GENERAL REPORT.

The following report comprises the work of the State Board of Health for the year ending Sept. 30, 1892, under the provisions of the organic act establishing the Board, and other special acts relating to the inspection of food and drugs, and to the supervision of the general subjects of water supply and sewerage.

The report embraces the following topics:

GENERAL REPORT OF THE Board.

REPORT TO THE LEGISLATURE UPON WATER SUPPLY AND SEWERAGE, EMBRACING THE ADVICE OF THE BOARD GIVEN UNDER THE AUTHORITY OF CHAPTER 375 OF THE ACTS OF 1888.

EXAMINATION OF ARTIFICIAL ICE.

FOOD AND DRUG INSPECTION.

SUMMARY OF WEEKLY MORTALITY REPORTS OF CITIES AND TOWNS.

INVESTIGATIONS OF RECENT EPIDEMICS OF TYPHOID FEVER IN MASSACHUSETTS

HEALTH OF CITIES AND TOWNS.

The following members comprised the Board in 1892:

At the annual meeting in June, 1892, the following officers were

Under the provisions of chapter 263 of the Acts of 1882, and chapter 375 of the Acts of 1888, the following officers were also chosen':

Under the Provisions of the Acts to protect the Purity of Inland Waters.

Chemist,
Biologist,

FREDERIC P. STEARNS.
JOSEPH P. DAVIS.
X. H GOODNOUGH.
THOMAS M. DROWN.
W. T. SEDGWICK.

Chemist in Charge of Experiment Station, ALLEN HAZEN.
Biologist at Experiment Station,

GEORGE W. FULLER.

INFECTIOUS DISEASES.

The year 1892, like the previous year, so far as concerned this Commonwealth, was not marked by any serious outbreak of epidemic disease, with the exception of the epidemics of influenza of 1891 and 1892, which began like that of 1889, near the close of the year 1891, and continued on through the months of December, January and February, and then disappeared. The course of these two epidemics is shown upon pages 746 and 747 of the last annual report of the Board (twenty-third Report, 1891). The diagrams there given do not, however, show the course of the milder epidemic which occurred in April, May and June, 1891.

Small-pox.

But few populations comprising over two million inhabitants (the German empire excepted) have been more exempt from small-pox during the decade ending with 1892 than the State of Massachusetts. The deaths from this cause in the State during the past ten years have been but fifty-one, which is a smaller number than has occurred during any consecutive ten years since 1830. The deaths from small-pox in Massachusetts for the decade ending 1882 were 922, and those for the decade ending 1872 were 2,375. While a considerable part of this unusual immunity is undoubtedly due to vaccination, we recognize that this method of prevention cannot account for all, since there is at present, as a result of neglect of local authorities, a very large unvaccinated contingent population. The towns which are most exposed to the invasion of small-pox (the paper-mill towns) are probably better protected than other parts of the State. Probably the reason for the unusual present immunity lies in the fact that this

disease has not been allowed to gain a foothold in the State, but has been suppressed in each instance upon its first appearance. There is no reason to believe, however, that this immunity will be perpetual, so long as neglect of vaccination is constantly increasing.

Deaths from SMALL-POX in Mass. by DECADES

1863 -1872

2375

1873-1882

922

1883 -1892

The following summary presents the history of such cases as occurred within the State during the year, so far as they came to the knowledge of the Board :

Record of Cases of Small-pox reported to the State Board of Health in 1892, under the Provisions of Chapter 138 of the Acts of 1883.

The following is the account of the epidemic in New Bedford, as made by the physician of the Board of Health of that city, in his report to that Board:

On June 3 the attention of your physician was called to suspicious illness in the middle tenement of house numbered 944 South Water Street. The investigation showed a young man, John Andrews, in the pustular stage of small-pox; two children of George Rivers, at the beginning of the stage of desquamation; a young woman, Andrews, who had had a mild case of varioloid, in the desquamation stage; and a baby of George Rivers, two years old, in the pustular stage of small-pox. Upstairs in the same house a French family lived. A man named York, with his wife and child, were visiting them. This child was in the pustular stage of small-pox.

