USA > Massachusetts > Middlesex County > Newton > Town of Newton annual report 1891 > Part 10
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Field Days.
The Board have held a large number of meetings for the purpose of transacting the necessary business, and of these,
10
REPORT OF BOARD OF HEALTH.
nine have been field meetings. The general objects of these field meetings were as follows:
Jan. 21. The Board visited the Engine House, West Newton, for the purpose of inspecting its sanitary condition ; the Lower Falls, for the purpose of abating several nuisances, and the new wards for contagious diseases at the Cottage Hospital. In the examinations at the latter place, the Board was accompanied by Mr. J. H. L. Coon, State Inspector of Public Buildings.
April 21. A visit was made to the piggery and plant owned by Mr. Mague on Lexington street, afterwards pro- ceeding to Auburndale, West Newton, Newtonville, Nonan- tum, and Newton, for the purpose of acting upon various complaints.
May 22. The Board visited the Lower Falls, Newton Centre and Nonantum, for the inspection of various places about which complaints had been made.
June 30. The Board made another visit to the "pig- gery " on Lexington street; viewed the alleged nuisance on Prospect street, as required by petition presented under the provisions of the statutes ; also various places in West New- ton, Newtonville, Newton Centre and Newton, including the gypsy camps, on account of complaints requiring action by the Board.
July 13. The Board made an examination of Boyd's Pond and the lower part of Laundry Brook.
Sept. 2. Mr. Wiswall, Dr. Baker and the agent in conjunction with members of the Watertown Board of Health and Selectmen, made an examination of the Charles River and places adjacent thereto, to see what steps could be taken to prevent farther pollution of the waters of the river.
Oct. 6. The Board paid a visit to the Lower Falls, West Newton, and Newton, examining various places complained of. The condition of Lemon's Brook and Laundry Brook also
11
REPORT OF BOARD OF HEALTH.
received attention. An inspection was then made of the carpet beating factory on Clinton street, owned by Simon A. White.
Dec. 28-29. The Board examined the estates benefited and damaged by the work of draining the "Mague meadows " so called, and Warren Avenue, under petitions of D. F. Inglis, et al., and Arthur R. Coe, et al.
Diseases dangerous to Public Health.
The care of diseases that are liable to become epidemic will always be one of the most important duties of a Board of Health. So far as it may be possible, efforts are made to trace the connection of each with some definite cause. While it is not always possible to locate the exact cause, yet almost always some contributing influences can be found, which, if they could have been remedied before the sickness came, would at least have mitigated its severity. The policy of placarding certain of the diseases dangerous to public health has been continued, and without doubt has contributed greatly towards preventing the spread of the disease beyond the confines of the estate where it appeared.
Small-pox.
Small-pox cases have now become so rare that it is only necessary to be prepared to act in the emergency when it arises. Medical science, however, has given us so much knowledge of this unwelcome visitor, that it is no longer difficult to cope with the disease when it makes its appear- ance.
Diphtheria.
Diphtheria has been less prevalent in 1891 than for several years past. It would seem that the persistent efforts of the Board in abolishing places liable to breed contamina- tion, enforced isolation at home, and the use of the conta- gious ward, were all bearing fruit and operating towards
12
REPORT OF BOARD OF HEALTH.
bringing down to a minimum point the number of cases from this dread disease. As long as we have people who will not recognize the necessity of strict isolation and quarantine in mild cases, will we have the disease in our midst. Much has been accomplished in educating our people to their pres- ent knowledge of the dangers and ravages from diphtheria, but there is still a great deal to be accomplished. The greatest difficulty encountered by this Board in dealing with cases of this disease is with people who dispute their physi- cian's diagnosis and insist that the conditions do not warrant the same or the necessity of our restrictions. This Board is not responsible for the diagnosis. Once made by the physi- cian and reported to us, it must stand, and be placed under the usual restrictions for the protection of the public. Better twenty, yes even a hundred reports of supposed diphtheria than one failure to correctly diagnose the disease.
A careful examination of the chart will show that in 1885-86 and 87 diphtheria had but few cases during the summer vacations of the schools. In 1888, however, the chart shows a somewhat different story. In 1889 the num- ber of cases were also less during the months of July and August, and in 1890 the disease diminished from the middle of June until it disappeared entirely for a few weeks. In 1891 similar facts are seen to exist. This examination would seem to point to two facts :- first, that many cases which are in reality diphtheria, or of a diphtheritic nature, have been con- sidered to be only tonsilitis, or severe colds; second, that all throat and even nasal troubles bordering on the diphtheritic nature, however treated, should as far as is possible, be com- pletely isolated from the rest of the family until all danger has passed. Even an ordinary cold is oft-times contagious although no serious results come from it. It is therefore easy to understand how our schools, through these unrecog- nized cases, often become the medium of communication for the spread of the disease. While we have been so fortunate
13
REPORT OF BOARD OF HEALTH.
during the last year in having less diphtheria, we cannot afford to relax our vigilance.
