since been taken. A petition from M. F. Ballister et al., for drainage east of Centre street between Franklin street and Hyde avenue, received similar action after a proper hearing. Petitions were received from D. F. Inglis et al., for drainage of the Mague meadows, so-called, and A. R. Coe et al., for drainage on Warren avenue and River street. Hearings were given on these and in accordance with the request of this Board an appropriation of $17,000 has been made to cover the cost of the work, which will be done during 1891. In the fall an important petition for the improvement of the westerly end of Bullough's pond, signed by several of our physicians, was received. While the Board recognized the importance of the work asked for, it felt obliged to lay the petition on the table, and during the present year further action may be taken upon it.
As the surface drainage of the city is to be provided for independently of the sewerage system, it would seem as if all work done by this Board under the provisions of the Public Statutes, Chapter 80, Sections 28-33, should event- ually become a part of this drainage system. Oftentimes the Board is obliged to delay action and give needed relief from the fact that there is no money available for such uses, and the City Council does not feel like increasing the year's expen- ditures in such an unexpected manner. The Board has power to expend an amount not exceeding $2,000 in this manner, but thus far all requests by this Board of the City Council for an appropriation have been granted. In order that prompt action can be taken, when necessary, upon petitions under the "wet land" act, this Board would recommend to the
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City Government the establishment of a loan of $200,000 to be drawn upon from time to time as necessity arises in the same manner as the water construction account is managed at the present time, viz .; by orders from the City Council passed upon recommendation of the Board of Health.
These petitions must necessarily come before us at various times, and the Board can work more efficiently and rapidly in this direction after some such measure has been passed.
Field Days.
More meetings of the Board have been held in various parts of the city than ever before.
April 15. The Board visited West Newton, Nonantum, Newton, Newton Centre, Thompsonville, and Chestnut Hill, acting upon various petitions, complaints, etc.
May 23. The Board visited Newton and examined various sources of complaint, taking action upon the same.
July 9. Through the courtesy of the Boston Board of Health this Board visited the sewerage works at Cow Pasture and Moon Island, the quarantine station, and the public institutions at Deer Island, using the health boat " Vigilant " for that purpose.
July. 26. Several places in West Newton were visited.
August 16 was an all day trip on the Charles river, from the pumping station at the Upper Falls to the Canoe club house in Waltham. An examination of the banks was made the whole length for the purpose of detecting any sources of contamination of the river from house drains, privies, etc.
September 9. The examination of the banks of the Charles river was further continued from North street to Watertown bridge. A visit was also made to various parts of Newtonville, Newton, and Newton Upper Falls for the purposes of inspection.
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October 10. The Board visited the Mague meadows, Cherry, River, and Waltham streets, and Warren avenue, for the purpose of viewing the premises, under the petitions of Inglis et al. and Coe et al.
December 13. Newton Upper Falls, Newton Centre, and Newtonville were visited for purposes of examination.
Glanders.
Only one case of this disease was reported to the Board during the year. As the owner desired to make sure that the animal was afflicted before disposing of him, notice was immediately given the State Cattle Commissioners, and they, in consultation with a local veterinary, decided that the disease was clearly glanders. The horse was accordingly killed and the stable was thoroughly disinfected under the directions of the Commissioners.
Pleuro-Pneumonia.
One case of suspected pleuro-pneumonia was reported to the Board. A veterinary was summoned, made a thorough examination of the animal, and decided that it was not a case of pleuro- or contagious pneumonia, and the cow has since entirely recovered.
Hospital for Contagious Diseases.
The construction of such a building in connection with the Newton Cottage Hospital was brought to the attention of the City Government by His Honor in his inaugural address, and the subject was referred to a special committee. Joint meetings of this special committee, the Board of Health, and the executive committee of the hospital were held, and ground plans, which met the approval of all, were submitted. Estimates, and afterwards revised estimates, were made of the cost of erection, and the special committee reported in
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favor of an appropriation of $10,000 for these buildings, which was made by the City Council. Previous to the adoption of this report articles of agreement were made whereby, in consideration of this amount being paid by the city, the hospital corporation furnishes the land for the same, and agrees to receive such patients as the city may send there, free of expense, and provide the necessary nursing, medical attendance, and take all proper care of the said cases. About the first of July, all preliminary arrangements having been completed, ground was broken and the erection of the buildings begun. At the present time, although not finished they are nearly so, and it is hoped that they will be ready for occupancy early in the present year. The build- ings erected are for the care of diphtheria, scarlet fever, and small-pox. There is also a building which will contain a morgue and an autopsy room. When these are finished and in good working order, Newton will be as well equipped for taking care of contagious diseases as any city of its size in the country.
House Offal.
In May, 1889, the contract for collecting house offal, which had been in force for three years, expired. Owing to the difficulties and uncertainties which arose in making a new one, the Board decided to make only a one year con- tract. This contract expired on the first of May, 1890. In April the contractor made application for a contract to run three years at a price to be agreed upon. The Board not desiring to do this endeavored to renew the old one for another year, but the contractor refused to do it. A hearing was given him by the Board, and he stated that undoubtedly he would be obliged to remove his plant from the "Island, " where it was situated, and unless he could be assured of a contract for a sufficient length of time he should not feel like going to the expense and trouble of establishing himself
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elsewhere, only to find himself thrown out of his contract within a few months. Other reasons were given, but this was the principal one. As no one else could be found who would take a one year's contract, the Board was compelled to change its policy of one year contracts, and accordingly notices were inserted in the local papers asking for bids for the removal of house offal for three years from May 1st, 1890. Only one party, Mr. Wm. H. Mague, the former contractor, responded, and he was accordingly awarded the contract. In 1889 he had put on a new equipment of teams, built especially for him, and he now has one of the best plants of its size in the State. He has succeeded in obtain- ing better men for his work, and as compared with former years the complaints have been few. Scarcely a half dozen have been received from the north side of the city, the greatest trouble seeming to be on the south side where the routes are necessarily longer and the houses more scattered. The only portions of the city where collections are not made at the present time are Nonantum and Oak Hill, districts where the citizens have apparently not desired to have the teams sent.
Malaria.
Much has been said in a semi-public way about the relation of malaria to the sewerage question. There has been no marked diminution in the number of cases over the two preceding years. The localities affected have, however changed somewhat, for during 1888 and 1889 the height of the disease seemed to be towards the southerly part of the city, while in 1890 it appeared to rage with greater force on the north side of the city.
There is a concurrence of sanitary opinion in the belief that sewage as such has little or no effect on malaria. The same can be said of cesspools. The disease is related to excess of water in the soil and rise of the ground water
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level. It has been for years a familiar faet to residents in the western states that malaria increases the number of its vietims rapidly where irrigation has been extensively intro- duced for agricultural purposes. What, then, is to be expected in the case of a city introducing a water supply without at the same time providing for its outflow? The result is to increase the storage of water in the soil, and, together with a large rainfall, furnishes a prominent factor in the development of paludal disease. The removal of stag- nant water and the drainage of swampy soil are the measures that promise the most in the way of relief.
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