The small-pox hospital had not been open for eleven years, but everything had been kept in readiness for cases, and the patients were all transferred to the hospital on the same day.

On the next day another suspicious case was reported at 646 South Water Street. It was found to be a case of small-pox in the beginning of the pustular stage, the patient being Charles Andrews, a brother of John Andrews. He was immediately transferred to the small-pox hospital. The other people living in both infected houses were transferred to the old poorhouse on French Avenue, where a quarantine station was established for persons who it was thought had been in any way exposed to the disease. The cases had been going on for at least two weeks, and it was impossible to say how far the contagion had gone.

On June 8 it was reported that William Andrews, a brother of the men who were already in the hospital, was ill. On investigation, he was found to have a mild case of varioloid. He lived at the east end of Coffin Avenue. He was transferred to the hospital, and the other people in the house to the quarantine station.

On June 9 a case was reported at 305 South Second Street. It proved to be a boy with a light case of varioloid. He was quarantined at home, and another family living upstairs in the house was transferred to the quarantine station.

On June 10 one of the children of the French family named Lemaux, who had lived upstairs at 944 South Water Street, came down with smallpox at the quarantine station, and was transferred to the small-pox hospital. On June 14 the other Lemaux child also developed small-pox, and was transferred from the quarantine station to the hospital.

On June 15 Joseph Francis was found to be suffering from small-pox at 169 South Second Street. He was employed by a grocer, and had taken provisions to the Rivers family. He was at once transferred to the hospital. He was seen at the beginning of the vesicular stage. The day after he was transferred he had profuse hemorrhages from the nose, mouth, kid

neys and bowels. There were very few pustules, but ecchymotic spots appeared on his extremities, and on the calf of the left leg there was a slough about two inches across. He died the night of June 16, and was buried the next day in the burying-ground near the hospital.

The small-pox hospital, being a small building, was crowded, and it was thought best to construct a cheap building, to be used in case other patients had to be brought to the hospital. A building was put up with eight rooms in it. It was not necessary to transfer any case to this building, but it was used for disinfecting purposes. One of the Rivers children, aged two years, had a severe confluent case of small-pox, and died from exhaustion. It was buried in the burying-ground near the hospital the next day.

On June 18 a case of small-pox was reported at 592 South First Street. This was a French boy who worked in a cotton mill, and had no apparent connection with the other cases. He was at once transferred to the hospital. He lived in a large three-story tenement house, and it was impossible to take all the inmates to the quarantine station. Only the families living on the same floor where the case occurred were transferred; the others were advised to leave the house, and they did so.

After the discovery of this case, it seemed probable that the epidemic might be extensive, and a general vaccination was advised, and ordered by the Board. This was carried out in all the factories in the city, and in the schools. A house-to-house vaccination was also ordered in the vicinity of the infected houses. The physicians were instructed to vaccinate all persons who had not been vaccinated within five years. All the tenements where cases of small-pox had been found were thoroughly fumigated and cleaned. All the furniture, carpets and clothing that had been exposed were destroyed. The tenements were washed with corrosive sublimate solution, and were entirely painted and papered.

The patients were kept in the hospital until all signs of desquamation had cleared up. Meanwhile they were washed with corrosive soap. When they were released, they were thoroughly washed with a corrosive sublimate solution, and given an entire outfit of new clothing. They were allowed to take nothing away from the hospital. After being thoroughly disinfected in this way, they were transferred to the quarantine house, and kept there several days before they were allowed to come to the city. No expense or trouble was spared to do this work thoroughly, and the result was that no new cases developed, either from the infected tenements or from the patients themselves. In the opinion of your physician, the importance of the quarantine station in this epidemic cannot be overestimated. It enabled us to vacate the infected houses at once, and not to have them occupied again until they had been thoroughly disinfected; it removed the persons living in these houses at once from a possible source of infection in the house, and it gave us the opportunity to watch the persons who had possibly been exposed to infection.