Influenza.
In the early part of the year influenza or (la grippe) reappeared, and while perhaps it was not as universally prev- alent as the year before, the fatalities resulting from its complications with other diseases were much greater. Many, weakened by an attack the year previous, succumbed to this fresh assault. Pneumonia was the favorite complication with influenza. The large increase in the number of deaths was mainly due to the prevalence of this disease. Many of those who have recovered still feel its effects, and it is even now exert- ing an influence on our death rate. While it is included among the list of preventable diseases, nothing has yet been found that we are aware of where a Board of Health could take any specific measures to stop its progress.
Measles.
Early in the spring of 1891 measles was placed in the list of diseases dangerous to public health. This was in keeping with similar action on the part of other boards of health, and the feelings and recommendations of the State Board of Health. Many people laugh at the idea of trying to control the spread of this disease, as it is considered a child's disease and of no great consequence. No good reason can be advanced for desiring a child to be sick with any disease, even what are termed children's diseases, for what may be all right in one instance may be all wrong in another. Because one child is rugged and can throw off the disease easily is no reason why we should allow that child to run at large freely and even attend school, and be the means of communicating it to a neighbor's or friend's child who may have an impaired physique, thus inflicting on them additional pain or expense, and possibly in extreme cases, fatal results.
14
REPORT OF BOARD OF HEALTH.
As an ounce of prevention is worth a pound of cure, we now require all cases of measles to be reported, and placard the premises for a reasonable length of time.
The number of cases reported last year was 136. These statistics are necessarily imperfect, especially as the disease was prevalent in almost every part of the city, and oftentimes no physician was employed. Now a start has been made and it is hoped that succeeding years will see this disease put under as thorough control and watchfulness as the other diseases of a contagious character.
Membranous Croup.
Not many cases of this disease have been reported to the Board, and what we can say on this subject has been fully covered in previous reports. The best authorities, both medical and sanitary are coming to agree on the point that there is no difference between membranous croup, so-called, and diphtheria. All that has been said therefore, with refer- ence to isolation, disinfection, etc., in cases of diphtheria is equally applicable to cases of membranous croup, so-called. However, we do not interfere with the opinions of any physician as to the character of the disease, but for the bene- fit of the public we enforce regulations relative to the care of the same.
Scarlet Fever.
The first four months of the year shows as many cases of scarlet fever as occurred during the whole of the preced- ing year. The close of school showed the usual absence of cases and emphasizes the point that our schools are the means of spreading contagious diseases, owing to the large number of unrecognized cases that occur.
In the colored district at West Newton, during the summer there were undoubtedly several cases of scarlet fever where no physician was ever in attendance, the disease being
15
REPORT OF BOARD OF HEALTH.
in such a mild form. Whether the parents of these children were really cognizant of the character of the disease, or were themselves deceived, calling it a heat rash, will never be known. We do know, that in September, one of the teachers in the Barnard school discovered a colored child in her room covered with scales and upon looking into the matter decided to report the facts to this Board for further investigation. As a result, it was found that nearly a dozen cases were then in progress, in various stages, and that some had already recovered. As the school-rooms and books had evidently become infected and the liability of future cases was great, the school was immediately closed and thoroughly disinfected. Such of the books as were known to have been in the posses- sion of the infected children were destroyed. There can be no question that the prompt work of the Board stopped any further progress of the disease in the school building, and the measures adopted in the infected district soon brought the disease under control.
About a month later, at Newton Centre, in the Rice and Mason schools, another outbreak occurred. As near as can be determined from our investigations, two children in differ- ent sections of the school district were sick with what the parents termed "malaria." At first no physician was called, and only when the infants in the families were found to be ill were they summoned, and the real cause of the trouble found out. As the members of these families had mingled freely with the school children, and as new cases were rapidly developing, the citizens became alarmed and demanded of the district committee the closing of the schools. After con- sulting with this Board, the committee deemed it advisable to accede to the request, and the buildings were as thorough- ly disinfected by us as the Barnard had been. Immediately almost, the spread of the disease was stopped, and again was demonstrated the responsibility of the schools for the com- munication of diseases.
16
REPORT OF BOARD OF HEALTH.
The disease has been of an exceedingly mild type and has puzzled our physicians several times as to whether it was really scarlet fever or not. The rash would often disappear in twenty-four hours after its appearance, and the child would not be so sick as to be in bed at all. The number of cases reported during the year has been 105.
Typhoid Fever.
There has been about the usual amount of this disease during the year. No one section of the city has been respon- sible for more than its share. It is exceedingly difficult for us to be able to trace the cause of this disease, as nearly the entire city is supplied with city water. The summer visita- tions of our citizens are responsible for the larger number of cases, and many unsanitary conditions are countenanced and overlooked at these places that would be instantly put down at home. In one family, where three cases occurred, one terminating fatally, the disease was shown conclusively to have been contracted in New Hampshire and brought here. There is the greatest need of care being taken by the house nurse of the dejections from the patients. As a rule, the physicians look after this point very carefully, but in a few instances they have given no directions whatever. In such we have endeavored to supplement the physician's work and given directions for the care of infected substances, such as vaults, cesspools, etc., Many of the cases which occur are sent by the attending physicians to the hospital at once and are then forgotten, so that we do not always receive as prompt reportals as are desired.
COTTAGE HOSPITAL.
This institution has continued its work in spite of many trials and discouragements. In response to the wishes of some of the physicians connected with the staff of the Hos- pital, the Agent of this Board made a very careful and ex-
17
REPORT OF BOARD OF HEALTH.
tended examination of the sanitary conditions existing there. The following exhaustive report was submitted to us, reveal- ing many facts of a startling character, and showing con- clusively that the fears of the physicians were well founded.
WEST NEWTON, MASS., Jan. 7, 1891. To the Board of Health of the City of Newton :
GENTLEMEN :- In accordance with the wishes of the Medical Board of the Newton Cottage Hospital as expressed to me through its chairman, Dr. Otis E. Hunt, I have made an examination of the Hospital buildings and surroundings, and would herewith submit the results of the same for your consideration, together with a few recommendations. I understand that a feeling of un- easiness was created in their minds by the fact that typhoid fever had developed among the nurses both in 1889 and 1890, and also during the month just past, in one of the patients in the "Georgia Leeson" Ward, who was being treated for an entirely different cause. Previous to receiving Dr. Hunt's communication, I had been making investigations of my own for the same reason, and I have endeavored to make it thorough and complete.
For the sake of convenience I have made the examination under various heads which will appear in the report. Not being familiar with the construction of the building, I was somewhat at a disadvantage, but every facility for investigation has been rendered me by all connected with the Hospital and also by the Architect.
PLUMBING.
This includes all pipes and fixtures for disposing of waste liquid matter and excreta. I find that all the soil and waste-pipes are properly hung and have a proper grade. All the fixtures are properly trapped and ventilated. I also gave them an unusually severe peppermint test and found the pipes and joints were all tight, the traps properly sealed, and no odor of peppermint was detected to show a leak.
I find that the slop sinks for both the male ward and what was formerly the female ward are lined with lead. This material in my judgment, is not a proper one for that purpose, as it retains
18
REPORT OF BOARD OF HEALTH.
more or less of the liquids passing over it, and is very difficult to cleanse. I fear that in spite of the large quantity of disinfectants used in the building some of the disease germs may be held here long enough to become a source of infection. I would therefore recommend that they be replaced with crockery ones, similar to those which are to be used in the contagious disease wards, or at least, have the linings replaced with enamelled iron, as has been recently done in the one connected with the "Georgia Leeson" Ward.
I also find that in the entry of the main building is a bowl or basin situated near the corridor leading to the male ward, which is not in use. As we are all sometimes liable to forget simple precautions, I would recommend that the basin be either put into constant use or taken out entirely, and the waste-pipe beyond the trap hermetically and surely sealed, so that no gases can escape into the building.
A remark was made that some odor had been detected at the sink in the dietary connected with the "Georgia Leeson" Ward. I think this comes from an accumulation of grease in the trap, and would be remedied by cleaning out or the use of potash.
I also find that the hoppers of the water closets are not pro- vided with local or seat vents. With the rooms arranged as they are at present, this is quite a serious cause of polluting the air breathed by the patients, although if the rooms are disconnected from the wards as I hope they will be, this objection would be greatly obviated. It is better of course, to have such vents than not. This applies also to the bath-room opposite the matron's room.
Before leaving this subject, I would say that the slop sinks which I have spoken of, are what we call long hoppers, and I would suggest that if they are changed in accordance with my recommendations, that, if it is possible, short hopper ones be sub- stituted for the long.
DRAINAGE.
Under this head, I include what might be called the out-of- doors plumbing and the cess-pools. I found that the fresh air inlets were working properly and that the currents were strong above the roofs. At the same time, complaints were made that
19
REPORT OF BOARD OF HEALTH.
owing to the constant use of the fixtures in the building, there was considerable odor coming from them at quite frequent inter- vals. This being the case, and knowing that the air which thus comes out may reach the wards at certain seasons, I would re- commend that the fresh air inlets be continued of undiminished size to the roofs, or to such elevation as will preclude the foul air, if any, from entering the wards. I present herewith a sketch which will perhaps make the condition of things with reference to cesspools more clearly understood.
20
EMALE WARD
LAUNDRY
>
A
B
KITCHEN AND - DORMITORIES
C
PLAN
A
C
B
W
W.
M
N
- S
S --
REPORT OF BOARD OF HEALTH.
A-Manhole. B-Old cesspool. C-New cesspool. WW-Level of water in A and C. MN-Pipe from A to B. SS-Level of water in B
SECTION
GEORGIA
LEESON WARD
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REPORT OF BOARD OF HEALTH.
I find that when cesspool "B" began to be overcrowded with the work demanded of it, a new cesspool "C" was built, with the idea of taking the overflow from "B" after receiving a portion of the daily flow from the main buildings.
From my examination, and from levels taken by the City Engineer, I find that the cesspool "C" undoubtedly receives nearly all the daily flowage from the old buildings of the hospital, and probably a portion of the discharge from the "Georgia Lee son" Ward; the cesspool "B" receives the discharge from the Laundry, a portion of the drainage from the "Georgia Leeson" Ward, and possibly a small amount of the remainder.
I find that the bottom of the cesspool "C" is 4ft. 3in. higher than the bottom of "B," and while unable to measure the areas at the bottom, I do not think there is difference enough to allow of "B's" getting filled and overflowing into "C." In my opinion, the overflow will always be the other way. I also was told that at the time Miss Sutherland was taken sick last September, "B" became full, the drain-pipes were stopped and backed up, and some of the sewage even appeared on the surface at "B." Mr. Mague was ordered to clean out the cesspools at the Hospital, but not knowing that a new one had been built, only "B" was emptied. As a consequence, in two weeks time the pipes again became clogged. I was sent for and I ordered both cesspools emptied, and the pipes cleaned. The water in "C" was at the same elevation as in "A," but was two feet or more lower in "B" than either "A" or "C," clearly showing that the pipe between "A" and "B" was stopped. Since this last clearing out, I believe there has been no trouble.
In this respect, I would recommend that a series of tanks with distributing pipes be built near the Washington street em- bankment to receive all the drainage from the new ward for private patients and the overflow from both "B" and "C." This is the same principle as will be in use for the contagious disease wards, and I think can be used here with good results.
VENTILATION.
My examinations with reference to ventilation have been conducted in company with Mr. J. H. L. Coon, State Inspector of Public Buildings, and all actual experiments for purity and
22
REPORT OF BOARD OF HEALTH.
currents of air were made by him. In order that you may see at a glance the results of the experiments, I submit at this time rough sketches of the wards, and by reference to them I think that everything will be clearly understood.
23
REPORT OF BOARD OF HEALTH.
D
V5
Va
R4
R 3
V4
V 7
-
D
D
PRIVATE
PRIVATE
V3
·V. CH.
FIREPLACE
PRIVATE
D
O
V2
V8
BATH ROOM
D
D
D
S
RI
R 2
DIET ROOM
VI
V 9
D
D
CORRIDOR.
C-Closets for clothing (patients).
D-Doors.
DD-Entrance from Diet room to Slop Sink room (always open). DW-Entrance from Ward to Slop Sink room (always open). S-Sink. SS-Slop Sink.
R-1-2-3-4-Hot air registers.
V-1 to 9-Ventilating registers below beds to carry off foul air. V-CH-Ventilating chimney.
GEORGIA LEESON WARD
C
SIS
OW
24
REPORT OF BOARD OF HEALTH.
EXPERIMENTS.
Georgia Leeson Ward, 4 patients in ward.
Register 1 Air coming in at a velocity of 240 feet per min., at temperature 1800
2
66
66 66
66
1640
3
66
66
66 300 60 320
66
66
66
66
1580
66 340 66 66
Vent Register 1 Velocity per minute 60 feet into ward
2 3 4
66
66
66
out of ward.
66 into ward. 5 66
66
66
66 66
6 7
66
66
60 60 90 50 0 0 100
66
66
66
9
66
66
20
66
66
66
. -
66 66 66 8
66 1400
4
66
66
66
66
Temperature of room taken at 6 feet above floor as follows : Door from corridor 70º -fireplace 66 º -door to private room on right 70 ° -door to room on opposite side of ward 69 º . Metallic thermometer of hospital registered 69 º at about 8 feet above floor. Temperature out of doors 20°. Good draught up the fire place. It took 42 fillings of the "Wolpert" air tester to discover amount of carbonic acid gas in the air of the room- 4% parts. Fifty fillings represents pure air.
25
REPORT OF BOARD OF HEALTH.
D
V 6
V 5
R 3
R 2
V7
V4
PRIVATE
PRIVATE
FIREPLACE
-
V. CH.
O
SS
S
D
PRIVATE
+
DW
O
V8
MALE
V2
BATH ROOM
D
-1-
VI0
R 4
vg
V
CORRIDOR O
D-Doors.
DW-Entrance from Ward to Bath and Slop Sink rooms (always open).
S-Bowl for glasses, dishes, etc.
SS-Slop Sink.
R-1-2-3-4-Hot air registers.
V-1 to 9-Ventilating registers below beds to carry off foul air. V-CH-Ventilating chimney.
WARD
V3
26
REPORT OF BOARD OF HEALTH.
EXPERIMENTS-MALE WARD.
Register 1 Air coming in - Velocity of 320 feet per minute, temperature 1420 2 66 66
152º
3
66
66 4. 66
66 1640
Vent Register 1 Velocity per minute, 70 feet into ward.
2
66
3 4
66
.6
66
66
66 5 66 66
66 66
6 66
66
6 7 66 66 66 66 66 8 66 66 9 66
66
90 70 60 60 60 100 120 80 6.
66
66 at a temp. of 72º
Vent Register in bath room, velocity per minute 80 feet into room.
Fireplace flue velocity per minute 320 feet out of ward.
Temperature of room taken at about 5 feet above floor as follows : On bedstead near entrance to bath-room 81º. Entrance to sun- ning room 75°. Entrance to private room on the left nearest sunning room 80º. Entrance to private room on the left nearest entrance to ward 78°. The ward thermometer agreed with the latter. Temperature out of doors 20 °. The "Wolpert" air tester showed 38 fillings, representing 53, parts of carbonic acid gas. Seven patients in the ward.
The experiments in the "Georgia Leeson" Ward show that the ventilating ducts in the floors under the beds instead of taking the foul air out of the room are bringing in air from the cellar, or occasionally one register will draw some of the air out and deliver it into the ward again through another register.
The experiments in the male ward show the same results, with the addition that a portion is delivered into the bath-room, to be drawn out into the ward with any foul air that may be mixed with it in its passage through. It is very evident from these ex- aminations that the fire-places have been the saving of the wards, and have undoubtedly averted serious consequences.
The principle of the system as designed by the architect is all right, but due care has not been taken to see that it was work- ing properly.
It was found that no heat had been provided in the flue of the ventilating chimney of the "Georgia Leeson" Ward, although the architect had called for it. This has probably been remedied
" 340 66
66 " 340
66 : 1300
66 " 260 66
66
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REPORT OF BOARD OF HEALTH.
by this time by the introduction of a steam pipe into the flue. This will answer for such months as there is steam in the build- ing. For such months as there shall be no steam, I would re- commend the introduction of a large "Bunsen " gas burner. But after this is done, I don't believe the system will be made to work properly as long as the present wooden duct chambers are used in the cellar leading to the chimney flue. The joints are all open, preventing the proper draught, and creating a draught of cellar air in the opposite direction into the ward, as is the case at pres- ent. I may perhaps be pardoned if I state that these wooden flues for ventilating purposes are contrary to the State law, as will be seen by a reference to the Acts of 1888, Chap. 426, Sec. 8. I would therefore recommend that the wooden ventilating ducts be removed and galvanized iron ones be substituted therefor, with elbows or curved bends instead of T or right angled ones. I would also recommend that the capacity of these ducts be in- . creased to more nearly correspond with that of the flue in the chimney.
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